Tracy Livingstone is Caldicott Guardian at Nightingale House Hospice in Wrexham, North Wales. The role is one of her many duties as Director of Nursing and Patient Services.
The hospice is an independent charity providing specialist palliative care. It has 16 beds for inpatients and runs day care services and out-patient rehabilitation. In addition to 105 members of staff, it has 550 volunteers who look after charity shops and provide other support.
Until last year the role of Caldicott Guardian was performed by the hospice medical director, a consultant in palliative medicine at the nearby Wrexham Maelor Hospital. He acted as Caldicott Guardian to both the hospital and the hospice. When he moved to another hospital, Tracy became Caldicott Guardian for the hospice.
“It has been a steep learning curve,” she says. Tracy qualified as a nurse in 1987 and became a director at Nightingale House in 2004, but she had no specialist knowledge of information governance. So the first task was to find out what the job involves.
Using internet searches and advice from the information governance team at the local hospital, she learned the basics. A training course run in London by Hospice UK provided useful learning and the opportunity to build a network of contacts in other hospices.
This has helped Tracy to develop policies and procedures to provide better protection for patients’ con dential data. For example, she noted a potential risk in the lists of names and addresses that were provided to the volunteer drivers bringing patients in for day care. Although they did not include detailed clinical information, the identity of people coming in to a palliative care unit was sensitive in itself.
The drivers are now equipped with shredder scissors so they can safely destroy the lists to avoid this information falling into the wrong hands. It was a technique that Tracy learned during the Hospice UK training.
The hospice has developed its own scenario-based training. For example, staff are asked how they would respond if A&E at the local hospital called at 4am on a Sunday wanting the home address where a patient should be returned. Staff discuss the issue and learn that it would be inappropriate to release personal information to help the hospital deal with a transport issue, but it might be ethically and legally correct to share allergy information about an unconscious patient to save a life.
Tracy says: “At present I spend 4-6 days a month specifically on information governance and Caldicott work, but that will probably reduce once we have all the processes that we need.”
She thinks the hospice benefits from having its own Caldicott Guardian. “We are a small unit and don’t have the pool of expertise that exists in the hospital. But we do have more intimate knowledge of the services we run and we can apply the Caldicott principles to the full. In a small organisation you can flounder so it’s really important to make sure that you have a network of expertise and resources to give you support. Don’t be afraid to ask for help.”
For the most part the legal guidelines and ethical principles that influence the decisions of Caldicott Guardians apply throughout the UK. In Wales they should also have regard to the Wales Accord on the Sharing of Personal Information.