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Don't Leave Home Without It: Preparing a Patient Safety 'Go' Form

Network - Fall 2008

In the aftermath of Hurricane Katrina, nearly 350 cancer patients from Louisiana and Mississippi arrived on the steps of MD Anderson with no medical information and little knowledge about their treatment plans.

As rising water threatened to sweep away a lifetime of memories and prized possessions, who had thought to grab something like medical records?

While we tend to think these things can’t happen to us, no one is totally safe from disasters like hurricanes, floods, tornadoes or fires. Yet, how many of us have thought of putting together our medical information so it is readily available, should we need to evacuate our homes?

Learning from adversity

Working with a team of administrators, Thomas Feeley, M.D., vice president for medical operations and head of the Division of Anesthesiology and Critical Care, witnessed the difficulty of piecing together, with little solid information to go on, the medical histories and treatment plans of Katrina victims.

“Given our experience of three years ago,” Feeley says, “we at MD Anderson fully understand the need for people to add a simple, one-page form to their emergency evacuation kit, along with water, flashlights and extra batteries.”

In a recent series of radio interviews, he shared the lessons learned at MD Anderson, emphasizing the following key points.

What goes on the ‘go’ form

Basically a patient safety “go” form is a one- or two-page document that lists a person’s pertinent medical information, including:

  • Up-to-date list of medical conditions that have been diagnosed
  • Medical history of surgeries and hospitalizations
  • Allergies
  • Any significant family medical history
  • Names and contact information for your doctors and pharmacy
  • Insurance information
  • Immunization records
  • Any laboratory information or results for those with complex medical histories

With this form, health care workers who are unfamiliar with a patient’s condition have more precise information to help them decide what needs to be done.

The form also can help eliminate confusion and avoid possible complications in emergency situations, such as administering medications to which a patient might be allergic.

Tips for patient safety medical forms

  • Make sure the form is stored in a waterproof, portable container such as a Ziploc bag.
  • Put the form in as many places as possible, including at work, in the car or on a computer. Back up information on a computer by storing it on a disk or memory storage device. The memory device can serve as the patient safety “go” form and is easily transportable.
  • Keep information nearby. In emergency situations, each individual should carry his or her own form, including children and the elderly.
  • Keep it updated. Be sure to refresh the patient safety “go” form after every doctor’s visit.

© 2015 The University of Texas MD Anderson Cancer Center