Medical Alert Identification: A “Scarlet Letter” or Tool for Diabetes Management

Who’s wearing identification? 

In spite of the importance of this safety measure, little research has been done to discover the degree of adherence to the recommendation for wearing of a medical alert identification. A recent search of MEDLINE and PubMed yielded only one study on this topic. In this study, researchers found that only 60% of the 100 children ranging in age from 6 to 17 years wore some form of medical identification indicating insulin usage (Siminerio, Clougherty, Gilliland, & Kelly, 2000). The literature search uncovered no other research studies addressing use of medical alert identification in other populations, e.g., medication/substance allergies and congenital adrenal hyperplasia, which might provide insight into the reasons for low adherence.

Potential barriers 

A possible barrier to wearing medical identification may be age-based preference for the mechanism of identification. It is reasonable to assume that a form of medical alert identification that is readily accepted by preschoolers may not be appropriate for teens. It is also reasonable to consider that teenagers may object to wearing any form of identification that sets them apart from their peers, as if they were wearing a “Scarlet Letter.” However, this challenge must not go unaddressed given the importance of wearing medical identification. Rather, each child with diabetes requires individual support to understand the serious nature of diabetes as a real part of his or her life that deserves a little extra attention to assure the child’s wellness and safety. This process may be frustrating at times for all involved, but it is one that is worth the work.

Another potential reason for failure to wear medical identification may be a lack of knowledge about the availability of and need for medical alert devices. It is paramount that this form of safety promotion be included among the many teaching topics on diabetic management addressed at the time of diagnosis. Websites to assist caregivers to obtain the identification should be initiated by the health care provider prior to discharge (Box 1). Providing an inexpensive but appropriate form of medical identification, funded either by the clinical setting or an outside resource, would be an excellent step in promoting adherence and emphasizing the importance of this safety measure. Additionally, revisiting the importance of wearing medical identification must be done in subsequent clinic visits in the review home management responsibilities, e.g., dietary support, levels of physical activity, insulin administration, and blood glucose monitoring.

Speculation regarding the low level of adherence also includes costs. Medical alert identification comes in a variety of shapes, including watchbands, necklaces, bracelets, and other forms of jewelry, as well as a wide price range (American Diabetes Association 2004a, American Diabetes Association 2004b). With the wide variety of styles to choose from and easy access to this potentially life-saving device, the question remains, why are the adherence rates not closer to 100%? This question must be addressed within the context of our practice.

Practice considerations 

How can practitioners go about increasing adherence to medical alert identification? A good place to start is by asking our patients to see whether indeed they have (and wear) medical identification. This must be done at each clinic visit to clarify the importance of this safety measure from the health care provider’s perspective and to “normalize” its presence. If we as health care providers do not give positive reinforcement to our patients for incorporating this form of diabetes management into their daily routine, then we miss the opportunity to provide the support that our patients need and deserve. Additionally, we must discover the rationale behind the choice of patients to not wear identification. Insight is gained into the barriers to wearing medical identification and to further obtain direction to override these barriers. Incentives for wearing medical identification might be an interesting and exciting way to help to decrease the rate of “missed” clinical appointments and increase the rate of adherence to this important home management tool. Incentives specific to the child’s level of growth and development may be as simple as colorful star charts, stickers, and the like for young children to obtaining a “scholarship” for diabetes camp for teens. There is no limit to the creative ways that clinicians can use to inspire patients to wear their medical identification.

Given the paucity of research on this dimension of care for children with chronic illnesses, tracking the effectiveness of diverse interventions to enhance adherence to wearing medical alert identification is an important step in building evidence-based practice. Identifying reasons why adherence remains a problem, such as loosing the identification or refusal to wear it and reasons for refusal, will provide valuable information for the development of forms of medical identification that will bypass these difficulties. These steps of assessment and intervention may be enhanced with a patient screening tool (Box 2) and handout (Box 3). The screening tool and handout may also be adapted for use with children with diagnoses other than diabetes that require medical alert identification.

Taking care of myself

Having diabetes requires that I do many things to protect my health. I must:

1.Check my blood glucose and record my results as often as necessary to inform me how to best manage my diabetes.

2.Take insulin as instructed by my doctor/nurse.

3.Daily engage in physical activity to help keep me healthy.

4.Be aware of what foods I am eating and how much/often I am eating.

5.Wear my medical alert identification to help protect me if I am not feeling well. It does this by telling others that I need help specific to my diabetes.

Although this seems like a lot of work to do, I will do my best to help protect my health. I can do this by following the plan of care given to me by my health care professionals and by asking my parents or other family members for help when needed. My health professional will show me on this form how well I am protecting my health by awarding stars for each of the five areas listed.

	Need more help	Doing well but can do better	Great job
	**	****	********
	Today’s total:
	1. Blood glucose results and recording: _______________________________
	2. Taking insulin as ordered: _______________________________________
	3. Participating in physical activity: _________________________________
	4. Diet therapy: _________________________________________________
	5. Wearing my medical alert identification: ___________________________
	Most importantly, I must remember that, “I CAN DO THIS!!!”

Conclusion 

Although the importance of wearing medical alert identification is documented in pivotal sources of diabetes information and care guidelines, little has been done to document adherence and barriers to adherence to this recommendation for this important component of the home management regimen. As health care providers, we must get excited about including assessing for a form of medical alert identification as part of our physical assessment of patients with diabetes. If we are as interested in the wearing of medical identification as we are in glycemic control, we are more likely to increase our patients’ adherence to this potentially life-saving component in their diabetes management and empower them to participate at a greater level in their diabetes management.