Computer power on the ward

‘MY IT skills were rubbish,’ admits Miki Mullally when asked why she applied to be seconded as project lead to the Manchester

Royal Infirmary pilot of a new patient alert system.

For Miki, who was a junior critical care ward sister when she joined the project last October, moving to work with technology seemed the most logical way to address her lack of experience.

‘The hospital is always asking you to be more IT literate and I knew that if I was in a position involving IT, it would force me to learn,’ she explains. ‘It actually put me in a good position with the nurses when I had to train them to use the system because I could understand their difficulties and fears about computer literacy.’

The Manchester pilot involves 100 nurses across two wards – the acute medical ward and the medical assessment ward.

They input patient observations, including blood pressure and oxygen saturation levels, into a hand-held computer. The software then calculates an individual early warning score (EWS) for each patient, which is plotted against a series of indicators to show whether their condition is deteriorating.

Most hospitals still record patient observations on handwritten charts. Some input data into hand-held computers but what makes the Manchester project unique is what the computer then does with that data.

If an EWS shows that a patient’s condition has deteriorated, the computer triggers an alert to the professional most appropriate to deal with the situation – be that a nurse or a consultant. If there is a delay in response, the next person in the loop is called until the machine has received a new series of observations and is satisfied that the condition has been dealt with effectively.

The hospital is working on the pilot in partnership with TrusTECH, part of the NHS Innovation Hub network, and MKM Consulting, which provides the technology behind the system.

The group hopes that, by reacting more quickly to changes in a patient’s condition, the new system will be able to reduce ICU admissions and length of stay.

Sarah Ingleby, critical care outreach worker at the hospital and project adviser, helped introduce the initial EWS system into the hospital in 2000. However, there were limitations with the old system.

‘It was used quite well. They [nurses] would write the early warning score down on a chart and the protocol was mainly followed but it was not working well in parts,’ she says.

With the manual system, when a patient’s early warning score reflected a deterioration, a nurse would inform a junior doctor, who would attend the patient. But this system meant that delays were unavoidable. ‘Sometimes the nurse would not contact
the doctor immediately or they would spend ages trying to contact the doctor, which could take hours,’ explains Sarah.

‘When they eventually arrived, sometimes the junior doctor did not know what to do and, at times, they did not feel able to contact their seniors because of a belief they should know it all, even if this may not be the case,’ she adds.

The system also posed problems for nurses. ‘Nurses may be too busy or just not recognise what is happening,’ she says.

‘For example, where there are patients who have lots of co-morbidities, who are normally quite sick, it is hard to know when there is a deterioration,’ she adds. ‘As a result of some of these issues, patients end up in intensive care and we hope the new technology will stop this.’

So how was the new system implemented?

Miki spent the first two months collecting data on the two wards taking part in the trial.

‘We had to make sure we had something to compare the trial to, so I collected all the data from the patients who had triggered an early warning score before the alert system was put in place,’ says Miki. ‘I would look at their notes to see what had been done and what their outcome was.’

To ensure the trial was supported, Miki had to ensure nurses were on side. ‘I spent lots of time on the wards before I had to
train the nurses in what to do, so it was a good opportunity for them to get to know me,’ she recalls.

Working in a new environment away from her colleagues was daunting, says

Miki, but she found a common bond with the nurses she began to train, who were also apprehensive about using technology.

‘I could spend as much time with people as they needed. Some picked it up really quickly and others needed more time. I’d get them to try it and they would see how easy it was and, when they picked it up, they would start to jest between themselves about it because they knew how to do it,’ she says.

‘They were worried that it was going to cause them extra work because they were having to do it all in duplicate and still fill in the handwritten charts but, because I was there every day and paying an interest, it had a really positive impact on the success of the training as I was able to show them there was nothing to fear,’ she adds.

The actual alert system went live last month.

Sarah says Miki’s training has paid off and nurses are already seeing the benefits of their hard work. ‘The nurse in charge of the ward gets a bleep on the initial trigger, so she knows exactly what is going on,’ says Sarah.

‘It has given them a good way of being able to teach as it allows them to go to the ward staff, talk about which patient
needs the most attention and ask their staff what they think could be done to make the patient better.

‘And it gives her greater confidence, because when the doctor walks on to the ward she can say automatically who is really ill and exactly what is going on,’ she adds. ‘Before, you would have to rely on your nurses coming and telling you what was going on but they might have been too busy to tell you or they may not have an understanding of the symptoms.’

Much time was spent ahead of the launch ensuring that all of the nurses and doctors understood the system. Sarah believes
this was key to the pilot’s smooth implementation. ‘It has all worked as it should and, when the alert goes off, people are responding very quickly – just like they should have been responding to the early warning scores all those years ago,’ she explains.

‘The nurses know they don’t have to spend two hours on the phone getting the doctor like they used to, and they are freeing up more time to care. It’s excellent because we now get the doctor when we need the doctor,’ she enthuses.

Miki’s hard work has not only benefited other nurses and developed her IT skills – it has won her a promotion.

‘In the time that I have been here, I have been promoted to senior sister. I put that down to the confidence I have gained form working on this project. It’s a really great feeling,’ she says.

‘All I can think about at the moment is how it is working but I think I will look back and be glad and proud to have been part of this.’

It will be another month before the team will have enough data to give a clear measure of the improvements the system has brought about.

‘This is all about improving patient experience,’ says Sarah.

‘Whether that means dying appropriately with the right treatment or being put in ICU with the right treatment, this is about making it better for the people we look after,’ she adds. ‘If the trial shows we can do this I’d like to think it can be introduced throughout the hospital because improving patient experience is what we are all here for.’

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