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Should all nursing documentation be standardised across the NHS?

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10 September, 2012

Should all nursing documentation be standardised across the NHS?

The Royal College of Nursing and the Royal College of Physicians have worked together to develop the National Early Warning Score (NEWS) system for recording vital signs in adults. They claim it could save up to 6,000 lives a year. They want to see it introduced in acute and community hospitals, nursing homes and ambulance services to increase consistency, reduce mistakes and ultimately improve outcomes for patients.

A recent study published in the journal BMJ Quality and Safety found there were nearly 12,000 avoidable deaths of adults in English acute hospitals annually. It found almost a third of these could be attributed to poor clinical monitoring, 29.7% from diagnostic errors and 21.1 % from inadequate drug or fluid management.

Readers' comments (24)

  • ABSOLUTELY!!! Standardised, and minimised!!! I have been to a number of trusts throughout my training and career, as well as a few private homes, and the variety of paperwork is overwhelming, exhausting, confusing, and not only does it take an inordinate amount of time just trying to figure out which piece of paper goes with which, but can often lead to omissions or mistakes for people who are not familiar with that articular form.

    This NEWS system is a great example of how paperwork can be standardised, but it should be rolled out across the board.

    There is no excuse now for every different place to have wildly differing sets of paperwork.

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  • Bit of an easy one this....yes!

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  • all the arguments seem to point to an affirmative answer. there seems to be no apparent reasons why this is not already so.

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  • YES!

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  • Yes, this sounds like a no brainier.

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  • michael stone

    Anonymous | 10-Sep-2012 7:45 am

    I think that put it pretty well - standardised paperwork should be used as much as possible.

    The problem is this bit:

    'and minimised!!!'

    Every time something goes horribly wrong, more specialists become involved, or someone (often an institution's management) wants to cover its own back, the paperwork gets lengthier. I'm not quite sure what the answer is to eliminating the unnecessary paperwork, but standardisation seems to offer almost exclusively benefits, to me.

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  • Yes, please! We have been shackled too long with the fear of writing having to document ABSOLUTELY EVERYTHING . I would welcome any improvement to reduce the amount of paperwork.

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  • Juggling Dog

    Anonymous | 11-Sep-2012 1:46 pm

    Yes, please! We have been shackled too long with the fear of writing having to document ABSOLUTELY EVERYTHING . I would welcome any improvement to reduce the amount of paperwork.

    But how does the amount of paperwork get reduced - I think Mike described why it expands, but how do you reduce it ?

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  • And it's a YES from me!!

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  • eileen shepherd

    The next question is how

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  • We tried a standardised booklet in our trust....it didn,t work as each speciality is so different, things that are appropriate for some areas to document are inappropriate for others, for example itu need to document airway, breathing, circulation conscious level ETC, where as a twenty year old ON THE ORTHOPAEDIC ward, in for IV antibiotic therapy for an infected finger certainly doesn't,t need this, so whilst standardised documentation sounds appealing, in reality it is not appropriate!

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  • Standardisation, is a must, it will be cheaper, and quicker. tick boxes, with added space for elaboration on evaluation. may be differrent colours for specialised areas, eg red for icu, so can tell at a glance where pt has been.

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  • 'and minimised!!!' perhaps a better term is 'concise'. I don't think this is an area that is addressed in any training/course.

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  • Anonymous

    jackie want | 11-Sep-2012 6:32 pm

    It perforce has to be standardisation for similar specialities. The point about the NEWS system, is it wants a standardised recording system for a set of basic measurements - if everyone uses the same system, then you can use feedback to fine-tune the 'warning markers' that you apply.

    And you could have standardised forms for the bits everyone records, with a further section for 'extras' felt necessary locally.

    Anonymous | 12-Sep-2012 0:34 am

    I don't think anybody has properly addressed the issue of expanding paperwork - one of many things that nobody is really in control of. But there is a complication with paperwork being a substitute for training/expertise, as well as being a fall-back position for when something went wrong. Less paperwork, will require that when clinicians appear to have made mistakes, they can defend why they did things without relying on 'I did it, because 'the rules' tell me to do it'.

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  • YES!

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  • George Kuchanny

    Yes! AND as Anonymous | 12-Sep-2012 0:34 am has already said CONCISE.

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  • There are a considerable number of 'health informaticians' across the UK who have nursing experience both operationally and on a project basis addressing handling sensitive patient data by compuetr means. Many of them will be registered under the UK Council for Health Informatics Professions, working operationally in the service or for solution providers. These people can help you to determine what structures can be used to make nursing records robust, coding factors etc. There have been systems available for many years, some interfacing with hopital / community / primary care systems to move towards a holistic patient history that can be consistently interpreted by all authorised professions. I would commend discussion with your local Health Informatics Department or contact UKCHIP and we could help to put you in touch with local expertise on our register.

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  • I would like to answer this question by saying that, yes, all nursing documentation should be standardised as, not only will it cut down on endless local paperwork (different Trusts have different amounts), it would also make it easier for when someone moves jobs to a new area (from the South Coast to Birmingham as an example) and would also help with temporary staff who may only work in an area for 1 night before working elsewhere the next.
    We have a version of this at our local Trust (called MEWS: Modified Early Warning System) implemented by ITU staff to enable all wards to have standardised Obs charts. And, mostly, it has been very successful, particularly for those area who do not deal with acute nursing day to day (stroke rehab, general rehab, delayed discharge etc). However, there is an issue I have noticed with it which was demonstrated quite clearly a while ago:

    We had a patient, admitted to our ward (an acute Cardiology Ward) late in the evening, who died during the night. Myself and the other staff nurse on that night were criticised for not recognising that the MEWS score had been breached by a Surgical Matron (the patient had a BP of 90/50). However, we argued that, as an acute Cardiology ward, we were used to seeing BPs at that level and much lower every day in patients who showed no clinical signs of having a low BP (an obvious side effect of patients with Heart Failure etc). This argument was accepted and, due to this, the documentation was adjusted to account for the possibility that a BP may be low but with no obvious symptoms.
    That may be just one example but it shows that, while standardised documentation may be a good and effective idea, there are always other aspects to consider. Personally, I do not take much notice of the MEWS figure but prefer to rely on my own observations of the patient as, if I relied on it too much, then I may not be so observant in noticing differences.

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  • I am a little concerned by your assertion that you take little notice of the MEWS scoring as you feel your own observation is better, yet you state a non cardiac patient triggered the MEWS and nothing was done because you applied you knowledge of acute cardiac care to a non cardiac patient? Surely this highlights why MEWS is of value, as a low BP in a non cardiac patient is a significant indicator and it did flag up that the patient was triggering.whereas you own observation failed to recognise the importance of it

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  • Absolutely - the time that is wasted and the resources - staff, printing etc - in developing documentation. Do not get me started on policies and guidelines - why can`t they be developed nationally?

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