Bedside rounding moves into the future
The introduction of a modern, technological approach to nurse rounding at the Royal Free London Foundation Trust has resulted in improved efficiency and patient care while also enhancing the image of nurses
By using Cerner Millennium, nurse rounding is being delivered and recorded at the bedside in real time at the Royal Free London NHS Foundation Trust. This ensures that patients are involved in their care and that nurse rounding is highly visible. Nurses look professional and modern, thereby increasing the level of patient confidence. Our accomplishment has improved both patient and staff experience.
- Engage nursing staff in electronic systems
- Improve patient care
- Reduce use of paper
- Reduce duplication of information
- Improve patient and staff experience
Nurse rounding was instigated at the trust in 2010, one year before its recommendation for use by the government, using the mnemonic CAPE - continence, analgesia, position, environment. The trust decided to transform the paper-based recording of this nursing activity into an electronic form because, due to the activity being performed every hour, it is an ideal way for nursing staff to learn how to use the handheld computer and the computerised system.
The Royal Free has been using Cerner Millennium for its patient administration and some clinical solutions since 2008, but many ward-based nurses were nervous
using the system, leaving it very much to the administration and clerical staff and those nurses who were happy to do so.
Four wards were chosen to implement the change. Engagement, involvement and training of ward nurses were undertaken early on in the project. Ownership by the
matrons and sisters was crucial as this was their project, their work and their wards.
At go-live, a senior nurse from the trust’s change team worked and supported each individual nurse on duty for the first week on each ward. Clinical support was
paramount and made a significant impact on ongoing nurse engagement and motivation. “The whole process to change our way of working was made easier by the
change team at the trust who have always been available to help us,” said Ndumiso Ndebele, junior charge nurse from one of the renal wards at the Royal Free.
Nurses record their nurse rounding assessment in real time at the patient bedside. This is achieved by using a mobile clinical assistant (MCA), which is an electronic tablet. Nurses are also able to look up patients’ blood results, update the patient handover information and check on other functions without leaving the patient’s side. Patients say that nurses look more professional and are delivering care commensurate with the 21st century.
This has saved time as nurses no longer have to find the patient’s folder and retrieve the nurse rounding chart. It also saves on paper and storage. Weekly reports are easier to formulate as all patient records may be accessed by a computer. Paperbased medical notes from discharged patients do not now need to be located. Nurse rounding compliance has improved on the selected wards and the real-time bed state has increased from 94% (prior to go-live) to 100%. This makes it easier to locate patients for infection control purposes and feeds into more efficient bed management. It also generates confidence for implementing future enhancements, such as electronic medical records and electronic prescribing. Nurses are now using electronic mechanisms via modern electronic tools. Even the most resistant nurses are agreeing to be champions for future ward roll-out.
Investigating patient complaints has become simplified. Information is collected and securely recorded in the electronic patient record in real time. This means that ward sisters and matrons have information about the nursing activity immediately to hand and can discuss this with patients and their relatives. Other hospital staff have witnessed the benefits and are eager to use the handheld computers for their activities. The doctors on these four wards have ceased to use the ward results book. Other nurse specialists want to use the tools to track their patients and document directly into their patient record.
Allison Burrell, RGN, MSc, BSc, is change manager. Royal Free London Foundation Trust.
- Quick and easy to use
- Improved documentation and data quality
- Increased adoption of electronic systems
- Improved compliance with guidelines
- Increased involvement of patients in their care