There is much publicity about the implementation of electronic patient records (EPRs), especially about the lack of nurses engaged in their content design and build.
Why is this? Does the implementation of EPRs require nurses’ tender loving care? Is the importance of recording nursing information electronically understood?
A recent NT survey highlighted the demands on nurses to complete documentation in a timely fashion (NT Feature, 18 September, p16). Can this be solved with EPRs?
According to many nurses who responded to the survey, it certainly can. Recording patient information once, in real time, is an excellent example of saving time and has the added bonus that you can audit the report as you go along.
The implementation of payment by results and practice-based commissioning requires the recording of clinical activity. However, a lack of standardisation across the profession results in some nursing activities being ‘invisible’. This lack of information could give managers the rationale for downgrading or redundancy.
A review of nursing practices around documentation should be considered. As nurses deliver 80% of direct care, it would be a prudent trust that addresses this activity to establish how much nursing care costs. However, it would be a wiser nurse who determines what the trust is collecting and monitoring. And what better way than with the EPR?
Let’s take the example of assessing a patient, usually a paper-based exercise. With an electronic system, the nurse logs on and finds the patient, accesses the electronic template and chooses from drop-down menus to input information.
What if there is no field to record the pulse? And not just the rate but whether it is regular, coupled or irregular? Could this happen? Maybe not with such vital data – but what if you are a nurse endoscopist and there is no field to record what type of polyp you have seen? What a disaster – and one that is more likely to happen if there has been no consultation in the building of the electronic template.
Nurse engagement is essential to ensure IT systems support the daily activities of nursing. The profession needs to know about the role software can play with regard to the patient journey. This does not undermine the performance of nurses – it encourages more productive thinking and challenging of practices.
Processes require consensus from users. This is where delays can occur. Nurses may not be in agreement or there may be no ‘higher’ body to provide ‘clinical sign-off’. A clear nursing voice was patently lacking in the recent Healthcare Commission report on the Clostridium difficile outbreak at Maidstone and Tunbridge Wells NHS Trust. With improvements in how we record patient information, is it not feasible that a similar future report would far more strongly echo the practice and effectiveness of nurses?
Service providers must know what nurses need from IT systems so that this can be built in. In England the local ownership programme provides this through the devolvement of responsibility of implementation from Connecting for Health to SHAs and trusts.
So how do you voice your concerns and become involved? By communicating with your trust via the informatics department, the director of nursing, the clinical leads for nursing or the RCN Nursing Information Forum.
Delivering healthcare requires improved IT systems that are aligned to clinical processes. Nurses can participate in the EPR programme by active engagement, advising and providing information, or passively when the system is implemented. Nurses can make a success of this programme as they are the main healthcare communicators.
The RCN information in nursing forum has been campaigning for increased awareness concerning EPRs and e-health so nurses are supported with information, guidance on professional issues and expert advice.
Sonia Budgen is clinical domain specialist at Computer Science Corporation