Technological advances can improve the way care is delivered. Sam Foster explains how her trust is embracing technology to design innovative products to benefit both staff and patients
Products and devices can have a major impact on care delivery and on productivity. While I agree with Eileen Sills’ comment that “the art of intuition must not become eroded with advances in technology”, IT can be used to measure care and improve efficiency, thereby releasing time to care.
To comply with the healthcare agenda, an industry of assessments, flowcharts and scoring matrices has evolved. The acute admission process that most trusts favour involves a booklet style document of up to 16 assessments. This has a repetitive feel for core data, and its ability to inform individualised care should be questioned.
In addition to this, nurses spend time handwriting handover and other notes, which give rise to repetition and waste.
During the implementation of the Productive Ward programme at Heart of England Foundation Trust, we found that, in line with the national average, about 25% of nurses’ time is spent on direct care and 26% on administration, at the computer or the nurses’ station.
We are fortunate to have some locally designed IT applications that enable electronic handover and e-referrals. Senior nurses use a portable tablet PC with a touch screen, the Panasonic Toughbook, to measure care and collect real time nursing quality and safety metrics.
As with many other trusts, early results of metrics demonstrated that our standard of nursing documentation was poor. To address this, we ran a rapid improvement week, attended by ward nurses, with the aim of automating our risk assessment process. They felt that our risk assessment booklet did not work at ward level.
We looked at metrics, used a violation assessment on the existing risk assessments and developed core admission questions that would trigger further risk questions. These questions were then field tested and proved to be as sensitive as traditional risk assessments. The theory behind this was that a comparison with a back to basics approach, where time is spent on a thorough face to face admission assessment, would reveal patient risks and needs. From this week, an automated risk assessment and safety plan are in development. These will be bolted onto our existing trust software.
Our next aim is to enable our nursing teams to spend as much time in bays as possible, rather than huddling around the nurses’ stations. To this end, new wards are being designed with touch points, which are standalone units for entering data. One of our ward teams is working with designers to develop the way we use these devices. This includes use in docking stations in bays, being docked into our medicines trolleys to enable administration of medicines via our electronic prescribing system and other ward processes.
The pilot of handheld devices is only halfway through but the feeling is this could be the way forward. Next steps include working with our faculty of health to produce podcast style tutorials to guide practice and implement policy guidance.
Innovation can have a significant impact on care delivery. The launch of the Nursing Times Products Awards this week recognises the role of products in transforming care and I am looking forward to judging the productive working category. We do need to be cautious around eroding the art of nursing – but we also need to embrace innovation.
Sam Foster is deputy chief nurse, Heart of England Foundation Trust