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Practice comment

Locally designed products and devices can transform patient care  


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


Readers' comments (4)

  • Isn't it time we started treating patients as human beings again and not as goods on a production line or packages of goods on the shelves in a supermarket which clearly doesn't work. Patients are individual human beings with as many individual differences as their are human beings. I have worked in a hospital factory and am appalled at these management procedures. Why can't hospitals be led by clinicians who understand the needs of patients as they used to be when care of the highest standards was provided.
    I get the impression that some staff are more intrigued by inventing all the IT software than they are in adequate patient care.

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  • Gemma Watford

    I agree with the above comments, patients have had enough of being treated as numbers, or packages on a goods line in a factory or goods on a supermarket shelf. Lets get back to basics where good old gfashioned traditional care procedures worked and the patient was the focus, surely thats how nursing patients should be done. And for goodness sake lets reduce the tick box culture and the targets and protocols as this drives most pople in these jobs up the wall and wanting to leave, creating a higher staff turnover, not good at all for morale, and certainly not a future fair for all!!

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  • From Anonymous | 7-Apr-2010 4:59 pm above
    Excellent comments from Gemma Watford.
    I live and work abroad where health care provision is excellent and the level of interpersonal confidence, trust, colleagiality between interdisciplinary staff and between staff and patients provides a highly professional and convivial work place and patient satisfaction is high. I can also vouch for this from a patient's point of view as well.
    Besides being an RN I have an MSc in Healthcare Management and at uni I learned about all the different and rapidly changing management styles adopted in the UK most of which originate in the USA and also the quality cycles from Japan, although these countries have totally different social sytems and cultures from our own. New systems are always being experimented with for a while before going on to something new and although positive changes are benificial to all concerned human beings also require some level of stability and a feeling of security in their working and personal lives not to mention the cost and wastage caused by too many of the changes.
    Sadly the curent system of putting everyone and everything into packages to be managed, despite as many individual differences, needs and wishes as there are individuals in the world, seems to be right across the board and around the world (but probably worse in the UK than anywhere else, at least in Europe) whether it is your bank, telephone service provider or healthcare provider. Unfortunately in the provision of healthcare it is more apparent and detrimental to the morale, motivation and mental and physical stamina of the staff with very serious implications on attitudes towards the patients and who are, or should be, central to the health services which reflects on the quality of their care. At a time when there seems to be less and less staff and ever increasing administrative duties posts are cut back and there is an attempt to automate everything as much as is technologically possible in the name of financial savings. Unfortunately much work which involves IT and digitalisation, and ticking boxes, is extremely time consuming and also highly demeaning and demotivating for staff and undermines their high level of professional training to care for patients. Such dehumanising technological tools and systems are only as good as the staff on whose input they rely and on their availability of time. With highly pressurised, worn out and demotivated staff, whose numbers are usually minimal in relation to the increasing amount of work produced by such systems, this can lead to serious errors as well as breaches in confidentiality through lost and stolen data, etc. etc. In my view, nurses who previously had more time for greater contact with their patients and relied on their professionalism, training, skills developed, experience and intution had a better overview of the patients individual needs as well as their wishes and were able to provide care of the highest quality.
    Increasing reliance on evolving IT methods, even more time consuming and frustrating when it goes wrong, seems to be here to stay for a very long time although bitter experience is beginning to prove in services management that there is poor tolerance for the current state of affairs in an increasingly individualised and globalised world. It is also time that the NHS and the UK looked outside their narrow confines and also beyond the USA styles of management to learn from other experts how they can once again best serve the needs of each individual patient and provide them with the best possible care at all levels (from the cradle to the grave - in hospitals, clinics, nursing care homes, etc. and in the community) - individualization theory for modern service delivery and marketing refers.
    However, I suspect as newer technologies develop and costs of healthcare and other services continue to rise we will see further increase in the number of experimental tools designed 'to help' do our jobs at even greater cost and wastage of financial resources and even less staff available to tick all the boxes as well as trying desperately to provide a caring service for their patients; and what about the dinky software (and probably extremely costly as well) produced by some bright sparks from an IT company being tested in a hospital for use at the bedside on a tablet compute rwhere nurses take a patient's history and notes on doctors' rounds. After later transferring the data to the main ward computer and then ticking more boxes it miracuously produces a nursing diagnosis, care plan and prescription for treatment which includes how long to spend talking to a patient and the required medication. The test case at the presentation was a recently widowed lady of over 70 years old, with a diagnosis of cancer, diarrhoea and possible depression hositalised as she was unable to manage alone at home. After taking the history and ticking the appropriate boxes for mild, moderate or severe diarrhoea and the same for depression the software produced the care plan, prescribed the dose and frequency of Immodium and suggested a 5-minute interview to confirm any signs of depression followed by a further 30 minutes of the nurses' time on a further occasion for a follow-up talk! Perhaps it could be programmed to produce a timetable for the care plan as wel lto fit in with the rest of the work on the ward! It would be very helpful indeed if we no longer had to think at all and perhaps we could employ a few robots to help out and boost staffing numbers!

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  • in fact it seems very silly indeed and totally wasteful that each hospital does its own thing. Only standardisation across the NHS will ensure that all patients are getting fair and equitable and accessible treatment of the highest standards.

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