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Analysis: How nurses have already benefited from NHS tracking technology pilots

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Sensors in soap dispensers could soon be used to check whether nurses have washed their hands, according to the first trust to trial “TeleTracking” technology in the NHS.

The Royal Wolverhampton NHS Trust has pioneered the use of real-time data, introducing electronic badges and bracelets similar to “Fitbit” devices to track staff, patients, beds and other equipment.

“I can see whether there are big differences between wards”

Rose Baker

Nursing Times has spoken to a senior nurse at the trust about the project so far and also a five further organisations that are hoping to start using the technology in the near future.

The West Midlands trust has reported significant improvements in bed management since 2015, leading to fewer cancelled operations and improved performance on accident and emergency waiting times.

The technology has also helped free up nurses to concentrate on patient care and has proved to be useful when investigating complaints and serious incidents, according to the trust’s associate chief nurse Rose Baker.

However, she admitted managers initially had to convince staff of the merits of what could be perceived as a “Big Brother” style surveillance system.

All 4,000 staff who have direct contact with patients – including nurses, doctors, allied health professionals and porters – now wear electronic badges, while all patients have electronic bracelets, allowing everyone’s location and movements to be tracked.

Key equipment such as infusion pumps, bladder scanners and ECG machines are also tagged so staff know exactly where to find them at any time.

“At the moment, we are doing everything with pens and paper and a written whiteboard”

Lorraine Walton

Ms Baker said the technology had made a big difference including “taking some of that stress and strain away” from nurses, releasing them to concentrate on core nursing tasks.

“Before nurses were on the phone trying to find stuff,” she said. “It used to take up to 60 minutes to find a bladder scanner, whereas now we can look on our system and within seconds bring up every bladder scanner in the organisation.”

Working in a similar way to an air traffic control system, the technology means staff can see instantly which patients need a bed, the beds that are free and those that need to be cleaned – leading to improved bed management and patient flow.

The trust’s patients are now three times more likely than previously to be directed to an appropriate bed, according to data published by the regulator NHS Improvement, which is overseeing a pilot.

It has helped reduce the number of operations cancelled due to lack of beds by 60% and has also helped reduce breaches of the four-hour A&E target caused by bed shortages.

“We’re expecting it to improve bed turnover rates”

Bernard Quinn

Previously, all discharge and transfer bed cleans were done by nursing teams – equating to an estimated 17 hours in total per day spent cleaning beds instead of caring for patients.

The trust now has a dedicated cleaning team who are automatically alerted to which beds need their attention via the TeleTracking system.

“On screen the bed will automatically turn brown, so the bed management team know it is empty but dirty,” said Ms Baker. “An automatic alert goes to the bed cleaning team and when they have completed the job and log off, the bed will turn green so the bed capacity team know they can now put a patient in it.”

The system is also used to make referrals to physiotherapy, occupational therapy, social care and other services, and can be used by nurses and other clinicians to track progress.

The trust first began exploring the use of real-time tracking in 2013-14, having won a grant from NHS England to invest in improving infection control.

Under the initial scheme, known locally as Safe Hands, the trust wanted to gather detailed information on hand washing practice and generate a “hand hygiene index for every ward” using sensors on soap dispensers.

Ms Baker told Nursing Times this was still the goal but there were some technical issues yet to be resolved. These included that staff tended to “wash and go”, so sensors needed to be sensitive enough to register that.

The Royal Wolverhampton NHS Trust

Nurses ‘get time back’ with tracking technology pilots

Source: Simon Glazebrook

Rose Baker

Water was also getting into electronic tags placed on the outside of dispensers. Ms Baker said the hope was the soap dispensers themselves could be modified to incorporate the technology inside.

But she said the TeleTracking system had already proved to be useful for improving infection control.

“If you have an outbreak you can be very clear which patient was by which patient, which staff went in with those patients and which bits of kit went in and where they went next,” she said.

She added that acuity and early warning scores for each patient were recorded on the system each day, and monthly data for each ward was used to skill mix reviews. Ms Baker said she was also using the system to take a detailed look at care hours per patient day, including the amount of direct and indirect contact nurses had with patients.

“I can’t say what they were doing or how well they did it, but I can see whether there are big differences between wards,” said told Nursing Times.

Other developments potentially include looking at how the system could be extended into integrated primary care services, perhaps tracking interactions with GPs and practice nurses.

Ms Baker said it had taken staff time to get used to the technology but now they would not be without it, and it had “become second nature”.

At the start, she admitted managers were worried nurses and others would “kick against it”. However, she said a key selling point was the safety aspects of the system, such as the fact all staff badges incorporate a panic button.

Meanwhile, the system can be programmed to sound an automatic alarm if a vulnerable or confused patient leaves the safety of a ward and even alert staff if a patient spends longer than expected in the bathroom.

Ms Baker said it had led to a calmer atmosphere on the wards and elsewhere. “It is much quieter on the wards because the phones aren’t constantly ringing,” she said.

In addition, Ms Baker said the technology could help deal with complaints and the investigation of serious incidents, because it showed that a nurse was with a patient at a certain time.

However, she said staff had been promised TeleTracking data on its own would never be used as the basis for a disciplinary procedure.

“When we sold it to staff we said it would not be Big Brother, it will be used as a piece of information that would be triangulated with lots of other sources,” Ms Baker said.

Up to five more NHS trusts look set to also trial the technology. University College London Hospitals NHS Foundation Trust is planning to launch its “Co-ordination Centre” programme in the autumn.

Unlike Wolverhampton, it will not yet be testing electronic badges for staff. However, it will use the technology to track equipment, manage beds and follow the progress of patients to a certain extent.

Clinical operations manager Lorraine Walton told Nursing Times she anticipated the system would give nurses on the ground “their time back”. “It will completely reduce the amount of calls bed managers make to ward staff and give them that time back to spend with their patients,” she said.

The trust has yet to install the technology but has run a number of “discovery sessions” with staff to look at current processes and how things might work differently in the future.

Ms Walton said there were understandable worries about the introduction of new technology, but she was encouraged that many staff had asked to become champions and “super users” for the programme, who would support the rest of their teams to use it.

She said the pilot was also useful preparation for the imminent widespread roll-out of electronic hospital records and would help staff get used to working with digital systems.

“At the moment, we are doing everything with pens and paper and a written whiteboard, but this will mean they get used to seeing information presented on screen in this way,” she said.

The Royal Wolverhampton NHS Trust

Nurses ‘get time back’ with tracking technology pilots

Source: Simon Glazebrook

Teletracking controllers at New Cross Hospital, Wolverhampton

Another pilot, the Countess of Chester NHS Foundation Trust, said it would be focusing on testing the “operational platform and hospital co-ordination centre” aspects of the technology. As at other pilot trusts, this will include automated porter requests and bed turnaround services, bed and theatre management, and equipment tracking.

The Mid and South Essex Success Regime – incorporating Mid Essex Hospital Services NHS Trust, Southend University Hospitals NHS Foundation Trust and Basildon and Thurrock University Hospital NHS Foundation Trust – has also been announced as one of the pilot sites.

It is likely to use the technology in a very similar way to the other pilots. However, the group of trusts have yet to confirm the extent or scope of its pilot scheme.

NHS Improvement said it had high hopes for the expanded pilots given results from Wolverhampton and the US, where the technology was first introduced.

“We’re expecting it to improve bed turnover rates. We’re also expecting it to have a positive impact on theatre utilisation as well.” said Bernard Quinn, the regulator’s director of improvement programmes.

He said the goal was to get the trials under way as swiftly as possible and start gauging the impact. “We’re trying to see how quickly we can get the pilots up and running and how quickly we can see the benefits flowing from it,” he said.

The Royal Wolverhampton NHS Trust

Nurses ‘get time back’ with tracking technology pilots

Source: Simon Glazebrook


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