Sensors in soap dispensers could soon be used to check whether nurses have washed their hands, the first trust to trial “TeleTracking” technology in the NHS has told Nursing Times.
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.
“It gives you real-time data that you can work with and use to improve services”
As a result, the trust told Nursing Times it had seen significant improvements in bed management since introducing the technology, leading to fewer cancelled operations and improved performance on A&E waiting times.
The technology had also helped free up nurses to concentrate on patient care and was a useful source of information when dealing with complaints and investigating 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.
Under the system, all 4,000 staff who have direct contact with patients – including nurses, doctors, allied health professionals and porters – 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.
“When we sold it to staff we said it would not be Big Brother”
The system was developed in the US for use in hospitals where everyone has an individual room. To replicate this at Wolverhampton, beds in bays or wards are now demarcated by infrared “virtual walls”.
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.
“It has taken a lot of the duplication and admin away,” she told Nursing Times. “Before nurses were on the phone trying to find stuff, whereas now using the system we can track patients, staff or bits of kit and it is much easier.
“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,” she said.
Working in a similar way to an air traffic control system, the technology means staff can see instantly which patients need a bed, which beds are free and those that need to be cleaned – leading to improved bed management and patient flow.
“It is much quieter on the wards because the phones aren’t constantly ringing”
Royal Wolverhampton patients are now three times more likely to be directed to an appropriate bed, according to data published by NHS Improvement, which is overseeing a pilot that will see the technology rolled out to five more trusts.
It has helped reduce the number of operations cancelled due to lack of beds by 60%. The technology has also helped the trust reduce breaches of the four-hour accident and emergency target caused by lack of beds.
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 bed cleaning team who are automatically alerted to which beds need their attention via the TeleTracking system.
“When patients are discharged their wristband goes into a drop-box. On screen that bed will automatically turn brown, so the bed management team know it is empty but dirty,” explained Ms Baker.
Timeline: Royal Wolverhampton’s tracking technology pilot
- September 2012 – trust began working with TeleTracking company
- March 2013 – went live with the asset tracking element
- July 2014 – started using TeleTracking real-time locating system technology to track not only assets but also patients and staff
- April 2015 – went live with the patient flow module
“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 that bed.”
The system is also used to make referrals to physiotherapy, occupational therapy, social care and other services, generating daily job lists for those professionals, and can be used by nurses and other clinicians to track progress.
The trust initially 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 scheme, known locally as Safe Hands, the organisation wanted to gather detailed information on hand washing practice and generate a “hand hygiene index for every ward” using sensors on soap dispensers, said Ms Baker.
She told Nursing Times this was still the goal but there were some technical issues yet to be resolved.
These include the fact staff to tend to “wash and go”, so sensors need to be sensitive enough to register that.
Meanwhile, water was 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.
Nurses ‘get time back’ with tracking technology pilots
Source: Simon Glazebrook
She said the TeleTracking system had proved to be an “enabler” alongside a range of other measures to improve 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.
“Did they go into the dirty utility area, so should be clean before they came back out, or did they go straight from one patient to another?
“It gives you real-time data that you can work with and use to improve services, but ultimately it is an IT system so it is not going to do it for you,” she noted.
Ms Baker said the NHS as a whole could make much better use of technology.
“We need to use IT in a much more effective and efficient manner and we need to bring it together,” she said.
“The NHS is very good at having ‘silo’ IT systems and one the beauties of this is that we have now got portering, patient flow, staff all being captured centrally so you can start to pull reports,” she highlighted.
Acuity and early warning scores for each patient are recorded on the system each day, and monthly data for each ward is used to inform bi-annual skill-mix reviews for all inpatient areas, she added.
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, doctors and others 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, so it helps you ask more questions,” 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.
Nurses ‘get time back’ with tracking technology pilots
Source: Simon Glazebrook
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. “You walk into our capacity office now – which is the central command and control for all bed admissions – and you’d think the phones were broken because they’re not ringing. It used to be non-stop.”
In addition, Ms Baker said the technology could help deal with complaints and the investigation of serious incidents.
“If someone says: “My mum’s not been seen” you can go into the system and show the member of the family a nurse was with them at this time, that time and another time,” she said. “If a patient has a fall, you can take the data out of the system to show the patient was here and the first nurse responded in X amount of time.
“We can evidence that now, whereas before we were relying on hand-written notes – we still use those but we also have the automated system, which can help give a much clearer picture,” she said. “You get good and bad information out of it, so it can show that yes – that person hasn’t been seen for whatever period and we can track it back to individual members of staff.”
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.
Royal Wolverhampton Trust’s TeleTracking results at a glance
Reduction in cancelled operations due to bed unavailability
Reduction in ‘on the day’ surgical cancellations
Reduction in the total number of bed days occupied by “medical outliers”
Reduction in patients’ medical length of stay