Humanising care in a digital world

Professor Janice SigsworthChief Nurse

Gerry Bolger RN, MHMNursing Informatics Lead/CCIO

20th April 2014 – eHealth Nursing Plenary

Creative Commons Licence

Agenda• About Imperial

• Why the digital agenda is important to nursing

• Changing landscape of IT

• What this means practice of care

• Role of CCIO-Nursing

• Safer Care project

• Making tech the enabler in the therapeutic relationship

St Mary’s Hospital, founded 1845St Mary’s Hospital is a major acute teaching hospital that diagnoses and treats a broad range of adult and child conditions. The hospital also provides maternity services and hosts one of the four major trauma centres in London.

Hammersmith Hospital, founded 1902Hammersmith is a specialist teaching hospital and hosts the heart attack and arrhythmia centre for north west London. It is well known for its research achievements; hosting a large community of Imperial College London researchers.

Charing Cross Hospital, founded 1818Charing Cross is an acute teaching hospital providing a range of adult clinical services. It hosts one of eight hyper acute stroke units in London.

Queen Charlotte’s & Chelsea Hospital, founded 1739Queen Charlotte’s & Chelsea Hospital provides maternity and women’s and neonatal services. It cares for women with high risk pregnancies through to those choosing midwife-led deliveries in the birth centre.

Western Eye Hospital, Marylebone, founded 1856Western Eye Hospital is a specialist ophthalmology hospital. It offers the only 24-hour emergency eye care service in west London.

Our hospitals and their services

Why IT is important to nursing

• Releasing time to care– Audits / gathering data

• Improving the patient experience

• Decision support• Improves nurse/care team

experience– Access to the same information

• Assurance across the continuum of care

Source: Dan Piarohttp://www.icecreamnation.org/wp-content/uploads/2012/05/hunter-gatherer-cartoon-by-Bizarro.gif

E-health policy perspectiveSystem

Information

Data for Transparent Performance

Quality of care transparent

Standards for 'meaningful use'

Digital Enablers

Electronic Patient Records (EPR)

Trust & Value

eRostering / EPR /

ePrescribing & information

Impact to Professional

s

Interoperable paperless records

Access to info & knowledge &

CCIOs

e-catalogue & costing to deliver

care

Benefit to Patients

Patient accessEPR, use of Apps

& make appointments

Enabled choices

EPR & ePrescribing

Five Year Forward

View

Personal Health &

Care 2020

Carter Review

Gerry Bolger

Changing digital landscape Moving From Moving ToReactive Care Proactive healthPerceived difficult patient Empowered userRecipients of care Co-producers of own careProblem focus Solution orientatedLimited data Evidence with InformationOpaque overview Transparent reality

What this means - Challenges• Change to practice• Need for standardised

working approaches• Workforce

– Transition challenges• IT enabled / informed

patients • Impact of technology in

the therapeutic relationship

Digital direction

Role of Nurse CCIO

Strategic analysis

Transformation

Patients & Practice

Information for

assurance

Personal Health & Care 2020 set this

as a recommendation

Why the - Safer Care ProjectIdentify

patients at risk

Rapid intervention

Release time to care

How? Bid to the Nurse Technology Fund

• Bedside monitoring• Supported by Dashboard for Patients at Risk• Releasing time to care• Introduce Sepsis alerting FY 2016/17

How we did it• Led by Nurse Directors

identified pilot & rollout areas

• 70 Bedside spot monitors for general wards areas

• Integrating existing bedside monitors for ED / Recovery / High Dependency areas (150 devices)

• Pilot in Nov• Rollout end of Jan• 50% complete end of March

What we learntBaseline• Completing NEWS on

paper 2.5 – 3.5 mins / a patient

• Manually record on EPR took 20 seconds longer

Since starting to implement• 209,750 data points

entered• 8179 sets of NEWS scores• Reduction 1:10 sec in

recording time• Releasing time to care =

167 nursing hours• NEWS visible on

Handover screen

Breakdown of NEWS•

37%

27%

19%

9%4%2%1%0%1%

% of NEWS Observation0 1 2 3 4 5 6 7 8+

94%

4% 2%

NEWS Score by Risk Low score 1-4 Medium score 5 & 6 High score 7+

0 1 2 3 4 5 6 7 8+0

500

1000

1500

2000

2500

3000

3500

Number of NEWS observations

Feedback from staff

What next• Finish rollout

– Integration devices– End user feedback – what could be improved.

• Analysis of SBAR• Introduce Sepsis Alerting & Management

Making tech the enabler

• Bedside care documentation

• Nursing routine care build into software

• Involve the patient – it’s their clinical information

• Team boards/handover• Use graphs – especially to

show improvements• Make the use of IT in care a

positive impression

I*LEVELS modelI* – Introduce

yourself / patient sees you

L – Let the patient look & involve

them

E – Eye contact with patient

V – value the contribution of the

computer

E – Explain what you are doing

L – log off

Source - Kaiser Permanente & *Virginia Mason