humanising technology
TRANSCRIPT
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