[London, UK/ Implementations] - The Royal Free London NHS Foundation Trust has gone live with the deployment of tablet computers on four wards. These allow nurses and consultants to gather and access information at the point of care, eliminating a large amount of data-entry duplication and time spent on administration.
The Royal Free has used laptops placed on carts on wheels (COWs) for some years, but their bulky, awkward design prevents bedside access and data input to patient records is cumbersome and time-consuming. Data has to be captured on paper forms then entered onto laptops located away from the patient. Laptops have an increased likelihood of breakdowns and also require a great deal of time to ensure infection control protocols are kept up to standard. This frustrated the Trust′s aim to seamlessly embed technology into its clinical processes.
The tablet PCs used are specially designed for use in a clinical environment — Mobile Clinical Assistants (MCAs). They have an integrated smart card reader for secure identification of the user and use the Windows operating system for secure integration with the existing electronic medical record application and network infrastructure across the hospital. The software interface is the same as on the Trust′s other computers, which staff have been using for some years, so they don′t need further training to use it. Infection control is also easier as the MCAs have a sealed design and are easily cleansed and disinfected with standard cleansers.
The portability of the tablets means nurses and consultants can enter data directly into the electronic medical record system at patients′ bedsides, eliminating data entry duplication, reducing the need for paper forms and increasing observation round productivity. In the first nine days of the project, over 700 observation rounds were made and wards complied with Care Quality Commission (CQC) best practices that were highlighted as needing attention following an earlier inspection.
Ward managers have more accurate insight into ′live beds′, tracking not only the number of available beds but also the location of a given patient — an important consideration for infection control. An unexpected bonus is that communication with support services such as portering and estates has improved, as they can be contacted directly via the tablet PCs while nurses are on their rounds. This real-time communication has accelerated the resolution of issues, such as faulty facilities.
Will Smart, Director of Information Management and Technology told BJHC, “The key issues are not just in terms of usability, but how the device fits into the work patterns in the organisation. Computers on wheels are not very useful if you want to access the system by the patient, so on many wards you can see staff on a long journey from bed to device and back again, which is good exercise, but not necessarily a very productive use of time.”
Nurses as champions
In preparing for the mobile technology, staff were fully engaged. “We started off with four exemplar wards to prove the technology,” said Will Smart. “We wanted mobile devices that would work in the physical geography of the wards. We ran workshops with clinicians over a week — for doctors, nurses etc — who had hands-on contact with devices, and left the decision to them which device they chose. My program team spent a lot of time in the exemplar wards working with nursing staff to understand their requirements and get them engaged.
“We focus on nurses rather than other medical staff as we found that nursing staff were becoming the champions and the other medical staff were following the nurses′ lead. Certainly in the ward areas they do most of the documentation. If we can get it right for them then it works for everyone else. Nurses are important in terms of how we roll it out and how we do technology generally.
“The productivity gain is not about doing something better we were previously doing. The productivity is where there is now a one-step process to put data in an electronic system. Previously we were collecting the data on a piece of paper then had a second process to capture that data electronically.”
“Interestingly we found benefits we weren′t expecting, such as around real-time bed state, where senior nurse time has been freed up. Senior ward managers can also take an MCA around the ward and see if a door is broken, roof tile discoloured, and can use the MCA to log directly into the estates help desk. We find that the MCA, because it is mobile, is being used for applications much broader than patient care delivery and is having real productivity benefits in other areas as well,” he added.
“We are also finding that data quality is improving. It is the old adage that data quality is improved if it is a by-product of an operational process. We have not always made data collection part of the operational process, but a parallel process. We are finding that by using the MCA we are making systems more immediate in terms of nursing usage and a by-product of that is data quality.” [hw][Photo: Royal London Hospital Photo credit by Dr Neil Clifton]