In July 2021, CareFlow Connect, a secure and mobile clinical communications and collaboration system designed to facilitate faster and safer care co-ordination for clinical teams within a hospital and across a care community, was implemented throughout Barnsley Hospital’s maternity service. As a result, inpatients and outpatients are experiencing improvements in patient care, with better safeguarding arising as a particularly significant benefit.
Vicki Carlisle, Digital Midwife at Barnsley Hospital NHS Foundation Trust explains, “We use CareFlow Connect for safeguarding pregnant patients and their babies by ensuring real-time documentation such as the latest police and court reports, as well as birth plans that we need to see to provide the most appropriate care, are easily accessible via the app.”
Rather than struggling to get hold of the safeguarding team out of hours, real-time oversight of a court case, police report, admission to ED, most recent birth plan, prior communication with the mental health team, the latest advice from the safeguarding team (regardless of their availability) or anything else relevant to the patient’s pregnancy journey is available to view in CareFlow Connect as a contemporary record. The safeguarding team adds documentation, information or advice to the patient’s record at any stage of the pregnancy, which means that relevant and up to date information is easy to access by the maternity service if the pregnant woman is admitted.
This means that as soon as a patient is admitted to an inpatient area, the midwife can see the latest safeguarding information straightaway. Once the patient is admitted, the maternity team pins the patient to a safeguarding list, which the safeguarding team checks daily. Regular communication and handover are maintained between the maternity professional and the safeguarding team, ensuring the most relevant and up to date information is available for any healthcare professional treating the patient. Additional awareness of the presence of the patient on the safeguarding list is enabled, so that appropriate action can be taken.
CareFlow Connect also facilitates images and picture messaging, which has useful applications for the maternity service. Vicki says, “Our maternity teams have demonstrated great initiative around providing patient centred care through taking images. For example, patients come back to us postnatally through the triage maternity assessment unit within the birth centre. They may need advice and treatment for a caesarean section wound. One team member may see them but they’re not on shift if she re-attends at a later point in time for further observations. By taking a picture of the affected areas, an accurate record is taken. Staff are not dependent on somebody else's verbal description, which is subjective ultimately.”
The maternity service has embraced electronic handover, using the SBAR method of communicating patient care between colleagues. CareFlow Connect’s handover feature incorporates Situation, Background, Assessment, Recommendation (SBAR); a popular technique in healthcare used to facilitate and prompt appropriate patient handover.
Before the clinical communication and coordination app was adopted, ‘SBAR stickers’ were used to handover patients between colleagues, involving a shift change or a handover of care between areas. This was in addition to a Word document saved on a shared drive, which only one person could access at a time, meaning there was no clear audit of the document as a handover tool. There was no audit trail to view in terms of who updated records or what information had been handed over between colleagues and during shift changes.
In inpatient areas, real-time SBAR handover is now possible, which provides an audit trail and can be completed during the shift rather than at a certain point in time, with midwives amending and updating tasks as and when required. If they’re called away at any time, patients can be handed over easily and accurately.
Vicki Carlisle, Digital Midwife at Barnsley Hospital NHS Foundation Trust explains, “I can clearly state, for example, that this patient had a requirement for blood tests. The notes are evident and are time and date stamped, so I can see whether the request was followed through, and it can’t be misinterpreted by the receiver.
Such high quality, auditable information has proved useful in high level investigations and root cause analysis, where we refer to the Connect handover audit, which reveals clear correspondence between colleagues and a full audit trail.”
Electronic handover has been introduced into some outpatient areas, such as clinics and the antenatal day unit, as occasionally patients will attend these as an outpatient but will require inpatient admission, following review. Staff within the antenatal clinic and day unit service will use SBAR handovers prior to transfer to the inpatient area. Again, this ensures a robust handover with clear, concise documentation and an audit trail right up to the point of handover.
In addition, the maternity service uses clinical tags to create patient lists, so the team can identify anything of interest without having to read through handovers. Examples of clinical tags include babies in special care to explain why the baby is not present with the mother, patients under the care of continuity of care teams, patient on IV antibiotics and those in induction of labour. Therefore, without fully reading every handover, the maternity teams can quickly glance at the patients in their care at any one time and see that they might have six patients undergoing inductions at a quick glance, without reading 25 handovers, for example.
The Maternity service are second within the Trust for the number of handovers they complete, with Critical Care being the first. In a typical month, 2730 handovers are completed on 431 patients. 63 of these handovers had patient tags added. Within the month, there could be 220 births and 1,613 active antenatal patients. Vicki says, “This shows that handovers work extremely well, and they’re completed on all patients, i.e., mothers and their babies. Our team are driving handovers forward and encouraging us to take the application of CareFlow Connect functionality to the next level.”
Staff testimonials on the use of CareFlow Connect for safeguarding purposes include:
Using CareFlow Connect to record safeguarding concerns with SBAR is an ideal way to capture an overview of these concerns.
CareFlow Connect is great and represents another way to communicate information to all staff. I can’t wait for the medical team to be involved.
We are using CareFlow Connect in outpatients to transfer patients onto the wards. As the SBAR is updated, staff obtain real time handover in relation to patient information and care plans.
There are limitless possibilities for using CareFlow Connect to further enhance patient care across the Trust. Using CareFlow Connect for Referrals across departments is the next priority. This includes referrals that occur within the Maternity service, as well as referrals from maternity to other specialties. In future, extending the capability of CareFlow Connect to offer referrals to other services treating pregnant women, so they can seek the advice of the maternity service, would offer immense value.
Currently, methods of making a referral are inconsistent and outdated. CareFlow Connect will help streamline referrals within the maternity service.
Internal referrals within the Maternity service are crucial and need to be handled efficiently. For example, patients may attend the triage Maternity Assessment Unit outside of normal working hours and they could require a follow-up appointment within the antenatal day unit. The triage service can send a referral to day services through CareFlow Connect and acknowledge that the patient needs to be seen, requesting a scan and a follow up appointment.
Plans are currently underway to get medical teams on board with electronic handovers and the teams have analysed the success of handovers within the maternity service, to transfer best practice. The maternity service will be working closely with medical teams to roll out CareFlow Connect including handovers, as one of the first Trust services to do so. As obstetric doctors work within gynaecological services as well as maternity, CareFlow Connect will support more streamlined crossover between the services.
Electronic handover will also be extended to the neonatal unit for babies that need to be transferred to the unit and then back onto a ward area. CareFlow Connect will support their transfer, offering a more robust audit trail of patient care, including the background and recommendations moving forward. Early pregnancy is another area that will be extended to for handover.
Task management is also possible within CareFlow Connect and this is another feature the maternity service intends to adopt. The use of System C’s e-Observation System, CareFlow Vitals, for all pregnant patients is another key goal.
All of which highlights that Barnsley Hospital is well on their transformational journey to improve patient care for maternity patients, with outdated practices being confined to the past. Vicki concludes, “We’ve found that the biggest challenge is not changing processes, it's changing organisational culture. But what's interesting is that once the culture changes and staff adopt a new system, they will devise their own ideas to improve the service. This means the improvements that can be achieved for patient care really are endless.”
