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Building a Digital Care Planning System for Nurses.

Claire Grant’s nursing career has taken her around the world, with spells in America, Australia, South Africa and Canada. But when she thinks about the project of which she’s proudest, it’s a recently-completed one at her hometown trust.

As the chief nursing information officer at Barnsley Hospital NHS Foundation Trust – the same place in which she originally trained as a nurse – Ms Grant was responsible for the recent implementation of a new digital care planning system.

This didn’t represent the organisation’s abandoning of paper care plans: that happened a few years ago, with the introduction of an electronic patient record (EPR) system that had included digital care planning.

“But we knew we weren’t happy with it,” explains Ms Grant. “The patient had to fit into multiple care plans [rather than having one plan which comprehensively addressed all needs]. It wasn’t particularly fit for purpose and we knew we needed to look at better content and usability.”

So when the trust tendered for a new EPR system, there was a desire to ensure it included a new setup for care plans. And that meant Ms Grant had the opportunity to work in partnership with System C, the organisation chosen to supply the new EPR – and for which she’s since taken up a role as clinical adoption specialist after leaving the trust late last year. The task: to “design care plans as first of type”.

It was a daunting mission (“there was a mountain to climb with no guide”). But there was real clarity on how it would be tackled.

“I thought: 'This needs to be an opportunity to build this with the staff nurses.' So I asked for a staff nurse or a band 6 from every single ward and speciality and also for representatives from the speciality teams – continence team, tissue viability, pain management team, the diabetic specialist nurses and so on.

“We started working groups, going through the care plan content. And what I used to say was: 'If you ideally wanted to make this from scratch, how would you do this?’”

It was a question which provoked different answers from different specialties, meaning hard work to ensure what resulted was something which suited all needs. The teams reviewed over 260 different needs that might need to be covered within a care plan, the associated goals, and thousands of activities to help meet them.

Meanwhile, senior nursing working groups were convened to manage the governance behind the care planning process, and a working group with System C to actually build what was being planned.

Ms Grant tended to liaise with the senior clinical effectiveness groups while IT nurse Abigail Searles managed the core group. Both were in regular contact with System C, working closely with the supplier to make the vision a reality “Between Abi and me we had a balance and knowledge of each area, which worked perfectly.”

It was a painstaking process; a “constant back and forth for about 18 months”. But the setup and care planning that came out of it is “something that's designed by the nurses for the nurses. I used to say ‘By Barnsley, For Barnsley’ for the working groups – because it should be designed by them, absolutely. Because they know better than anybody else.”

The solution went live in July this year. Now every patient has but one care plan – “the plan fits to the patient, not the patient to multiple plans” – which is bespoke to them and their changing needs.

The core plan centres on eating, drinking, sleeping and managing risks of falls and so on. Then if a patient has an additional need – because, for instance, they have diabetes – the nurse simply clicks a few buttons to add that to the core plan. As a patient recovers or becomes more unwell, the plan is quickly adapted accordingly.

The new setup, which ties into the System C EPR at the trust, also makes it much easier to liaise with patients and carers on plans.

“The trust has lots of computers on wheels now, and the nurses can actually sit at the side of the bed and fill in the care plan with the patient and their relatives.”

It may have been built by Barnsley for Barnsley, but the templates will now be made available to other trusts that use System C. “The program and the way it functions is applicable to any trust,” points out Ms Grant.

“What's mind blowing is that it will never stop. This will develop and expand and improve as time goes on. I can't wait to be part of it.”

First published in Nursing Times, February 2021

Image of Doctor at hospital with patient