Nottingham University Hospitals NHS Trust (NUH) and Sherwood Forest Hospitals Foundation Trust (SFHFT) provide maternity care for over 11,000 pregnant people annually. This work forms an integral part of the care the Trusts provide to Nottinghamshire’s ever-increasing population of over 800,000 people.
Due to the volume of care that the Trusts provide each year it was agreed that an integrated maternity system with the very latest digital workflows should be sourced.
After a robust procurement process through the Shared Business Services framework, the Trusts jointly procured System C’s BadgerNet bringing huge benefits to both team efficiency and patient safety. BadgerNet is an end-to-end maternity service supporting all aspects of electronic recording for pregnant people and children’s health. Digital, clinical and operational teams across the two Trusts came together to implement the system in eight months, the most significant implementation of BadgerNet in recent years.
BadgerNet is currently used by almost all NHS Trusts, as well as many maternity units, within the UK. By the end of 2023 it is estimated that a staggering 45% of UK pregnancies will be recorded on BadgerNet.
The aim for maternity teams across the two Trusts was to replace three different technology solutions and two paper processes and combine them into a single usable system. Prior to BadgerNet, patient notes were stored electronically during antenatal and postnatal care and on paper during intrapartum care resulting in information being stored on different systems. This required staff to spend time accessing and chasing information and duplicating notes, all of which had a negative impact on clinical safety.
Since pregnant people receive care from several hospitals throughout their pregnancy, information had to be shared between multiple sites. This was being done by fax which was not only slow but had the potential for error and posed a risk to patient privacy, or it was written in the person’s paper based handheld notes, which could be forgotten or not looked at in between visits. Also, the handwritten notes were often not filled in or illegible, or the potential for paper to fall out.
Community services were also impacted as staff couldn’t use the technology offline, if they were somewhere with patchy Wi-Fi, so paper notes would be taken and typed up once back at the hospital. Complex appointments could be 90-minutes long which would take a long time to type up; information could be forgotten or ‘soft’ details that may not make sense at the time could be left out.
The Trusts jointly commissioned BadgerNet through a tender process, utilising £1.7million awarded by the NHS Unified Tech Fund. Following a three-month tender process, BadgerNet was chosen because of its easy access to care records, the ability to share records across sites, and its patient-facing app. They were particularly interested in the community functions; midwives would be able to download records offline to work on in people’s homes and re-upload later. Being provided with an app was also a significant draw as it provides a better experience for staff and, being cloud-based, system updates could be pushed out more easily. The end-to-end service meant that all activity would be visible across teams, making it quicker to access information and make decisions, and make auditing and reporting easier. BadgerNet comprises two systems that seamlessly fit together and allow information to be updated and shared easily.
Deployment started in April 2022, in both the large acute system and a smaller district hospital, which meant the teams didn’t have to compromise on functionality. The digital teams at the two sites came together to build a strong, trusted team of clinical, technical, and project staff. They trained maternity staff using a ‘train the trainer’ model, providing a one-day training session and having expert trainers on hand during the six-week go-live. They worked closely with their BadgerNet account manager and clinical specialists who are midwives, to evolve the system based on their needs and take any issues forward.
The Trusts went live with BadgerNet in November 2022, eight months after procurement, and the process from multiple paper and technology systems to one system was challenging but was strengthened by the Trust that staff had in the team.
Adam Wisdish, Programme Manager, Nottingham University Hospitals NHS Trust:
“This was a fast procurement and deployment, and it was only possible because we established a closeknit team. It was difficult at first as we were bringing two Trusts together and staff were used to working with different systems, and I think it was only possible because staff trusted us. Since go-live staff have embraced the system and they tell us that it is allowing them to focus on patient care rather than admin.”
The overall aim was to create a better pregnancy experience for patients, by improving the experience for staff. Staff can now access the information they need quickly and safely, while allowing pregnant people to have more control over their care. The main benefits include:
More informed staff - frontline staff can access the entire patient record, across different sites, whenever they need it. They are much more informed about the patient and their personal journey ahead of appointments.
Better community care - community midwives can record notes offline by downloading records and inputting notes at people’s homes, which can be uploaded on their return. Community resilience is improved as it enables real-time recording of all events wherever they occur, and they are not duplicating information or missing key details back at the hospital.
Better patient experience - pregnant people don’t have to repeat information to different staff or worry about their records being inaccessible across sites. They also have access to BadgerNet Maternity Notes, a secure online portal and app that holds their care plan, appointments, information leaflets, a diary, and provides alerts for key health information.
Audits and reporting - all data is in one place and there is visibility across teams of what actions have been taken. Midwives are not reliant on administrative teams to surface information and governance teams can easily access data for audits and reporting.
Improved security - the patient-facing app is only accessible by login, offering more security than handwritten notes in the red book. Confidential patient information, such as partners, diseases or concerns, cannot be accessed by third parties.
User-friendly - staff feedback on the UI has been positive and the system is cloud-based so there is no downtime for updates. The system is regularly updated in response to changes in technology, innovation, customer suggestions, or regulatory requirements.
Targeted support - the data provides stronger population health information so the Trusts can better target and scale initiatives, such as smoking cessation.
Joshua Downey, Digital Midwife, Nottingham University Hospitals NHS Trust:
“The big wins for us have been the seamless transfer of information between Trusts, community midwives being able to work offline, and pregnant people having an app where they can access and store information about their care.”
Embedding the new system has significantly improved the experience for staff and patients.
Over 90% of pregnant people at the Trusts use the app
Feedback is that people use the app more than the old antenatal paper notes
Trusts have been able to share the records for pregnant people and women who have moved from one area to another
It is saving staff time in accessing and duplicating information in different systems
Staff can focus on direct patient care and less on administrative tasks
The system is reducing the need for paper, and they have already removed five cabinets of paper.
Claire Madon, CNIO, Sherwood Forest Hospitals Foundation Trust
“Working across two Trusts, our only agenda was to improve our patients’ safety and outcomes. We did this by helping staff to provide safer, more efficient care that also protects their own wellbeing. But what it also means is that our birthing person carries a live digital record of their care, on their phone, at all times. It helps everyone be more connected and up to date.”
The system is only as good as the data you put in it. Acute coordinators run a daily report to see missing data items, with staff updating it and sharing learnings. Accurate data allows you to provide better care and identify trends that can support health initiatives.
The ‘train the trainer’ process was helpful, but staff wanted to be able to practise on the system and discuss their needs. Providing clinically-led training and discovery sessions with subject matter experts would have enabled staff to feel better equipped to use the system.
Get it live as soon as possible and continually build on it. It was difficult to cut back functions to allow go-live in eight months, and there will be teething problems, but now they have a system that offers much more for staff and patients.
The team is continuously working to improve the functionality of the system and quality of data and provide more services for patients. The trusts have plans for the patient portal and app, including more educational information so it becomes the go-to source for accurate information. They also aim for it to be compatible with Android and available in multiple different languages to serve their population.
In five years’ time, the Trusts plan to have a cardiotocography integration, to have integrated BadgerNet neonatal and with a third party EPR for e-observations. Other Trusts in the surrounding areas are also looking to procure BadgerNet, which will make it more joined up for patients coming from outside of their region.
Find out more about BadgerNet Maternity.
