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An electronic solution to recording observations at Barking, Havering & Redbridge

Barking, Havering and Redbridge University Hospitals Trust implemented CareFlow Vitals to record observations electronically. Claire Read reports

When James Avery speaks about the implementation of electronic vital signs recording at his trust, he is very clear that it was not an IT project.

“Our clinical information and our incident reporting and event analysis in particular, clearly identified an issue with deteriorating patients,” explains the deputy chief nurse at Barking, Havering and Redbridge University Hospitals Trust.

He explored a number of possible solutions, and it just happened that the most promising was a digital one.

“The evidence base shows that with high levels of training and paper-based systems you can reach a certain level, but there are many more opportunities to improve performance by electronically calculating early warning scores and issuing notifications. So that’s when we started to think about an electronic solution.”

It is, he feels, an important distinction when nurse leaders are introducing a new technological solution – focus not on the shiny device, but instead on the clinical problem that needs addressing.

The evidence at Barking, Havering and Redbridge is that it is an approach which has paid dividends. Since the introduction of System C’s CareFlow Vitals electronic observation system, observations are taken according to clinical need; early warning score calculations are correct; and prompt escalation occurs in the event of patient deterioration.

Rather than taking vital signs and recording the data on hard copy charts, nurses now enter the data into an iPod Touch. The CareFlow Vitals software automatically calculates the early warning score – in line with the second version of the national early warning score (NEWS2) – and advises on appropriate action. It also supports an array of nursing assessments, including the Malnutrition Universal Screening Tool (MUST), and allows users to record indwelling devices and fluid balance.

It is a big shift but, according to Mr Avery, the conscious decision that this was a clinical, rather than a technological project made a big difference here too. “It was nursing-led, and it was clear this was about adding value, saving and releasing nursing time; that what we were asking clinical staff to do wasn’t additional activity.”

That the software runs on an Apple device was also helpful. “As most people now have smartphones, it was a logical choice. We haven’t experienced any resistant issues to people being able to understand and make use of the system, because it does take you through the stages of recording each of the observations and assessments.”

That’s part of the reason the business case for the implementation emphasised the new system would be one and a half times’ faster than the traditional paper method. In putting together the case – a challenge familiar to many nurse leaders – Mr Avery sought to build a broad consensus at the same time as maintaining the clinical focus.

“I received support from the finance and IT teams on the technical and financial aspects and then completed the clinical aspects, which was basically reviewing literature base on deterioration, reviewing around the current state, and then how we’re going to deliver it and the benefits it would show,” he says.

“I spent quite a bit of time talking to non-executive directors, getting them to come to wards with me. And then when it came to the point of presenting the business case to full board, all understood exactly what it was we wanted to do and what the benefits were and how they related to the trust’s safety objectives. So we built a compelling case for delivering this.”

The value is now going beyond the immediate benefit of improved observations processes. Mr Avery says the sheer quantity of data collected on the system is enabling a sophisticated understanding of the picture from ward to ward.

“If you analyse that data you can understand trends, you can see how timely observations are on wards. If you look at the early warning scores by clinical area, you can see how sick the patients in the ward are, and see trends over time.

You can then sit that data alongside the safer nursing care tool, and better understand acuity. It helps you understand demand within that clinical area, and what the patient and workforce needs are and what response is needed,” he says.

It can also help identify areas for improvement – indwelling devices, for example, have been a recent area of focus – but enables celebration too. The trust identifies a ward of the week, and the data from vitals is part of determining which it should be. Yet further evidence, were it needed, that the benefits of a successful technology implementation go a long way beyond equipping nurses with up-to-date devices.

This case study originally appeared in Nursing Times, April 2019.