Pennine Acute Hospitals
NHS Trust is to roll-out CSC-developed electronic whiteboards to 97 wards across its five hospitals before the end March 2012, following a pilot on eight wards that is already starting to show improvements in efficiency and patient safety.
Replacing conventional handwritten whiteboards, VisiWard is interfaced to the trust’s patient administration system (PAS) giving clinical staff visibility of patients and bed status in real time. Information displayed on the e-whiteboards currently includes the patient’s name, age, room, bed, consultant’s name, admission date, and expected discharge date. It also highlights patients that are medically fit to be discharged, empty beds and beds that are earmarked for a new admission or transfer.
The move follows the recommendations of the trust’s productive ward team formed to examine ways of improving efficiency on wards. It found, not unsurprisingly, that handwritten whiteboards were different across each ward and contained different information in different formats with no guarantee that details were up-to-date. Crucially, it concluded that this disparity of information could present a patient safety risk.
The review coincided with a trust-wide roll-out of CSC’s
PAS. The recommendation from clinical staff was for electronic whiteboards to reflect the information contained in PatientCentre to guarantee details were consistent and timely.
The next step was to work with CSC to agree the feasibility and define a specification. A fundamental requirement was to standardise the board layout and information presented. Previously, staff transferring to a different ward would have to learn the peculiarities of the resident whiteboard.
Employing an agile development philosophy with clinical staff involved at every step, the system was ready within four months of an initial kick-off meeting in June 2011.
“As with any true agile development, we have responded to users’ requirements and taken feedback from the wards at each stage,” said Mick Heaton, the trust’s senior project manager.
The first steps included a series of workshops with staff from eight pilot wards to get a basic specification of what information should be displayed on the e-whiteboards.
“It was vital to engage clinical staff fully from the outset to avoid developing something that doesn’t suit the wards and would not be used,” said Libby Woodcock, Pennine Acute’s EPR system development and implementation officer. “Whiteboards are central to the function of a ward, so having buy-in from clinicians is essential under any plans to replace them.”
A former nurse, Woodcock says the project demanded a change in culture. “We are implementing change and given the number of wards it was essential that nurses embraced this. They do not see information technology or booking-in patients as their priority, so it is about getting them to adopt a different mindset. Working with nurses, doctors and consultants has been a key focus of the project.”
An example of meeting users’ needs was the late addition of a refresh button. The system updates automatically every five minutes but users wanted the ability to refresh instantly to reflect new admissions to check patient details and special requirements. “This has proved very useful and very popular,” Heaton said, “but was not something we felt was needed initially, but shows the value of involving users early on.”
He says the project has helped “crystallize” the data entered in PatientCentre. “Nurses are starting to see the benefit of inputting information into the PAS. They were more inclined to keep whiteboards updated as they saw the PAS as merely an admin tool, so there was a huge disparity between the two. VisiWard now makes it obvious where they are not doing things so is forcing change.”
“The e-whiteboards ensure that admissions, discharges, and transfers are up-to-date because it is now visible for all to see, so is having a positive impact,” Woodcock added.
Heaton says clinical staff value the system. “Consultants like it because they can search and locate the status of their patients on different wards without having to visit the ward and decipher handwritten boards.”
He says the system has been shown to save time as patient information is now highly visible on 42-inch plasma touch screens. “Nurses are no longer faced with constant interruptions and this allows them to focus more time on patient care.
“The main benefits are around patient safety,” Heaton said. “For example, it removes the need for queries from bed managers as they will have instant access to live data to plan the admissions and discharges of patients.”
Woodcock says previously bed managers spent an inordinate amount of time on the phone to ward managers or trawling the buildings for empty beds. “VisiWard will be the first point of call, which will save time, effort and leg work.”
She also says the system is helping focus the team on “bed blockers”. “This will help reduce the overall length of stay as these blockages are now highly visible for all to see. Ward managers are now questioning their counterparts on other wards over why patients have not been discharged.”
VisiWard is currently installed on four wards; a rehabilitation ward at Royal Oldham, a 72-hour ward at Fairfield, and orthopaedic and trauma wards at North Manchester General. Woodcock says these were selected as they have very different processes so offered the opportunity to test the system fully.
A roll-out to the remaining 93 wards that use PatientCentre will begin in January and is set to be completed by the end of March.
But the trust has plans to exploit the technology further. A subsequent phase will see more clinical information available, such as infections, diabetes and special dietary needs, which will be displayed as unmistakable icons. Sticking with its agile principles, the project team has already engaged with doctors, nurses and ward managers over what clinical information they feel is needed and is drawing up a “hit list” of priorities.
“Our goal is to ensure that any health professional can glean a mass of information quickly, either on the ward or remotely, so saving valuable time and minimising interruptions,” Woodcock said.
There are also plans for a web-app so non-operational staff, such as catering, have a read-only access.
A third phase will allow staff to use the touch-screens to update the PAS, which will again save time. Staff will also be able to visually “drag-and-drop” patients to a different bed, room or ward for example, with the PAS updated automatically. These phases are scheduled for completion before the end of 2012.
“The PatientCentre upgrade has proved a catalyst for change,” Heaton said. “We are working in partnership with CSC to roll-out clinically-valued systems as part of a trust-wide EPR; e-whiteboards are a fundamental component of this wider strategy.”
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