Prior to working with Alcidion, WDHB’s physiological vital signs and assessments were paper-based and held in patient folders and on charts. EWS calculations were performed manually by nurses who would then follow a written protocol for appropriate response and escalation. This system relied heavily on accurately measuring a full set of vital signs, correctly calculating the EWS and prompt follow-up actions based on the written protocol. Manual compliance audits showed variations in standards and knowledge across individuals, teams, days of week and time of day.
These patient paper-based records needed to be accessed by various multi-disciplinary team members and were sometimes not returned in a timely fashion. In turn, nurses were unable to record vital signs directly to the patient chart; they did not have access to the EWS protocol; and other relevant documents were not available to record or assess risk. This approach also presented challenges that come with managing multiple folders and impacted the effectiveness of handovers and ward rounds.
WDHB recognised it needed a solution that could provide clinical decision support capabilities, help identify deteriorating patients by automatically calculating an Early Warning Score (EWS), alert appropriate clinicians and provide prompts to the clinician for follow up actions. This information needed to be available for nurse managers and nurses to identify overdue or incomplete observation sets or assessments; and provide access for other clinicians to view patient status onsite or remotely.
Some of the key drivers for change were to:
- Improve patient outcomes
- Improve productivity and release time to care for patients
- Improve the experience of patients and families through timely intervention and support
- Improve staff experience with better communication across teams and timely response to support requests
- Improve the assurance of care standards through real-time reporting and improved compliance with reduced variation and improved audit capability
Patientrack was the solution chosen by WDHB to deliver these objectives. Patientrack replaced paper-based observation recording, and automated EWS calculations. It is available on devices for use at the bedside where assessment details can be recorded and available to all users anywhere, any time.
The solution delivered included:
- Observation profiles with defined schedules for taking a patient’s set of observations
- Calculation of adult EWS scores based on observation data to identify patients at risk of deterioration
- Assessments and related charts to monitor a patient’s condition including neurological, fluids, stools, weight, PIVC and smoking history
- Ability for WDHB administrators to create additional observation profiles for the hospital due to feedback received from nursing staff
- Flags to support end-of-life care and non-resuscitation identifiers for patients
- Customised views (My Views) based on user needs
- Automated alerts to notify recipients of a patient’s condition as and when required
Since implementation, Patientrack has been rolled out across over 400 beds on two acute sites, with 70 beds added every two weeks. Over 800 health professionals are logging into Patientrack using a variety of devices to access clinical data. iPad minis are being carried by clinical staff and offering mobility for data access and capture.
“Now, all the doctor needs is access to any computer or one of the tablet devices stationed in the ward and immediately they can read the patient’s chart simultaneously. Also, the outreach nurse can be elsewhere in the hospital and still be aware of who are the sickest patients and re-prioritise their work based on EWS scoring and other observations.”
– Peter Groom, eVitals Clinical Lead & Clinical Nurse Specialist, Waitemata District Health Board
WDHB is experiencing a 100% completion rate for observations using Patientrack on the ward. Through the use of Patientrack’s My Views, the Outreach Team is more aware of a patients’ conditions.
Wards using Patientrack are experiencing consistent improvements in clinical audits such as 100% compliance for cannula and bowel assessments, which had never been achieved before.
“The new real-time system means we will no longer rely on paper charts to search for records and identify patterns, which ultimately means safer care and more clinical time to focus on the patient.”
– Jenny Parr, Associate Director of Nursing, Waitemata District Health Board
The fast uptake and perceived benefits of Patientrack are already being realised by nursing staff, managers and clinicians; and the project team is receiving numerous suggestions for new assessments and features to help it further streamline processes and enhance workflow. Additional assessments WDHB plans to include are sepsis, glucose, Venous Thromboembolism (VTE), Morse falls and Malnutrition Universal Screening Tool (MUST).
Subsequent work includes automating the comprehensive nursing assessment. The aim is to improve the nursing assessment process by offering the potential to screen the ‘well’ patient, reduce the requirement for repeated assessments, save nursing time and direct nurses to areas of concern.