Coping With Digital Changes On The Ward
In an era where everything is governed by technology, Kim Wright discusses how advances in technology have challenged, changed and shaped the future of the healthcare profession.
21st July 2017
Written by Kim Wright.
Apps are the way forward. Mobile working is the future.
I’m a fifty-something ex-nurse with a lifetime of working in the NHS. I spent my early 80’s student nurse years at Queen Elizabeth Hospital, Birmingham. How it has changed since then!
It was a historic building with nightingale wards and a grey lady haunting the corridors at night. Now it’s a super-modern monolith of a hospital, with single rooms and double espresso; Costa is ever-present and always busy.
After moving to London, getting married and having 2 children, I returned to nursing. Then, in the early 90’s, my husband (an RAF man) was posted to Somerset and I landed on a busy surgical ward, in a small general hospital.
That was where my fascination with clinical and patient-related information began; Nursing records, care planning, integrated care pathways, paper notes, electronic patient records (EPR). You name it, I was involved with it!
I became an audit project nurse, an ‘Information for Health’ project manager, then an informatics specialist nurse at one of the large Bristol Hospitals. In 2005, the NHS world welcomed ‘information technology’. EPR was young, private sector system suppliers were inexperienced and project managers like me were knocked flat by the stress-laden juggernaut that was the National Programme for IT, or NPfIT.
Fast forward to 2012, I was a Programme Manager in the IT department in that same small hospital where I had loved nursing and loved information. A new boss younger than me, and restructuring of the department, left me facing a bigger, unhappier job with a smaller wage. So, when voluntary redundancy was offered, I took the money and ran!
Here I am, 5 years later, back in love with information. I’ve spent the last 5 years working for a supplier of data quality services to the NHS. Experience of hospitals, systems, processes and clinical information in hospitals across the country has revived my interest.
I’m now back in the South West, leading hospital technology projects all over again. Except this time, it’s DIGITAL!
It’s more of the same, just the labels are different. Value statements, driver diagrams, wireframes, paperlight and Global Digital Exemplars.
I’m now the wise owl.
I have all the experience. I know the pitfalls.
All around me are young, new and keen.
I love my job. I’m back in the NHS family which I didn’t realise I missed so much. I have work-life balance, and the wisdom to take things one at a time. Keep things simple, don’t re-invent the wheel and definitely don’t run things up the flagpole!
How has modern technology helped healthcare and the NHS?
Technology in the NHS has come a long way in a relatively short time.
Looking back to the 1980’s, technology of any sort was quite rare. There were anaesthetic machines which enabled the mixing of anaesthetic gases for delivery to the patient in theatres. Intensive Care Units had telemetry which enabled observation of vital signs to be viewed away from the bedside. Large old style TVs were suspended from the ceiling in the ward office.
As a student nurse, I worked on a cardiac surgery ward, but there were no electronic devices to aid monitoring of vital signs or delivery of intravenous drugs. Neither were there machines to measure blood pressure/temperature, or manage the delivery intravenous fluids. Medical and nursing records were completely on paper.
The only ‘technology’ I can remember was the Nelson inhaler, which was filled with boiling water with added menthol crystals and given to every patient daily at 2pm. Nowadays, this would be a health and safety nightmare!
The use of electronic devices has revolutionised the delivery, if not the documenting of drugs and fluids. Pain control can be delivered in several ways; Patches, syringe drivers and patient-controlled analgesia (PCA) to name a few.
Technology has also arrived in the form of some records, such as appointments and recording admissions to hospital. Some hospitals have started to implement electronic prescribing and administration of medicines. A huge step forward in the digital health world.
Vital signs are now measured using machines, and it can be hard to find a sphygmomanometer on the wards these days. Manual thermometers are now unheard of due to the glass, and the mercury within them.
Electronic records are the pinnacle of information technology. There is such potential for improvements in safety alone. The ability of software to take a set of vital signs from a machine and show it as a graphed trend, with an immediate alert to the mobile phone of the right person if it is outside parameters, promises to make paper redundant and revolutionise the early detection of the deteriorating patient.
The emerging interoperability between systems via the use of common messaging standards such as HL7, is enabling information to be shared quickly and usefully. Imagine the impact of joining up a Fitbit to a medical record for someone with a breathing or heart problem? Could this alert the GP/paramedic or other clinician to an impending crisis before the ambulance is called?
How hard is it to implement new systems and technologies to pre-existing foundations?
Doing NHS IT projects is hard. The NHS has changed so much in the last 30-40 years. The decreasing budget and increasing speed of change is bound to make forthcoming developments harder to do well. Change related to implementing new systems is not easy; NHS culture is hard to change.
Clinicians are used to using paper. Their processes revolve around it. It is tangible, robust, easy to use, relatively cheap and does not need charging! However, it is hard to store, hard to retrieve, cannot be easily shared and does not generally allow patients to receive seamless and joined up care.
Technology is also expensive, as is the effort required to ensure its successful implementation and sustained use. Once you’ve managed to implement something, even if it is small, it requires regular updating and maintenance. Data quality needs attention; downtime procedures need to be documented and practiced, so everyone knows what to do when a nearby builder digs through the fibre optics!
Do you ever receive backlash from professionals regarding the new technology?
People use PCs and laptops in their daily lives. But clinicians often regard their use at work as ‘admin’ and so nothing to do with the job they do.
One reason they give, is that they do not want to be taken away from the bedside. However, even if a hospital provides laptops on wheels and PC stations near patients, a nurse or a doctor will queue out of habit for the PC at the nurses’ station, or take the medical case notes to the nurses’ station to complete, rather than sitting with the patient.
People use their phones for everything. However, put on a nurses’ uniform, and the phone becomes something for home life, or a quick look at Facebook during lunch. Not for use at work.
Quite often, a supplier can provide some but not all of the requirements NHS teams are looking for. Good software ideas are abundant, and the NHS forward-thinkers jump on them, often imposing unrealistic expectations of their use. This leads to disappointment and loss of faith further down the line.
A good project manager will seek to control expectations. It’s better to under-promise and over-deliver.
But NHS staff are changing. When people get what they need in terms of technology, it improves life for both them, and their patients. Then the rare phenomenon of there being barely a call to the project team after a go-live is reward enough!
The caring professions are increasingly embracing the need to use technology to care for patients. Digital innovation is beginning to appear everywhere. Using it to create opportunities to deliver improved patient care is my 5-year challenge.
Wish me luck!