The digital ward - using mobile technology in the inpatient ward environment

Birmingham and Solihull Mental Health NHS Foundation Trust implemented a physical observation application to transform the way patients’ physical observations are recorded.

Situation

Nurses within ward teams engage in regular patient observation processes and procedures on a day-to-day basis which make up a large portion of their working day. However, these processes are predominantly paper-based and open to some issues of quality, efficiency and safety which may be better addressed by a technical solution.

Aspiration

The digital ward project was devised to introduce mobile technology into the inpatient ward environment, providing much needed efficiency gains for nursing staff at the Trust.

Solution and impact

The physical observation application runs on handheld devices (tablets and smartphones). This means that an individual plan for how often a patient or service user needs to be physically observed can be recorded in a place which is accessible to all relevant professionals. It also prompts clinicians as to when physical observations need to be taken and ensures that results are recorded in a single place which is available in real time to all. It ensures that all data is displayed on the Trust-approved NEWS (national early warning score) charts and allows professionals to track results accordingly.

The application allows clinical responses to be programmed when certain parameters (NEWS) are met, advising the professionals of actions that can be taken.

Certain technical prerequisites were in place for this work prior to implementation:

• electronic patient record (EPR) with capability to send patient information and observation-scheduling information to an integration engine
• an in-house information and communications technology (ICT) development team or a clear and detailed specification to which an external developer could work
• mobile devices (ruggedized tablets and smartphones were the devices chosen by nursing staff)
• wireless network capable of supporting the devices and movement throughout wards
• dedicated development and project teams
• engagement from senior and operational nursing staff

Functionality

The solution is a mobile application.

Capabilities

• Point-of-care physical observation recording
• Alerting of staff when observations are due, including for special clinical scenarios (such as clozapine titration)
• Results recorded in a single place which is available in real time to all
• Data displayed on the Trust-approved NEWS charts, allowing professionals to track results accordingly
• Automatically calculates service users’ NEWS score and their body mass index (BMI)
• Provides guidance to staff on what action they could take depending on what the NEWS score is

Scope

For use in the mental health inpatient setting.

Digital capture of records, assessments and plans

This has been the primary improvement realised by the implementation of the physical observation application.

Decision support

Patients’ physical health trends (upwards and downwards) monitoring and display, both at patient level and ward level (dashboard). This provides assistance in the detection of deteriorating health with a visual indicator providing early warning to nursing staff

Key learning points

Quality and safety

Prior to implementation, staff would manually plot the NEWS score, which could lead to unnecessary interpretation or error depending on the skill and experience level of the staff member. This process is now automated, removing the need for manual plotting.

Staff and patient experience

The application has had a positive impact on both staff and patient experience. Staff have a reliable tool that supports them to capture vital observations in a much quicker way than before. They see the innovation as directly contributing to making their working lives easier, thanks to the automation of scheduling from the EPR and the alerts and RAG statuses showing when observations are due across the ward.

Resource sustainability

Following the introduction of the application and integration from the EPR, transcribing observation schedules from the EPR to paper is no longer needed. This provides considerable time saving when scaled across the hundreds of patients in the Trust’s care at any one time. This is also applicable to the reverse of the process, with physical health data recorded directly into the application rather than on paper and transcribed back into the EPR.

Key figures/quotes

“The digital ward system has revolutionised the way that our inpatient staff do their work. It has transformed an inefficient and outdated system into something fit for the 21st century, and which delivers clear benefits for patients in terms of quality and safety of care.”
Dr James Reed, consultant forensic psychiatrist and chief clinical information officer, Birmingham and Solihull Mental Health NHS Foundation Trust

Find out more

Read more about the GDE blueprint (requires login)

Key contact

Dr James Reed, consultant forensic psychiatrist and chief clinical information officer, Birmingham and Solihull Mental Health NHS Foundation Trust

jamesreed@nhs.net