Last month, West Suffolk NHS Foundation Trust - one of the UK’s leading acute care providers - celebrated the third anniversary of their electronic patient records (EPR) system, e-Care, powered by Cerner Millennium®. In this edition of our blog, Paul Morris – the Trust’s deputy chief nurse and head of patient safety – outlines how the system has helped staff save time, resources, and perhaps even patients’ lives.
Among our Trust’s top ambitions are to create a ‘no-blame’ culture within the workforce, and to deliver high levels of patient safety. These two goals are intimately linked, and the introduction of our e-Care EPR has dramatically improved the patient safety team's capabilities over the past few years.
Today, within minutes of receiving an incident form, the team can review and respond accordingly. Besides generating time savings, this also allows for a greater emphasis on the learning and implementation of changes.
Although it might be a distant memory for some of our staff, a little over three years ago we had a paper-based system. Clinicians would walk up to a ward or clinical area to try and locate a patient’s notes, flip through them and perhaps need to make a photocopy. Once back in the office, they would need to start unpicking them in order to plan the scope of the clinical investigation, copying and transcribing the handwritten notes onto an electronic format.
With our patient notes now recorded digitally, time is instantly saved for our clinical staff.
Saving time (and reinvesting it)
Once we realised the benefits our EPR was delivering, and the time savings achieved through its usage, we decided we wanted to invest that time into examining more thoroughly patient safety in our organisation. We wanted to look at all dimensions of care, using the EPR to not only look at an individual patient when an incident occurred, but also what was happening on the ward in general at the specific moment something happened.
Through this approach, our EPR enabled us to identify patterns and trends early on, and rather than using it to look at just the core numbers – such as patients and basic observations – we are now using it to report context, including level of acuity, patient demand, and staffing numbers. This gives us the visibility we need to look at ways that we can improve our performance.
Creating a just culture
Our EPR is one of the places where everybody involved in a patient’s care documents a record of the care given. So, it was vital that we used this to develop not just a no-blame culture when it came to clinical incidents, but a just culture too.
This isn’t an easy thing to achieve. How many people have made a mistake? How many people have gone to a clinical review meeting and felt that there's a no-blame atmosphere in that room?
However, something has happened and regardless of who was involved, we need to identify what that was and why, to ensure we can learn from it and minimise the chances of those mistakes happening again.
Our EPR provides the context alongside the data, allowing us to paint a three-dimensional picture about what happened before, during and after a clinical incident.
We can use our extra time to really focus on learning, and the mitigating actions we can take. Additionally, we can establish potential links between current and previous incidents, maximising the impact our analysis and outcomes of the investigation process will have in the improvement of patient safety and care quality.
Learning the 'why?'
The EPR is a fantastic tool to simply look at ‘the numbers’. For instance, we can check how long it took a patient to get their medications. Did a nurse take lying and standing blood pressures for the patients in a way that meets NICE guidance? We can swiftly pull up all that data, but what’s most important is what we do with it afterwards.
In addition to checking compliance with clinical guidance best practice, we take it to the next level and ask "why?". Why are we doing well in one domain but not another? Too often we spend time identifying what is going right or wrong without looking at the at the reasons behind it.
The EPR enables us to investigate reasons behind incidents properly, providing us with the headspace to start working with our colleagues from all areas of the Trust to to implement a multidisciplinary approach to understanding the background of patient safety incidents.
Together, our quality improvement team, patient safety team, informatics team, medical and nursing colleagues, and allied health professionals, explore our performance to determine what it is that makes things go wrong or right in certain areas, and how do we either minimise or indeed replicate them.
For example, by examining samples of lying and standing blood pressure scores against NICE guidance, and working with the falls team to identify and detect possible future issues, we can implement changes to our clinical practice to avoid further incidents.
By using the data we get from our EPR alongside information we're getting from compatible complementary systems, we can make informed decisions about where our senior team should focus their attention during their next ‘quality walkabout’.
During these unannounced quality checks, our executives, non-executive directors and governors can go to a particular clinical area guided by the data we collect – data which may flag changes in a specific area, for instance.
We can use early warning scores, a reporting delay, or maybe a falls increase – all of these factors can lead us to look into an area and pre-empt problems before they have an impact on patient safety.
In short, I feel that our EPR has enabled us to drive changes in practice that allow us to take our patient safety strategy to the next level - it has given us improved efficiency and the time to start looking at other ways of working, as well as providing us with the tools to learn from quality data and make informed choices.
West Suffolk Hospital is an award-winning, vibrant, friendly and accessible hospital on the edge of Bury St Edmunds. Rated ‘outstanding’ by the Care Quality Commission, it has around 430 beds open at one time and serves a population of around 280,000 within 600 square miles. As well as running the hospital, West Suffolk NHS Foundation Trust is joining up NHS care across the area providing many of the community services in West Suffolk. It delivers high-quality services in a variety of settings including people’s own homes, care homes, day centres, schools, GP surgeries and health centres, as well as the Newmarket Community Hospital inpatient unit and clinics.