Barwon Health took a novel approach to enhancing person centred care as part of the Best Care for Older People (BCOP) project – they stopped writing things down. Of course they haven’t stopped gathering information about their patients; it’s just that now they complete all assessments of new patients electronically. Using laptops or iPads, nursing staff are now able to comprehensively assess patients at the bedside, recording all information and making referrals to allied health services as they go.
The decision to embark on changing the way the organisation approached risk assessments came about because of a focus on the principles of person centred care. Staff working on the BCOP project recognised that the paper based system of assessment and referral did not encourage engagement with the patient. It also meant that staff were duplicating information and that information was not always recorded, or recorded in a timely manner.
“It’s all about engagement with that person… [working] in collaboration with that person, and educating them on their risks.”
“To me it was around person centred care – we had this paper based system that we may or may not have filled out, but when we did we just ticked it,” says Sonya Whitehand, a NUM who has been involved in the project from the pilot stage. “What we were asking [the team] to do now was to actually take a device, sit with the person, actually ask them some questions and develop a plan in collaboration with them; so we were asking them to work in a person centred way…”
Barwon Health’s electronic assessment and referral system uses portable devices – laptops and iPads – to enable staff to conduct screening and assessment at the bedside. Once a patient is admitted, a nurse sits with them at their bedside. They log-in uniquely to the system and access the patient’s information, such as their hospital ID and date of birth details. The assessment process involves completing a suite of screens, assessing areas including cognition, falls risk, depression, risk of malnourishment and pressure ulcer risk.
Each screening tool is completed by the nurse with the patient and the system records the answers and the overall scores. Recommendations for action are triggered according to each screens’ outcome, including interventions and allied health referrals. These can then be discussed with the patient at the time and care planning can occur in a collaborative way. Patients also gain more understanding of their risks and what they can do to minimise them.
The system also uses the information entered to generate reports for the patient’s file and automatically populates their electronic medical record, reducing administrative time as information is not being entered multiple times. Hospital administrators are also able to track completion rates and results in real time and use this data for benchmarking and statistical analysis.
Developing and implementing the system was not without its bumps along the way, however. As Karen Heseltine, BCOP Project Manager says, “[when] we decided to go down the electronic route… we didn’t realise actually how long it would take and the journey that we went along really.” The project team found themselves on a steep learning curve as they tried to negotiate the complexities of introducing a new electronic system into the existing health service IT systems. Not only did they need to develop new software components to use for the assessments, but also find a hardware platform on which to run it and integrate the system into the existing systems and the hospital’s wireless network.
Along with the technological issues the team faced, they also needed to convince ward staff who were to use the product that it was a good idea, despite the perception that the new system would take extra time, and the need for many to learn a whole new set of IT skills.
Engaging with staff on the pilot ward from the outset was crucial to achieving this. Staff were asked for their input into the questions, as well as for continuous feedback on the usability of the system in the ward setting. Training was also approached in an ongoing, informal way, allowing staff to take as much or as little time as they needed to learn the new system.
“We were asking them to work in a person centred way…”
Lessons from implementing electronic assessments on the pilot ward and the enthusiasm of the staff helped with the success of the roll out to the broader organisation. The electronic screening and assessment tool is now used across all adult inpatient acute and sub-acute wards in Barwon Health – over 400 beds in total. As well as shifting the focus of assessment from administrative task to patient engagement, it has meant that assessment is now standardised for all adult inpatients.
The project has had an impact beyond that originally envisaged and unexpected new applications and offshoots of the system are continually being discovered. For example, one of the surgical wards has started using the hardware to show patients their x-rays at the bedside. The team is also continually coming up with new ideas for the electronic system, such as using the information to generate discharge summary information rather than this having to be separately created, and having each ward’s journey board become electronic and populated by information from the system.
Other uses for the software are also being developed. One of the most comprehensive is the development of electronic care plans for use by all palliative care teams. The team hope that this electronic care plan will provide the basis for developing similar tools for other settings in the organisation.
No matter what new uses are developed in the future, the focus remains firmly on the patient. Everything that is done is with a view to embedding person centred care into everyday clinical practice by building administrative systems that are time efficient and that engage and involve the patient as a partner in their care. The team also hope that their experience can be used by others to find ways to utilise technology to enhance patient care. As Trish Mant, Practice Development Coordinator, says, “It’s all about engagement with that person… [working] in collaboration with that person, and educating them on their risks.”