Major investment in mobile technology gives teams freedom to care.
We provide more than 230 NHS services across England ranging from primary care, such as GP practices, to community services, including sexual health and district nursing.
Our Community Nursing services at Goldsworth Park, Woking, and Chertsey in Surrey have 37 district nurses who provide care and support for patients in their homes during the day, out of hours and at weekends. Patients are referred to the service by GPs.
As with many of our services, the major challenges within Community Nursing are around historic ways of working including the reliance on paper records and old IT systems. Inputting data multiple times takes up valuable time which clinical staff could be spending with patients. Processes involving paper forms and records are also open to error or loss affecting patient safety.
We carried out a detailed review of these services and, after analysing all available performance information, observing nurses and conducting staff interviews, we found:
- Only a third of a nurse’s average day was spent with patients; approximately a third was spent on administration and the rest of their time was spent on travel and other tasks.
- The existing RiO computer system was difficult and time-consuming to use.
- Paper referral forms from GPs were sometimes incomplete meaning nurses did not have all the required information about their patients.
- Some appointments were missed due to misplaced paper notes and lack of a formal staff handover
- Patients were sometimes not at home for their appointments as messages they left on the service answerphone were not passed on to the relevant nurse.
- Staff morale was affected by burdensome administration
Making the difference
In November 2013, after a multi-million pound investment, detailed consultation and development, we introduced a new clinical management solution to tackle these issues. The key part of this is Total Mobile, a complete solution which eliminates paperwork, support clinicians’ normal ways of working and provides real-time information about the patient at the point of care.
- All nurses were provided with mobile tablets to manage their entire role including appointments, email and reporting
- All referrals are now triaged, tracked and monitored through Total Mobile’s system and all appointments are centrally booked according to their priority.
- GPs are encouraged to complete referral forms to ensure all required information is provided and can be input into the system by an administrator.
- Appointments are electronically scheduled via the hub, with tasks and information downloaded to each nurse’s mobile device remotely, reducing need for multiple base visits.
- All nurses are centrally co-ordinated and tasked through their hub by a senior District Nurse (Band 6), who matches/adjusts, in real time, staff to appointments according to clinical priorities.
- Nurses complete clinical documentation in the patient’s home, which automatically uploads into the existing RiO system after the visit and tablets can operate when offline.
- Nurses have a protected lunch break, handover and learning time during each day within the new way of working.
After the initial six weeks of the project we have achieved our initial goals and given clinicians the freedom to focus on what they are trained to do:
- 30% increase in face to face time with patients
- Almost 2 additional visits per nurse per day
- 60% improvement in clinical records time
- 42% improvement in referral handling and scheduling
- 100% increase in time for staff lunch and handover
- 30% saving in travel time, associated with less ‘trips to base’
As all patient data is securely captured and stored as one electronic record and made appropriately available to other clinicians (such as the patient’s GP), all information is accurate and up to date, which makes care safer.
Since introducing the system we have seen other improvements including a reduction in appointments missed and patients not attending appointments.
We will continue to review the progress of the solution as we aim to maximise and demonstrate the benefits in terms of health outcomes for patients, cost savings for the public and staff satisfaction.
We will also look to explore other opportunities offered by the mobile devices and Total Mobile, such as allowing staff to order equipment while with patients therefore involving them in their own care.
The long-term plan is to roll out the solution in our other community services nationwide.