1. Humanising care in a digital world Professor Janice Sigsworth Chief Nurse Gerry Bolger RN, MHM Nursing Informatics Lead/CCIO 20 th April 2014 – eHealth Nursing Plenary

2. Creative Commons Licence

3. Agenda About Imperial Why the digital agenda is important to nursing Changing landscape of IT What this means practice of care Role of CCIO-Nursing Safer Care project Making tech the enabler in the therapeutic relationship

5. St Mary’s Hospital, founded 1845 St Mary’s Hospital is a major acute teaching hospital that diagnoses and treats a broad range of adult and child conditions. The hospital also provides maternity services and hosts one of the four major trauma centres in London. Hammersmith Hospital, founded 1902 Hammersmith is a specialist teaching hospital and hosts the heart attack and arrhythmia centre for north west London. It is well known for its research achievements; hosting a large community of Imperial College London researchers. Charing Cross Hospital, founded 1818 Charing Cross is an acute teaching hospital providing a range of adult clinical services. It hosts one of eight hyper acute stroke units in London. Queen Charlotte’s & Chelsea Hospital, founded 1739 Queen Charlotte’s & Chelsea Hospital provides maternity and women’s and neonatal services. It cares for women with high risk pregnancies through to those choosing midwife-led deliveries in the birth centre. Western Eye Hospital, Marylebone, founded 1856 Western Eye Hospital is a specialist ophthalmology hospital. It offers the only 24-hour emergency eye care service in west London. Our hospitals and their services

6. Why IT is important to nursing Releasing time to care – Audits / gathering data Improving the patient experience Decision support Improves nurse/care team experience – Access to the same information Assurance across the continuum of care Source: Dan Piaro http://www.icecreamnation.org/wp-content/uploads/2012/05/hunter-gatherer-cartoon-by-Bizarro.gif

7. E-health policy perspective System Information Data for Transparent Performance Quality of care transparent Standards for 'meaningful use' Digital Enablers Electronic Patient Records (EPR) Trust & Value eRostering / EPR / ePrescribing & information Impact to Professionals Interoperable paperless records Access to info & knowledge & CCIOs e-catalogue & costing to deliver care Benefit to Patients Patient access EPR, use of Apps & make appointments Enabled choices EPR & ePrescribing Five Year Forward View Personal Health & Care 2020 Carter Review Gerry Bolger

8. Changing digital landscape Moving FromMoving To Reactive CareProactive health Perceived difficult patientEmpowered user Recipients of careCo-producers of own care Problem focusSolution orientated Limited dataEvidence with Information Opaque overviewTransparent reality

9. What this means - Challenges Change to practice Need for standardised working approaches Workforce – Transition challenges IT enabled / informed patients Impact of technology in the therapeutic relationship

10. Digital direction

11. Role of Nurse CCIO Strategic analysis Transformation Patients & Practice Information for assurance Personal Health & Care 2020 set this as a recommendation

12. Why the - Safer Care Project Identify patients at risk Rapid intervention Release time to care

13. How? Bid to the Nurse Technology Fund Bedside monitoring Supported by Dashboard for Patients at Risk Releasing time to care Introduce Sepsis alerting FY 2016/17

14. How we did it Led by Nurse Directors identified pilot & rollout areas 70 Bedside spot monitors for general wards areas Integrating existing bedside monitors for ED / Recovery / High Dependency areas (150 devices) Pilot in Nov Rollout end of Jan 50% complete end of March

15. What we learnt Baseline Completing NEWS on paper 2.5 – 3.5 mins / a patient Manually record on EPR took 20 seconds longer Since starting to implement 209,750 data points entered 8179 sets of NEWS scores Reduction 1:10 sec in recording time Releasing time to care = 167 nursing hours NEWS visible on Handover screen

16. Breakdown of NEWS

18. Feedback from staff

19. What next Finish rollout – Integration devices – End user feedback – what could be improved. Analysis of SBAR Introduce Sepsis Alerting & Management

20. Making tech the enabler Bedside care documentation Nursing routine care build into software Involve the patient – it’s their clinical information Team boards/handover Use graphs – especially to show improvements Make the use of IT in care a positive impression

21. I*LEVELS model I* – Introduce yourself / patient sees you L – Let the patient look & involve them E – Eye contact with patient V – value the contribution of the computer E – Explain what you are doing L – log off Source - Kaiser Permanente & *Virginia Mason

22. Questions?