New technology combined with innovative ways of working is helping trusts
to meet the Working Time Directive.
Projects are being piloted by trusts seeking new ways of staff communication to improve patient safety and to assist with meeting WTD compliance. By Lynne Greenwood.
They include the iBleep rapid response system and specially designed hand over packages like VitalPac, both using wireless technology with personal digital assistants (PDAs).
Salisbury NHS Foundation Trust has devised its own IT handover system called Hospital at Night Patient List.
The system enables day staff to enter details of patients who may be at risk or need reviewing, which can be transferred easily to Hospital at Night (HaN).
Junior doctor Ruth Verrier-Jones helped to pilot the system, she said: “If I had such a patient during the day, I would always tell my senior verbally but entering the information on a system helps with the transfer of information to night staff.
“They can immediately see why the patient is on the list and the key points around their condition and treatment.”
Trust project manager Debbie Dupont explains that the system does not replace the traditional verbal ‘handover’, she said:
“We have designed a base room where day teams leaving the hospital meet with core staff coming on duty to verbally handover.
“The new system means that they now have access to electronically written support, a list which can be printed to carry out. If a person cannot attend the handover they can access the information electronically.”
Almost 200 people, mainly junior doctors but including senior house officers, registrars and consultants, have now been trained on the system, which has been in place for almost two years but used more extensively in the last 12 months.
Debbie said: “It enables staff to know which patient they have to see, why and how urgently. The feedback from medical staff is that it is valuable and particularly beneficial at night.
“One doctor told me, ‘I don’t even have to look for a nurse, I know where I am going and who I am going to see’.”
The trust believes the system will help with WTD compliance, enabling a smaller core group of doctors working at night to all have access to the information and will benefit patient safety.
At London’s Imperial College Healthcare NHS Trust, Dr Graeme Wilson, consultant respiratory physician, is the clinical lead for the streamlined ward working project.
He explains that VitalPac is an electronic system currently being used to record patients’ observations, including temperature, blood pressure, heart rate and neurological status on PDAs instead of the traditional paper charts.
The project, which started at Charing Cross Hospital in the autumn of 2007, is currently being trialled by nurses on patients admitted to two acute medical wards and the high dependency/coronary care unit.
The software is ward based and as each nurse must log into the system, it’s possible to identify who records each piece of information.
Doctors can also access the information on computers in other parts of the hospital, making it possible to view the observations both of individual patients and a patient group as a whole.
There are currently 170 registered users of the system which has 22 PDAs and six tablet PCs for doctors’ use.
Dr Wilson said: “If a doctor is away from the ward, he or she can access the information remotely to enable them to decide on a patient’s condition and the need for intervention. We expect this to impact on patient care and safety as it eliminates potential errors or confusion in transmitting the information verbally or in the information being wrongly interpreted.”
The recorded observations allow each patient to be given a modified early warning score (MEWS). This is a physiological ‘track and trigger’ system which, when it reaches pre-set limits, requires the nurse to alert a senior nurse, night practitioner or doctor.
“This system is not intended to replace doctor/patient interaction, but to indicate more specifically when a patient’s condition may require urgent review by a doctor,” he said.
Dr Wilson believes the technology will help with WTD compliance by reducing the amount of paperwork and by assisting junior doctors as they move to new shift patterns which will require them to cover wards which may be unfamiliar to them.
As nurses and site practitioners are increasingly trained to take on roles traditionally the responsibility of junior doctors, new systems will allow those doctors to concentrate on the patients who need their timely intervention.
There are plans for the VitalPac system to be extended to assist with infection control, by identifying patients who have been screened for MRSA or those at a high risk of contracting clostridium difficile.
Running alongside VitalPac is an iWard project, based on software designed around a hand over document for each individual patient and a bed management system which enables nursing staff to see empty beds and discharge dates ‘in real time’.
The system records each patient’s diagnosis, investigations completed and pending, social factors and any planned discharge date. If the patient is transferred to another ward, the information goes with them and can be accessed by everyone involved in their care including doctors, nurses, physiotherapy and occupational therapists.
This compares with the existing system where there are different style documents for medical, nursing and other staff. Currently each ward has its own way of recording patient lists on which the information is recreated or updated two or three times a day, Dr Wilson explained.
The new integrated system allows all hospital staff involved in a patient’s care to share the same information which can also be printed in a variety of formats for purposes including ward rounds and nurses’ handovers.
He said: “This new system saves time, reduces the number of occasions a patient has to be asked for information and the number of times that information is recreated, reducing the possibilities of errors.”
Another piece of new technology on trial is a large electronic computer board, installed in a room off the acute medical ward, used by ward staff for daily bed management discussions of particular cases.
The interactive board can also display x-rays, allowing users to highlight abnormalities for teaching purposes.
Dr Wilson likens it to the technology used on television to highlight football players on programmes like Match of the Day.
“It allows us to remove patient identifiers where appropriate, to view good quality electronic images and to drag and drop information on to the screen. It’s early days but seems to us a very neat piece of kit,” he said.
Dr Wilson admits there have been some problems with the VitalPac technology and that wireless coverage is still patchy and needs to be extended across the hospital as a whole.
“The system was rather clunky at first, but we are very lucky in having an excellent working relationship between management, clinicians and the IT staff who have given us great support.”
IT staff have worked closely with clinical colleagues, spending time on the wards to observe ways of working and involving junior doctors in testing solutions.
“People have been prepared to spend time in each others’ departments to make sure we come up with workable solutions,” he said.
All the trials are still in progress and have yet to be evaluated.
Working Time Directive 2009 
