The content for nursing

1. The content for nursing Understanding their needs Gerry Bolger @digitalgerry Nurse Lead – ICT – Imperial College Healthcare NHS Trust

2. This session Where we want to get to & challenges for nurses Complexity of nursing & why HIT is key to being an enabler The move from data gatherer to information What needs to happen

3. Our simple ambition

4. Where we want to get to HIT enabled healthcare

5. Challenge for nurses • Massive amount of patient data • Multiple applications (now) • Poor end user experience • Duplication (often poor data quality) • Limited access to patient information • … and

6. Nursing Work “and the invisible part…mindfulness and sensemaking” Move patient to new bed Nursing home assessment LPN she is covering BP machine problems Signature for narcotics New nursing assistant arrives Patient moved up in bed Cart Patient risk of falling Staffing Hand off assessment Narcotic keys Hang IV for her Staffing Hang IV Beds Fingerstick machine Checks updates in computer Checks updates in computer Planning for new shift Gets IV bags, Checks orders in binder Oral meds Checks orders in binder Oral meds Oral meds, topical cream IV push Insulin Hangs IV Pain med Topical cream Hangs IV Hangs IV Hangs IV Hangs IV Hangs IV IV push 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 IV pump alarm Other RN leaves floor Other RN returns IV pump alarm Weigh patient IV pump alarm IV pump alarm Dinner Other RN needs binder Water for patient Children on floor Water for patient Other RN dinner Wife of patient Pain med request Fingerstick machine calibration Narcotic keys Narcotic meds too many to put in cart MD asks to tape down IV Emily Patterson PhD VA-Getting At Patient Safety (GAPS) Center

7. Nurse stacking theory Is a dynamic process and dependent on the ability of the nurse to be mindful and engage in accurate sense-making in the midst of unpredictable and constantly changing situations (Ebright et al 2003)

8. Right timing of technology • User friendly • Supportive to give key up-to-date information • Clear & concise • Reduce stress to change & promote a healthy work environment • Safety focussed • Barriers to ineffective care designed out

9. Information versus data

10. Change isn’t just practice • Design of eDocs often replicates poor existing documentation • Documentation versus transformation of care processes • Benefits often on ROI rather than value • Releasing time to care • Front ending versus data mining & aggregation • Not investing in what matters at point of care • Cost constraints impacting on benefit realisation

11. Success isn’t just about workflows • Literacy • NNIST found that job roles/descriptions not setting out adequate skills to meet the demands for technology • Mobile technology ≠ PC literacy Customer facing skills needs to be taught

12. Kaiser Permanente, 2004 The Permanente Journal

14. Enabling technology to support care delivery http://www.intel.com/content/www/us/en/healthcare-it/intel-mobile-point-of-care-selector.html

15. What needs to happen • Local configuration • Assessments based on need & workflows • Standardisation • Generic documentation • Nursing diagnosis / interventions & outcomes with other MDT coding i.e. SNOMED-CT • Smart APIs • Data mining / Symantec / Language Processing • Data aggregation

16. Via Vitalhub, Ontario Canada www.vitalhub.com

17. Summary • Providing nursing care is complex • Complexity is amplified by the current work approaches & fragmentation • Focus shouldn’t be about technology but information & knowledge • Technology is the enabler • Change is practise, culture & approaches are needed to transformation the benefits & value for care delivery