Engaging Nurses in IT change in an Acute Hospital

1. Engaging Nurses in IT change in an Acute Hospital Date 2nd May 2012

2. Jane Ennis Clinical Coding and Service Development Manager Royal Bournemouth and Christchurch Hospitals Orna Lovelady Clinical Adoption/Engagement Manager Royal Bournemouth and Christchurch Hospitals

3. Why Change? • Efficient management of documents to increase productivity • Expensive and Time Wasting vs. Powerful and Flexible

4. Resistance to Change • Culture • Low priority given to the importance of communication. “I don’t have time to do the eIDF” • Focused working hours on treating patients “I am doing patient care, my proper job, I will do the eIDF if I get time” • The wider organisational problem that impact on a clinicians time. “My team will never do this, we simply don’t have the time”

5. Use and Design • A poorly designed healthcare form has the ability to introduce new hazards – • What were we offered as a solution • How new technologies affect the workflow • Hardware solutions • Well designed computer screens are more than just user friendly, they promote data accuracy • Form design, review and updates A good software design will help prevent human error.

6. Training • Dedicated 1:1 training sessions • Follow up group sessions • Target audience • On the spot training support

7. Clinician Engagement • Critical part of achieving successful and lasting change. • Knowledge, strengths and weaknesses – Project should be practical, sensible and doable. • Evidence based –clinician involvement should be part of every change process • Gain Commitment at all stages of redesign. Improvements can fail due to lack of clinical support.

8. Nurse Practitioner Comments Listening: • We were lucky enough when we moved…. We were able to design it (computer area for the clinicians to use) and I asked for a very long desk, because not only do you have your own medial team, but you have lots of to their team coming in. We acquired a second computer for that desk which has become invaluable with the eIDF's. Understanding Frustrations: • Sometimes on other wards it gets very frustrating when there is not a free computer so you can't do any eIDF’s • We try to get an eIDF prepared during the inpatient stay; we will add to, fill in some of the fields while they are inpatient, planning their discharge and then complete it on the day they actually are going home. We try to do that, but it doesn’t always work in practice

9. Working with Nurses • We have had a change with our work load …and that has helped me have time to fit the discharge summary into the day. Because initially I had to stay to do them and then I got really fed up with it I have to say. So I complained, and now I can fit them in … I got quicker at them which has made the difference. • I personally prefer the electronic discharge summaries, it helps in my work when you are looking back and you haven't got a patient notes. You can refer to the previous summaries and get information from that, and I do use that quite a lot. So yeah I prefer they are done electronically.

10. Where we have got to • 99.2% of all inpatient have a completed eIDF.

11. “..development can be likened to a train that never stops. To take advantage of this development you have to climb on the train.”Hogme Sandvik MD PhD, General Practioner, Bergen, Norway.