1
Nursing practice Continuity of care Compliance to adherence Get it right for the patient, get it right for the Board Fill in with patient Langauge to prompt discussion with patient Patient held record Tool to help build a relationship Searchable IT system Confidence in ability to use professional judgement Get to know a patient Record keeping Multi-disciplinary record Important legal document All documentation needs to be electronic More time for care would shorten length of stay for patient Value More supportive Audit Tech/ systems Mobile working tablets/docking stations desirable Not just another IT system Process & tech innovation together Process before product Big change delivered in small steps Non-standard across boards More time to spend with patients More effective use of people we have got Individualised Care Change needs scientific research grounding Testing water for other changes Directorate & nurses need ownership ‘Freer’ negotiation with suppliers Multidisciplinary approach Pilots should be agile in adjustment & improvement Needs to involve junior nurses New eco-system for change/innovation Cost of replace & repair Procure- ment Get better at record keeping before a move to electronic Electronic system could trigger activities e.g. drug schedule India - trained scribe generates report during procedure Processes similar to other industries e.g. oil Be more ‘Apple-y’ Siri or Cortana for nurses Denmark - fully electronic Real time recording could be intrusive, limiting & breech confidentiality Speech recognition works for doctors due to slower turn around time needed External influence Desirable Future State Historic Assurance Reflection of patient care Suite of measures rather than tickbox Quality of care Patient feedback Looking for good (External) (Internal) Governance Scrutiny Measure- ment Audit Available at right time & place Support Staff Redirect role to be more about care Health care support workers encouraged to write on records Up-skilling support & admin staff Student nurses Evidence-based Change how we train people Workplace culture Involve in procurement Keep people current Do no harm All will use it if can see it’s beneficial Code of practice Person centred (choice, perspective, understanding) Patient involvement Prescribe care appropriately Providing care Professional judgement Only as good as information entred Each Board procure & fund own system Current system not used to full capacity Failing in use of CHI system (11.5m for 5m) TrakCare is clunky & unintuitive Different systems for different needs Compatability of systems Support Staff [ [ “Conversation isn’t on the radar anymore unfortunately” Nursing practice Documentation discourages patient centred care Decision making on level of care & prioritisation Underutilised information Handover & nurses notes are valuable If it’s not written down it didn’t happen Waste of time/chore Nostalgia for when nurses had time for patients Patient relationship Nothing behind a tickbox Perception nurses can’t use professional judgement anymore Tickbox mentality External scrutiny has influenced tickboxes Record keeping Evidence of process Important legal document Historic Vale of Leven Enquiry Assurance Roper-Logan-Tierney model of nursing Underutilised Unsupportive to role of nurse Healthcare support workers encouraged to write on records Administrative role to support senior nurse saved 20% of time Student nurses Move between wards where each do records differently Evidence-based Anxiety/fear to use professional judgement Learn old-fashioned approach to record keeping on ward Value Workplace culture Waste of time that could be spent giving care Become a task-based workforce Do record keeping in middle/end shift Keep people current Do no harm Doctors take direction from nurses Senior level under- estimate what it takes to complete a record Outcome measures may not reflect patient care Staff-to-patient ratio Out -of-date model of assessment Over-complicated Quality of care SBRI only suitable for ‘hang on’ systems Costs are key - each board has different considerations Legacy systems Must show return on investment Overarching rules (World Trade Org.) Innaccurate or misinterpreted requirements TrakCare procured with little clinical input Lack of education behind improvement work Audit for quantitative measurement Looking for good Nursing Records: Current issues Current Changes Litigation Risk Assessment (External) (Internal) Sea of Green - selective data Audit not helpful or supportive Procure- ment Professional judgement At risk by being paper-based Content influenced by policy/legislation Fragmented, missing or incomplete Paper based format Providing care Code of practice Detrimental effect on care Information is gathered & duplicated multiple times Not searchable Takes alot of time Outdated documentation Not fit for purpose Governance Scrutiny Measure- ment Audit Risk averse [ [ “Do you want me to write about it, or deliver it?” “How do requirements for change get blurred even when top and [ [ [ [ “We have measurements coming out of our ears!” “Scrutiny is looking for problems, assurance is looking for positives.” [ [ Technology & systems Data sharing Perception/ attitude Current use Resistant to adopting technology in workplace Need to see benefit before adopting Challenge keeping everyone’s knowledge up to date Long, challenging switch over process Able to track patient & notes location in hospital Laptops to do rounds - type as you go Benefit in accessing results more quickly Digitised paper record Record keeping Paper Light Change in progress Reduction in size of paper document Mix of paper & electronic record keeping SBAR handover - way of ordering conversation Narrative of free text Traffic light system for quick decision making Professional judgement ‘What matters to me’ boards at patient beds Culture of Innovation Innovation champions Innovation training in the NHS “There’s a psychological benefit for nurses, not being faced with a stack of paper.” [ [ Nursing practice Workplace culture Providing care Up-skilling support staff to address short fall of ten interviews undertaken by GSA researchers with senior nursing professionals across six health boards in Scotland and features direct quotes to illustrate certain points. There are three parts to the visualisation, which describe the current issues discussed, what is currently undergoing change and what a desirable future nursing record might look like. brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Glasgow School of Art: RADAR
