EHI Awards 2010: Straight to the heart of nursing

A Nursing Metrics system developed at Heart of England NHS Foundation Trust won the ‘excellence in healthcare information management’ category of the E-Health Insider Awards 2010.

Nursing is often seen as the clinical discipline that lags behind when it comes to using IT. Not so at the Heart of England NHS Foundation Trust, where work on a system called Nursing Metrics was not only recognised at last year’s EHI Awards, but is attracting attention from across the country.

Systems integration manager, Neil Scott, and senior nurse, Jo Richmond, worked together on the project, which has made a huge impact on care in the hospital and is now being adopted in Cornwall, Ireland, Chester and South Birmingham Community Healthcare services.

Standards are good

The origins of Nursing Metrics lie in the familiar standards for nursing care that have been tried and tested over many years.

Elements of care such as pain control, pressure area care, nutrition and safeguarding privacy and dignity have traditionally been the cornerstones of nursing and nurse researchers have sought ways of measuring and modelling them.

Richmond, who leads on quality and standards in nursing at the trust, explained that these traditional standards were in place before the Nursing Metrics programme started. But when it came to measuring performance against the standards: “Results took six months to arrive.”

When a new chief nurse, Mandie Sunderland, arrived at Heart of England in 2008 she instigated some radical changes.

In her previous job at Blackpool Fylde and Wyre Hospitals NHS Foundation Trust, she had been working on a system to measure nursing team and ward performance based on seven indicators: falls assessment, medicine prescribing and administration, food and nutrition, pressure area care, pain management, patient observations and infection prevention and control.

She told nurses in Birmingham that she wanted the same kind of approach at her new trust, which is one of the largest in England. Richmond explains: “We started measuring [these indicators] across every ward, every month and were using the system to drive change.”

But paper makes it hard to measure them

The snag was that the system was still paper-based. So Richmond started to work with Scott to see how IT could streamline the monitoring processes and, crucially, make the feedback to nurses more fresh and immediate.

In the first phase of the work, the nursing staff used Formic data capture technology to record data and manipulate it to produce reports on the key indicators.

However, Richmond’s verdict was that the system was not very user-friendly and still didn’t deliver the good or bad news about nursing performance to staff quickly or precisely enough. “All I could say to a nurse on a ward was that I got the impression that this or that was not quite right.”

Phase II was developed in-house by Scott and capitalised on the trust’s investment in a new wireless network, newly-installed COWs (Computers on Wheels), and Toughbook ruggedised laptops.

Under the current iteration of Nursing Metrics, senior nurses go to a ward that is not their own and carefully interrogate 10 patient records held at the end of the bed. They enter data from the notes into the Nursing Metrics checklists.

“Immediately I can get into real-time results and see both the overall picture and the detail,” Richmond says.

Feedback is given on the spot to the senior sister and the team. If results come up with a red or amber warning, the senior nurse assessing the ward can help staff focus on areas that need improvement.

The visits are monthly, but wards that are giving cause for concern are visited weekly and intensive support is offered until they improve.

The system ensures that 400-500 sets of patient notes are examined in detail every month. Richmond feels the results speak for themselves; there were 36 wards on red alert in January 2010, but this figure dropped to zero by August and had risen to just two by September.

“We have definitely improved processes and also managed to show people what the trust’s standard is,” Richmond concludes.

Patients feedback, too

Alongside Nursing Metrics, the trust uses software developed in-house to record and analyse patients’ experiences. The two complement one another well, as Nursing Metrics measures the process of care and the patient experience software measures the outcome from the patient’s perspective.

The award-winning work has created great and growing interest with enquiries from around the country. Several other healthcare providers are at an advanced stage in testing and adopting the system.

A website www.TestYourCare.com has been set up to provide further information and anyone interested in learning more about Nursing Metrics can contact Neil Scott.

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