O uality & 46 QUALITY & SAFETY
A column by Maureen Flynn
Safety
A clinical information system built for nurses by nurses
• Continuity of care: each person has one electronic patient record that can be accessed between locations – eg. sharing of clinical information between community hospitals and day care centres • Comprehensive care: responses to screening questions within the care needs assessment tool prompt nurses when developing care plans • Consistency: workflow can direct nurses through a preferred care model to reflect agreed practices/policies • Adaptability: electronic forms can be configured internally in OPS when necessary to meet the needs of various models of nursing or updates from practice development • Visibility: improved workflow management with use of an interactive dashboard (currently in development phase) • Accuracy: legibility and quality of updated information, eg. improving processes of CSARS applications/ QCM metrics data collection • Traceability: all forms that are editable have audit history • Efficiency: bespoke reporting aims to reduce significantly the time spent on manual reports by staff, with many able to auto populate details from set fields on the system Benefits of the CareNotes clinical information system
This month’s column shares the story of how nurses are using technology to lead quality care while integrating systems. Older person services (OPS) in Donegal have been using electronic nursing records since 1999. Over time there has been a need to evolve and progress in response to evidence-informed practices and leg- islation. In response, CareNotes, a clinical information system, has been adopted across 11 community hospitals in Donegal. CareNotes CareNotes is an electronic solution, from IT service company Advanced, that comes with an ‘assisted build’. It has core care forms pre-set for people’s details (admis- sions and discharges) with the ability to design, personalise and link all later care forms. In Donegal this integrates informa- tion from (i) single assessment tool (SAT), (ii) comprehensive geriatric assessment (CGA), (iii) nursing care processes encom- passing all transactions associated with care, (iv) HIQA Standards, and (v) quality care-metrics data collection. The clinical system is used to track care delivery and reduce the burden of measurement. Leading the change The development is led and supported by practice development, directors of nursing, specialist link nurses and front- line staff. Input was also sought from health and social care professionals at local and national level. The system was introduced, over nine months, with the help of the HSE Office of the Chief Information Clinical Officer (OoCIO). Technical, infrastructural and change management issues have been addressed and the system is cloud based in line with the OoCIO’s cloud first policy. All staff are also setup with a HSE OutlookWebmail account giving each indi- vidual an electronic footprint. As system is cloud based with a UK vendor, a VPN link was setup between the HSE and Advanced. All GDPR points have been addressed and
• Assurance: ability to ensure that all mandatory documentation supporting the nursing process is updated • Quality improvement: early indications using QCM data collections suggest there is an improvement in person centred care plans with this system
the system is now used by 387 nurses caring for 375 people. Staff also train as system administrators and report writers. Enabling implementation Phase One of this project (develop- ment and implementation of replacement system) will be complete by end 2019. Feedback from the staff has been largely positive and staff are kept informed of updates through a monthly newsletter. Staff engagement was key in order to plan for support and protected time, with the initial release for training and subse- quent data input. Support is provided via an internal support team. Opinions and suggestions are being actively sought for inclusion in Phase Two. Central to implementation phase has been the enthusiasm and willingness of staff to develop and implement a system to improve overall quality of patient care delivery and audit. Phase Two will look to streamline pro- cesses and documentation further, aspiring to a paper-light nursing record. It is also
intended to expand to other health profes- sionals, eg. GPs, and integration of other information systems where possible. Finally, the expansion of access to the system to other locations with CHO1, which covers Donegal, Sligo, Leitrim and West Cavan. Opportunity to learn more At your next team, unit or department meeting you might talk about plans for electronic patient records in your area and if information systems that you use might be incorporated. You can find out more above the developments in Donegal by contacting the nursing project lead AnnMarie Noone, email t o : A n n M a r i e . N o o n e @ h s e . i e o r carenotes.support@hse.ie, and OoCIO senior project manager: Lorraine Gilmartin at email: Lorraine.gilmartin@hse.ie Maureen Flynn is the director of nursingONMSD, QI Connections Lead, HSE National Quality ImprovementTeam Acknowledgement: ParticularthankstoMauraGillen, nurse practicedevelopmentofficer,OlderPersonServices,Donegal, andMichelleO’Hara-Donnelly,QCMprojectofficer, NMPDU NorthWest, for collaboration in preparingthis column
The National Quality Improvement (QI) Team, led by Dr Philip Crowley, supports services to lead sustain- able improvements for safer better health care. We partner with staff and people who use our health and social care services to champion, enable and demonstrate QI achieving measurably better and safer care. Read more at: www.qualityimprovement.ie or link with us on Twitter: @NationalQI
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