Summary

Innovation of nursing record keeping processes and systems is needed to improve patient safety and care. Almost all of the NHS Scotland regions use paper-based nursing records, which can cause problems such as loss of information, poor quality recording of care, and lack of access to existing patient information. It also creates a large administrative overhead. This is against the well-understood backdrop of chronic underfunding and understaffing within the NHS.

The primary finding of our research is that there is a desire and need to move to electronic health records (EHRs), and that it is important that this should go hand-in-hand with work to increase the amount of professional judgement that nurses can use within care (opposed to too many forms and task-based working). Ongoing work to make nursing records more person-centred should continue, with the eventual goal being a move to a multi-disciplinary patient-centred record.

A particular problem for nursing staff is that they work with their hands and so record keeping is often delayed until after the time of care. This delay can be significant and can compromise the integrity of the records system. This is the case whether using paper or electronic record systems. We found no suitable existing solution for enabling time-of-care record keeping.

Finally, the methods of progress within NHS Scotland’s regions are as important as the desired changes. “One shot” procurement should be replaced as far as possible by pre-procurement working with industry, and ideally with long-term working relationships.

Film credit: Louise Mather

NURSING RECORDS DHI

Background

The Nursing Records project is a step in the patient safety project with Open Innovation NHS Scotland. The first workshop was hosted by NHS Grampian (Innovation Cluster, 2016) on 23 September 2016. Following an invitation from Andrew Fowlie, Health and Care Innovations at Scottish Government, the DHI Design Team were asked to host an event to look at technology for improving nursing record keeping, including industry partners that could be supported by the open innovation process in future.

Aims

The project sought to address future technology options to improve nursing record keeping. The aims were to:

  • understand the current issues affecting nursing record keeping;

  • promote co-operation between industry partners who might have technology that could benefit nursing practice and record keeping;

  • and to serve as a focal event to maintain enthusiasm and sustain current improvement effort within NHS Scotland.

Nurses spend a significant amount of time completing multiple admission forms, risk indicators and subsequent care plans. Engaging with patients in a meaningful manner whilst undertaking this volume of documentation can often lose its meaning and value. Record Keeping is a key part of patient care and if this can be achieved in a timelier, more efficient and person centred way it will add so much value to the health care journey.

Professor Amanda Croft

Executive Director of Nursing, Midwifery and Allied Health Professionals, NHS Grampian

Recommendations

Electronic Health Records

A desire to move to electronic health records (EHRs) that are interoperable with the current system (TrakCare) was of clear importance. Elidir Health's CHAI system was presented as a good example, however it was noted that CHAI is a process focused system rather than being more person-centred.

Professional Judgement

Alongside the development of EHRs, participants highlighted a need to increase the amount of professional judgement nurses can bring to care, opposed to too many mandatory forms and task-based working, that can have a detrimental impact on patient care. Restructuring of the record keeping process that reflects how nurses work and supports them in delivering patient care is required.

Person-Centred Care

Ongoing work should continue to make the nursing records more person-centred through supporting a move to a multidisciplinary record that is centred on the patient as a whole.

In addition, the workshop also highlighted two overarching points which support the primary recommendations:

Long-term Working Relationship With Industry

In order to procure a system that reflects the above requirements, building long-term working relationships with industry partners is recommended. “One-shot” procurement should be replaced as much as possible by pre-procurement working with industry, and ideally with long-term working relationships. This would ensure that the industry partner fully understands the requirements and can adjust according to need.

National Steering Group

Participants recognised the magnitude of change required is high, and expressed the need for a steering group that could address the above points at a national level. An amnesty for innovation was discussed as a way to provide protected space and time to trial and ideate new processes and documentation without fear of scrutiny from external bodies.

Nursing Records Resources

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