How the use of phones and tablets at bedsides is transforming nursing


Nurses in hospitals across England are increasingly using mobile technology to radically improve their ability to monitor and treat patients.

The days of physical charts on clipboards hooked onto the ends of beds are numbered, as more and more Trusts embrace the potential of using digital technology.

Orthopaedic Discharge Sister Bev Tytler at South Tees

Caron Swinscoe, Clinical Lead for Nursing at NHS Digital, says:

"Good clinical care is all about information and communication. 

"Bedside technology gives clinical staff crucial information about patients in the palm of their hand which is accurate, up-to-date and shared by the whole team. Used effectively, it can ensure that changes in patients' conditions are noted in real time and help to ensure early recognition and quick action, vital in the care of sick patients.

"There is emerging evidence that mobile technology helps doctors and nurses to spend more time on wards, visible to other staff, patients and visitors. More time to spend with their patients is the greatest gift that technology can give to a clinician.

"Engaging clinicians in decisions about new technology is crucial. Our experience is that investing in e-technology to assist clinicians is just the beginning. By ensuring that developments are clinically driven and clinically led the potential benefits for patients and clinicians are huge."

One Trust that is showing that to be true is South Tees Hospitals NHS Foundation Trust.

When NHS England launched the Nursing Technology Fund at the end of 2012, South Tees were among the many NHS bodies to bid for cash.

Their bid was thought so strong that they received the highest amount of any Trust for funding new technology for clinical staff - £1.4 million which was predominantly used to invest in iPods and iPads.

Lindsay Garcia, nurse consultant of critical care services at South Tees, says the change has been transformational:

"When we first started, we had colleagues coming to us saying 'I don't even own a mobile phone, how am I going to manage?' But we have developed a culture here where we embrace the opportunities new technology can bring and the results have been incredibly beneficial."

Initially, the Trust commissioned a system that allowed them to conduct electronic surveillance of vital signs.

Nurses at bedsides input data into iPods instead of charts. This saves time, and also allows the data to be used in an intelligent way. It also means that doctors can review clinical symptoms remotely, meaning that they can make decisions about care more quickly. 

The system mitigates against human error such as under-counting, as the system automatically calculates scores which are available to see in real time.

The Trust has also built key messages for nurses into the devices, reminding them of what is expected of them depending on the severity of the patient's condition, helping to ensure patients always get the treatment they need.

Now the Trust is expanding its use of the mobile technology further.

A system is being implemented which will pull lab results for acute kidney injuries onto mobile devices and computers on the ward. 

AKI, also known as acute renal failure, is a serious and sudden episode of kidney failure or kidney damage which is common in patients who are in hospital, especially in older adults.

Lindsay Garcia says:

"Acute kidney injuries are very dependent on time-critical intervention; patients can deteriorate rapidly. Previously, we had to retrieve test results from pathology, but our new system allows us to pull them straight from the lab onto devices in nurses' hands and by bedsides so we can see them immediately. This obviously has a hugely positive impact on the care we can provide to patients."

A sepsis symptom alert system is now being implemented which will prompt nurses to check for symptoms and alert them when a sepsis screening may be needed.

And the Trust is also investigating using the technology for fluid management, allowing nurses to get real time accumulative fluid balance.

The devices contain data for every patient on the ward, so at any point and time nurses and doctors can see patients' states in real time. This makes ward rounds much more efficient and effective.

The information includes times of last observations, and shows when the next observations are due - useful both for nurses on the wards and for managers who can monitor performance and use the data to inform decision-making.

Soon the Trust will be able to put all blood results automatically onto its tablets.

Lindsay Garcia says simplicity is the key to making sure the clinical team embrace the technology at their disposal and ensure its implementation is successful:

"The more we can get onto devices by bedsides, the better it is for nurses and patients. The key is to make it as easy as possible, keeping the tools simple so nurses can learn to use them quickly.

"If you make it difficult or complicated, clinicians will revert back to paper. Our systems are extremely straight forward to navigate - all our clinicians are required to do is input digits and click through yes / no screens."