Location: Lancashire Teaching Hospitals NHS Foundation Trust
The Lancashire Teaching Hospitals NHS Foundation Trust is one of the first in the UK to have installed fully compliant, integrated NEWS2 e-vital signs devices integrated with the Electronic Patient Record (EPR), helping caregivers detect and respond to patients at risk of deterioration quicker.
Staff no longer have to transcribe observations onto a paper chart and leave the patient to manually enter this data into a separate PC to calculate the early warning score. All of this can now be done quickly at the bedside via Mindray VS-900 monitors. By removing manual, time-consuming steps, caregivers can now identify and act on subtle signs of patient deterioration immediately, helping to enhance patient outcomes and release nursing time back to care.
Challenges
- Evidence supports up to 34.5% of manually calculated NEWS scores are incorrect or may have missing information, raising the potential to miss deteriorating patients
- The Trust were already using Mindray VS-900 vital signs monitors to calculate early warning scores, but needed to upgrade over 350 devices with the updated NEWS2 protocol – the new national standard
- The Trust had to meet a challenging timescale (just three months), to achieve its target of becoming NEWS2 compliant
- As the vital signs devices were already in operation, the upgrade required careful project planning to ensure patient safety and continuation of service, throughout the process
- Continued connectivity and integration with the EPR was essential
The solution
- Vital signs monitoring: Around 350 VS-900 vital signs monitoring devices were initially provided and subsequently upgraded to meet the Trust’s evolving needs
- NEWS2: Provision of automated calculation of NEWS2 for rapid identification of deterioration
- Integration into QuadraMed EPR: The VS-900 devices now send NEWS2 and vital signs directly from the bedside to the hospital’s EPR system (Harris Healthcare QuadraMed)
- Data visibility: E-vital signs can now be viewed from any ward or department by the multi-disciplinary team
- Bespoke configuration: This includes the facility to input information on how oxygen is delivered – i.e. via face mask; as well as alert messages specific to the Trust – such as who should be called, and on what number, in the case of an escalation. Clinical staff are also able to enter manual information such as respiration rate and urine output
- Collaboration: Effective teamwork between Mindray and the Trust, resulted in all the testing, configurations and upgrading of the monitors being completed in just one week
Outcomes
- The flow of patient data directly from the monitor into the EPR helps save time and reduce errors through more efficient workflows and the reduction of manual transcription
- The Trust estimates that it saved 2,232 hours of nursing time just in the first month
- An audit showed 100% compliance in the documentation of all NEWS2 observation values with 100% accurate NEWS2 calculations
- On-screen prompts aid clinical decision-making and ensure correct protocols are followed for NEWS2
- Enhanced patient safety through rapid identification of deterioration – the whole process is automated, helping to speed up intervention by the outreach team
- On-call doctors can prioritise patients according to clinical need, by having instant access to observations
- Qualifies for the UK Department of Health’s Commissioning for Quality and Innovation (CQUIN) payment, through the system’s ability to provide timely detection of deterioration in patients, particularly around sepsis
Conclusion
Caregivers now have the confidence that complete sets of patient observations and accurate NEWS2 scores are documented at the bedside, and are immediately visible from any computer in the Trust. This in turn allows for faster identification of patient deterioration, enabling a timely response, rapid intervention and delivery of better care and outcomes.
Mindray’s ability to produce such a significant software change, accommodating NEWS2 on the VS-900, in record time, was an impressive achievement – a fact that was recognised by the Trust, which has led to a high degree of customer satisfaction. For a project that would normally be rolled out over a period of months, Mindray and the Trust’s project delivery team went the extra mile to achieve NEWS2 compliance, which will have a positive impact on patient care. Susan Birch, Project Manager at the Trust, praised the dedication of the whole team to “deliver what was promised, on time and within scope.
