What are we trying to achieve?
Our project goal is to be able to capture all current nursing observations and charts in an electronic format using a handheld device, so that nurses and doctors will have easier and faster access to their patients’ information.
Our aims are to:
- improve patient safety
- ensure that nursing observations are completed on time and accurately
- ensure that information is available for clinical staff to identify deteriorating patients early and deliver treatment quickly
What have we done?
Waitemata and Canterbury DHBs are the first in New Zealand to undertake an eVitals project to record patient observations on our wards using electronic handheld devices. Having eVitals and our partner project ePrescribing is a first step towards implementing an electronic patient record at Waitemata DHB [view more about ePrescribing].
A mobile solution for iPad minis has been developed using the Patientrack system to be able to electronically collate vital signs and other relevant patient information. A steering group was formed to provide direction for the initial implementation of eVitals including:
- the type of patient information to be collated
- the roll out schedule for our inpatient wards across North Shore and Waitakere Hospitals
eVitals Clinical Team
Our eVitals clinical team of 6 nurses was established to:
- support the development and customisation of the Patientrack system, including testing of the forms and customised charts
- provide training and support for nurses, doctors, allied health and other ward staff as eVitals is rolled out to each ward
eVitals clinical coaching team
eVitals – Patientrack System
With the Patientrack system the following views and functions are available on iPad minis:
1. 'Patients' and 'My Views' pages
The 'Patients' page provides ward level overview for clinical staff to be able to view their observations and activities due. Staff can also access their patient information from this view.
eVitals main page of Patientrack showing ward overview
As observations become due an alert appears on this page for the assigned nurse to action:
Main page view show observations due and activity list
The ‘My Views’ page provides a list of all patients on the wards including key observation information:
Ward view of all patients including latest observation information
2. Patient Observations
For each patient we are able to electronically record observations (ie blood pressure, temperature, heart rate), fluids, weight, smoking history, prescriptions and admission information. This information is securely stored but is also available for other healthcare staff within the hospital, and also to GPs or other specialists.
eVitals form to collect patient observations
Smokefree support and referral chart
3. Patient Charts
Electronic charts have been developed to replace following paper based charts:
- weight, fluid balance, bowel
- intravenous cannula
- neurological observations
Fluid balance assessment and chart
Clinical Staff Access
Prior to eVitals, clinicians had to visit the ward to access a patient’s chart to make further decisions on treatment. Patient observations and other information can now be securely accessed from any DHB computer by our clinicians so that they can check up on their patients even if they are not on the ward.
Clinician access to eVitals data from computers
Did we make a difference?
After a successful initial trial on Anawhata ward in Waitakere Hospital, eVitals is now being rolled out across all the adult wards at North Shore and Waitakere hospitals. The initial results from our trial show that:
- all sets of vital signs are being completed - this means that heart rate, respiratory rate, blood pressure, oxygen saturations, consciousness level and pain score are recorded every time observations are taken
100% of early warning scores are correct and documented
- 100% compliance on the last audit of intravenous cannula care for Anawhata ward
- improved charting of patient weights and bowel habit
The feedback from nurses and doctors has been very positive:
nurses are happy with the electronic solution and don’t miss the paper forms at all
- nurses reported significant time savings with observation and prescription charges now available in their pockets - prior to the trial nurses spent an average of 31 minutes a shift finding notes
- doctors find it more convenient being able to check up on their patients without leaving their clinic or the operating theatre
Where to from here?
Over the next year we have plans to:
continue rolling out eVitals across all adult inpatient ward, expanding to our emergency departments and maternity units in 2017
- add the nursing admission documentation and further clinical charts to eVitals, with an aim to have all patient charts available electronically by 2018
- automate calls to doctors (using the Early Warning System) when observations indicate deterioration, saving the nurse’s time while they attend to the deteriorating patient but also ensuring the patient gets prompt attention
Our mobile solution using iPad minis currently only has eVitals and ePrescribing, however we are investigating extending the use of the devices for nurses and doctors to be able to review blood results, check investigations and review previous notes on these secure mobile devices.
We have also showcased our solution to other DHBs who are interested in implementing eVitals.