Talk Health and Care

Involve staff they know what they're talking about

Paperless care, does not sit well with me. It was being trial-ed. As a qualified nurse I had a personal log in, and after handover I had a smart phone and there I had to record all for my patients.

I found the obstructions to providing care in the way I felt it should be done was impeded by the system. An App (Vita Pac) took me through observation capture on a child but the system didnt allow for me to make a clinical judgement and omit the blood pressure. A suggestion was made that I make up a number in order to be able to move on.

On another occasion, i arrived before handover to a busy ward and had not hand held gadget. So could not help a surgeon on how a patient was, observations, pain relief as there were not charts to which to refer.

Another occasion, I arrived to take up my hand held and was not required to put in a personal password, but to use a generic code for all bank nurses, which meant the value of IT to audit trail all care was lost.

To my mind IT and going paperless was being implemented as digital is the future, I was told it was not consulted on as an idea by the trust with clinical staff. I felt it detracted from my care, positively encouraged me to mis-record to enable me to move on through the system, and an algarythm replaced my clinical judgement which necessatated upsetting a child to take a BP reading that was inappropriate. And hampered a doctor in his review as I was ignorant of the patient without access to IT.

To me this is not progress and makes being a professional unrewarding, wastes my expertese, and the same App, suggests as a nurse I cannot be responsible for assessing my observations I have to consult a doctor. It was all a disempowering experience.

Clinical staff should be consulted on what would enhance patient care. It should nt be for some digital sales pitch to convince a hospital that their product will be good for patients. Care should be driven by what helps us do our jobs better. If we do go to digital it needs involvement of staff to develop systems that help us do the job better.

Other wise as health professionals we will be driven to care for systems and not the patients, i think to some extent Ive seen that happen already in my career. I was trained to be responsible and accountable for any care I gave, now I have to tick boxes and follow algarithms, deviations that respond to patient individuality are sadly more frowned upon now.

So my message would be is listen to staff, caring is an art, not a science, or a system.

edited on Oct 25, 2018 by Adam DHSC

(Account removed) 4 months ago

User need is at the heart of most Tech ideas but it sounds like some of the projects you have been involved with missed the mark. Were you given a chance to provide feedback on the tools you used? Secretary of State Matt Hancock announced his Tech Vision last week - it'd be great if you could have a read and see what you'd like to be included https://www.gov.uk/government/news/matt-hanco...em-in-the-world

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Jacqui 4 months ago

I think patient need should be at the heart of technical ideas. Some things have been great, I was a paediatric intensive care sister at GOSH and had run up and down staircases to labs with blood samples or a precious glass straw of blood for gas analysis. The day near patient, or bedside testing of some blood samples came in was fantastic, it helped us tweek patient care fast and effictively. I'm not against technology but am only impressed by IT that arises to enhance our patient care.
As a bank nurse I was not involved in the introduction of paperless approach I merely walked into it. I did provide feedback before I left the ward, who knows whether it got back to anyone of note, but I tried because I think it was important that there were several instances where paperless had meant lesser care provision.The other issue is that often in the NHS whether it was simple computers on the ward, or electronic gadgets there is never as many as are practical supplied, so again I often found even with care planning that often clinicians take short cuts and dont use the system well enough as they dont have enough access to a computer terminal, or the softwear takes a long time because it doesnt cross populate another area.
Health provision is complex, and Ive heard people say they didnt know where on a system to put a piece of information as an explanation for why it didnt get recorded.
Its equally frightening that the younger clinicicans are more familiar with technology and rely on it to heavily and lose the ability to go back to basic principles to observe and note clinical signs. The most obvious example is an O2 saturation monitor, it gives and indication of how well perfused a patient is, but placement of the probe is key, as is the functioning of the kit. If a poor reading I would say recent clincians are less inclined to also look at colour, respiratory effort, general demeanor of the patient in addition to the machine.
And it does take a lot of work by skilled experienced clinicians with time to consider scenarios, troubleshoot problems with new technology, and I am not sure there is the experience in the development or the early pilots that there might be. Private companies want to sell us what they think we need,and they are good at sellling, clinicians in the field are hard pressed to get the job done when trialling new things rather than reflect and consider
premutations, whether it has down sides as well as upsides. No one is keen to hear negative comments and the maker will of course tell the trust they can iron out the teething problems!!
As I say some developments can be good but I think we have to be wary as we do with cold callers. If we need IT to help us care better we search that out and develop it with a company. I fear is this technological age there is a danger the mangers are like kids in a sweetie shop and easily talked into the idea that companies with IT can sell us solutions which the clinicians are obliged to work with.
I'm just not convinced all IT is for the better, and Id definitley think as I said before there must be clinical people involved in the development.
My last worry is that having spent a career in paediatrics there is so often an assumption that what works in adults only needs a little modification to work in children and over the years its been a nightmare to wrestle with technology they try and adapt or have tried to sell to trusts on the basis it works for kids too and it doesnt, alarms dont cope with 0-18 yr olds, or the complex situations or variations of caring for children of all ages!!!
I'm not negative, but I realise to make IT and technology work for children takes an inordinate amount of research and development time and that makes things expensive, also the clinical expertese to pull into R&D must be few and far between. But I do still think its a hazard to future care of children. Just a for instance look at CTG in maternity, its great there is the technology but it is still only as good as the clinician using or interpreting it, having it is great but then it doesnt take the place of skill or clinical judgement, or proper staffing ratios. And whichever way you look at it computer records are still not as accessible as paper, yes i can lose the bit of paper, but it wouldnt prevent me looking after the patient. In the recent NHS crash patient care was totally undermined cos the computers were infected!!!!

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(Account removed) 4 months ago

The changes needed for tech that works for all does mean that technology needs to be reviewed regularly. This is where the feedback that covers what isn't working is so vital. Did you see the news over the summer about the piece of AI moorfields hospital have been trialing? https://www.moorfields.nhs.uk/content/breakth...e-care-patients Not all technology ends up working in practice. I don't know how familiar you are with the process but often projects will go through an alpha, beta then go live. Most issues will be ironed out in the alpha and beta stages but as with most things until you set it live it is hard to know exactly what issues come up. The basics like making sure the computers are up to date and working is something highlighted in the tech vision. It must of been an incredible experience working as part of the team at GOSH. I read about the innovative surgery they did earlier this week. What would you like to see done better within your area?

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Jacqui 4 months ago

Ive said my piece... partly as a sign off. I saw this platform and its been a place to leave all that I needed to say. I loved most of my career, I was good, keen on improvement, leading stuff from clinical to strategic health authority, forever striving to make a difference. But trying to deliver care, with Political meddling, politics in the NHS world, stretched resources made working within it increasingly difficult as years have gone by. I'm a little disillusioned and sad with where the NHS has arrived and I worry for it. I am retiring I've done 39 yrs, I wanted to do 40... but I dont' feel valued, I'm done!
You're right, there is some great stuff happening, some amazing people, the sadness is its isolated greatness, there is poor consistancy in the NHS, and inequity in delivery. My area has always been children and young people, as a nurse, health visitor, manager, commissioner and back to nursing again, and there was always so much I wanted and tried to do. GOSH was great but most children are looked after elsewhere with less fanfare or funding.
I think there should be more investment in proper universal child health and welfare, paediatric nurses available at the front end of the health process, in primary care and then an equity between mental and physical health of our young. (I've a 23 yr old daughter struggled with mental health illness since she was 12, I've lived experience of acute and community CAMHS as a parent, and the poor access to support she has an adult). Ironically and amazingly, she has almost completed training as a speech and language therapist and likely to spend her working life in the NHS.
Invest to grow a healthier generation of the population and you will make savings in the overall budget in the longer term. It's basic care for all, is the answer, and the founding principles that have got a bit lost.
I'll stop ranting now. Signing off.

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