Implementing technology to support the deteriorating patient in acute care: evaluating staff views
Early warning scores (EWS) have been widely used to aid in the detection of deterioration. The use of technology, alongside EWS, may improve patient safety and lead to improvements in the accuracy of documentation.
The aim of this service evaluation was to understand nurses' and healthcare support worker views around the implementation of handheld electronic devices for documenting care related to the deteriorating patient.
Before the implementation of an electronic handheld device, in-depth semi-structured interviews with nursing staff and healthcare support workers were undertaken to explore the context for improvement. The Consolidated Framework for Implementation Research was used to analyse, organise and present data, to ensure systematic inquiry across the range of potential facilitators and challenges perceived by staff. In all, 11 interviews were undertaken across three speciality areas (four wards).
Challenges to the use of new technology included staff apprehension around training and education needs and the uncertainty of technological reliability in the clinical setting. Potential facilitators to support the implementation of this technology were: the potential for improved communication across the individual ward and hospital setting and the potential for more streamlined processes for escalation of concerns.
Three main recommendations for practice emerged. First, nurses should be involved in the development of the systems. Appropriate time is required to embed the technology in practice. Finally, thought must be given not just to the absolute number of devices required and their reliability, but also how new technology interacts in each individual context.
Improving the safety of patient care is a priority for service users, frontline staff, healthcare managers and policymakers (Healthcare Improvement Scotland, 2017). This is especially true in the acute care hospital setting, which is known to be an area where there is a high incidence of preventable harms (Hogan et al, 2012). A specific target area for the prevention of patient harm is the management of the deteriorating patient (Jensen et al, 2018).
In the hours leading up to a cardiac arrest or an admission to an intensive care unit (ICU), many patients on general hospital wards have signs and symptoms of clinical deterioration (McGaughey et al, 2010). Evidence demonstrates that up to 80% of patients could be identified in the 24 hours before one of the above events and that 21-41% of ICU admissions from general ward settings are potentially avoidable (McQuillan et al, 1998; National Confidential Enquiry into Patient Outcome and Death, 2005; Buist et al, 2004). Furthermore, patients transferred unexpectedly to the ICU often have worse clinical outcomes and increased mortality (Jäderling et al, 2013).
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