Analysis

RCNi launches interactive decision support tool created by nurses for nurses

Evidence-based resource aids clinical decision-making at the bedside

Evidence-based resource aids clinical decision-making at the bedside

  • The interactive point-of-care tool helps with assessments
  • Guidance on how to proceed is based on answers given by the nurse
  • Helps nurses reach safe, appropriate decisions in line with evidence and guidelines

Picture: Getty Images

The theory behind good clinical decision-making in nursing care is straightforward enough. Whether the choices to be made are simple or more complex, the core skills required remain similar.

23

areas of care are covered by RCNi Decision Support, with wide applicability across acute and community nursing care

Among those skills are critical thinking; knowledge and the application of evidence; communication with colleagues, patients and relatives; and the ability to reflect on and learn from experience.

In practice, however, making the right choice every time, in all circumstances, is challenging.

Up to date and on hand

Too few staff, too many patients, distraction, fatigue, simple human error – the possible pitfalls are many and the consequences of making the wrong decision are potentially serious for patient and nurse.

Now, though, help is at hand. RCNi has launched a new, interactive point-of-care tool that helps nurses to ensure their assessment and treatment plan is safe, appropriate and in line with the most up-to-date evidence and guidelines.

RCNi Decision Support, launched on 12 September, is accessible on a PC, Mac or tablet, covers more than 100 topics across 23 specialties. The specialties have been selected according to what will have the most positive effect on patient safety and care standards, and range from cardiac care to mental health, diabetes and resuscitation (see box).

Richard_Hatchett©DG
Richard Hatchett: The tool provides
the information nurses need at every
step. Picture: David Gee

RCNi senior nurse editor Richard Hatchett explains that each topic included in the tool highlights decisions that need to be made early by a nurse undertaking assessment or treatment.

‘RCNi Decision Support does that by posing questions relating to patient observations,’ he says. ‘It then provides guidance on how to proceed based on the answers given by the nurse.’

Standardising best practice

Importantly, it uses red flags to ensure immediate action and escalation when appropriate, so a nurse using the tool is left in no doubt when further steps need to be taken without delay.

Dr Hatchett is keen to emphasise that the tool does not make decisions for nurses. ‘Rather it supports and guides them through the process by providing the information they need at every step.’

He says RCNi Decision Support has been designed to help standardise best practice in  organisations. ‘In doing so, it promotes a consistency in the standard of care by ensuring all staff are following guidance that is evidence-based and up to date.’

What are the specialties?

RCNi Decision Support covers 100 topics in the following 23 specialties:

  • Infection control
  • Medicines management
  • Nutrition
  • Diabetes
  • Mental health
  • Resuscitation
  • Intensive care
  • Endocrine
  • Safeguarding
  • Pharmacology
  • Wound care
  • First aid
  • Communication
  • Children
  • Midwifery
  • Pre- and post-pregnancy
  • Bowel and kidney
  • Respiratory
  • Intravenous therapy
  • Pain
  • Venous
  • Cardiac
  • General

The 23 areas of care covered by RCNi Decision Support have wide applicability across the general workforce in acute and community sectors. Each of the 100-plus topics included within those 23 areas focuses on best practice, current evidence, patient safety and reducing common errors in practice.

Peer-reviewed content

The topics are logically structured, and include an overview, initial and ongoing assessment, as well as a glossary, bibliography and summary of decisions made. Appropriate links are included to Cochrane reviews and seminal studies, and to bodies such as the National Institute for Health and Care Excellence, the Department of Health and Social Care, and the Scottish Intercollegiate Guidelines Network.

Written by nurses with vast experience in the relevant fields, the topics have undergone internal and external peer reviews. The external review panel comprises expert nurses, clinical specialists and lecturers who check for accuracy, validity and current use.

‘We’ve asked the writers to use the latest best practice guideline so all the content is based on evidence,’ says Dr Hatchett.

Regular reviews

Reviews will be undertaken regularly to ensure the content remains current, and topics will be updated whenever guidelines and evidence change.

Dr Hatchett says a key advantage of RCNi Decision Support is that it can be customised in line with local policies and procedures. ‘With catheterisation, for example, a note can be added saying that in this organisation we use this particular type of catheter. That helps shape the decision pathway according to what goes on in practice locally.’

The tool can also be customised to allow users to download a locally relevant document or procedure without having to interrupt or suspend patient care.

Quick, intuitive and simple to navigate

Similarly, and to help save time and improve decision-making, various nursing calculators and toolkits are included within the platform, such as the National Early Warning Score, the Verbal Rating Scale and the Glasgow Coma Scale.

Furthermore, the tool's functionality is quick, intuitive, simple to navigate and easy to use, meaning staff require only minimal training before they are ready to use it in practice settings.

RCNi Decision Support: the benefits at the bedside

The interactive tool brings benefits for nurses and organisations by:

  • Standardising practice. Every nurse can provide the same quality of care in every setting
  • Improving patient experience, safety and outcomes. Clinical decisions are founded on evidence-based information underpinned by current guidance and delivered at the point of care
  • Saving time. The speed of assessment is increased and time is not wasted on unreliable internet searches
  • Saving money. It avoids the cost of unnecessary and expensive tests and investigations
  • Helping reduce mistakes by ensuring compliance with national guidelines
  • Increasing engagement of staff by empowering them to make clinical decisions autonomously
  • Allowing review of decisions made, for cross-referencing later with patient records if required
  • Increasing nurses’ confidence to make clinical decisions in unfamiliar settings or situations

The tool can be used on PC, laptop or tablet

 

 

Barry Quinn, director of nursing for cancer and palliative care at Barts Health NHS Trust and consultant editor of Nursing Standard’s sister publication Nursing Management, says: ‘This is an exciting time for nursing, full of opportunity and development.

‘But within the increasing complexity of health and social care today, nurses are required to deliver the core skills of nursing care alongside an increasing need to develop technical clinical skills.

‘Because it is designed by nurses for nurses the approach to the decision-making process is grounded in the values and core skills of the profession’

Barry Quinn, director of nursing for cancer and palliative care at Barts Health NHS Trust, and consultant editor of Nursing Management

‘RCNi Decision Support is a practical, evidence-based tool to support nursing colleagues in a vast range of practices and settings,’ adds Dr Quinn. ‘The value of the support tool is that it guides the individual nurse to apply critical thinking to the clinical decision-making process.


Barry Quinn: ‘Its value is that it guides
nurses to apply critical thinking.’ 
Picture: David Gee

‘And because it is designed by nurses for nurses it ensures that the approach to the decision-making process is grounded in the values and core skills of the nursing profession.’

100-plus

topics included within the 23 areas of care, focusing on best practice, current evidence, patient safety and reducing common errors

Key among the benefits of RCNi Decision Support are efficiency and time saving, both valuable assets when nursing teams are working within restricted budgets.

The tool will also help senior nurses use their time more effectively by providing junior staff and nurses new to an area of care with the confidence and knowledge to make decisions autonomously yet with clear instructions about when to escalate.

RCNi editorial advisory board chair Caroline Shuldham is delighted that the support resource is available. ‘Nurses make multiple clinical decisions every day, and many are complex and central to patients’ well-being,’ says Dr Shuldham. ‘So it’s great to have a digital resource at hand to guide nurses when they need help.’

Making clinical decisions in practice

RCNi Decision Support guides a nurse’s critical thinking when assessing and treating patients, but does not make clinical decisions on the nurse’s behalf.

King’s College London senior teaching fellow in adult nursing Mary Raleigh says: ‘I have found over the years that one of the most important things in how you make a clinical decision is how you engage with the patient. By that, I mean how you communicate with them.’

She suggests using a framework called ICE, which involves exploring the patient’s ideas, concerns and expectations.

Allow time to talk – and listen well

‘Allow them some time to talk at this stage and listen well,’ Dr Raleigh advises.

Bring together more objective data such as vital signs and combine all the information gathered from the patient with intuitive reasoning, evidence, and knowledge from practice and formal education.

‘I would put all of those forms of knowledge together to make a clinical decision.’

But most important, she says, is involving the patient. ‘No decision without me. That’s my top tip on how to make clinical decisions in practice.’

 

Daniel Allen is a freelance health writer

 


Find out more

  • For further information or to request a FREE TRIAL of the tool click here

 

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