Nurse-led technology helps to improve patient experience and outcomes
E-observations play a major part indentifying sepsis and other life-threatening conditions, but clinical judgement and bedside care is still essential
Hospitals in Manchester are using nurse-led technology to identify sepsis and other life-threatening conditions.
Sarah Ingleby, lead nurse for the acute care and hospital at night teams at Central Manchester University Hospitals NHS Foundation Trust (CMFT), says the Patientrack electronic system has helped staff identify, manage and treat sepsis.
‘When a child comes in, you think ‘sepsis’ and then move on to other things. We need to think 'sepsis' every time. With this system, combined with clinical observations, it is less likely to slip through the net.’
In the UK there are as many as 200,000 cases of sepsis, resulting in up to 60,000 deaths each year *. According to health secretary Jeremy Hunt, about 12,000 of these deaths may be avoidable.
In 2000, CMFT implemented early warning scores (EWS) to identify deteriorating patients. However, it was found that staff sometimes lacked the confidence to manage very sick patients and senior staff were not always alerted to deteriorating patients as quickly as they should have been.
‘There were different reasons why people were reluctant to escalate, such as “I think I’ve done everything I can” or “I want to escalate, but I don’t want to bother the doctor”,' says Ms Ingleby.
The trust introduced Patientrack in 2009, having considered many other systems. So how does it work in practice?
‘The observations are entered at the bedside using a handheld device,' says Ms Ingleby. 'If someone is a bit poorly, it bleeps the nurse in charge. If they get sicker it bleeps the junior doctor, if they become very sick it bleeps the senior doctor and critical care.
'Therefore the nurse never has to leave a deteriorating patient to chase round looking for a doctor. She knows that the doctor will respond.’
Ms Ingleby is keen to stress that clinical judgement is also essential. ‘We cannot rely on electronic systems 100%. They are only one part of an overall approach.
'You also need to make sure that staff have the correct level of expertise and critical care skills. That is why in every ward I have a nurse who has been on an acute illness management course.’
Nurses need to do more than simply respond to a bleep. ‘You have to be taught how to manage a person who may not trigger the EWS,' she says. 'For example, they may be on beta blockers so their heart rate might not be so fast even though they are dehydrated.’
Several other trusts have installed the system. NHS Fife was the first health board in Scotland to introduce Patientrack at the Victoria Hospital, Kirkcaldy. And in March, cardiac arrests had fallen by two thirds after only 6 months of using the technology. It is also being hailed as a great success at Harrogate and District NHS Foundation Trust.
Patientrack has now been embedded in all inpatient areas in 55 wards in adult and children’s hospitals across Manchester.
‘Engagement of staff was key to getting this right but they were convinced very quickly,' says Ms Ingleby. 'It was the alerts and the fact that doctors are central to the system that got people on board.’
Over time the company has worked with staff to develop Patientrack's use for a number of different assessments that have come from the wards.
Robust reporting system
The system is also popular with patients who like the fact that staff are automatically alerted when they are ill.
Ms Ingleby says there are other benefits. ‘There is a screen on every ward where you can see who has triggered an alert,' she says. 'If I come on night duty, I can go to a patient and say “I see you have been feeling poorly". Also, critical care can send a patient to the ward and then keep an eye on the screen to see if the patient has got a bit sicker.’
She says all this is backed up with a robust reporting system. ‘I can see on the screen if someone has not responded. Response rates are reviewed each week and staff are held accountable.’
Since Patientrack was introduced, the trust has seen a 50% reduction in cardiac arrests, reduced critical care length of stay and reduced risk of mortality for out of hours’ admissions. The length of stay for patients with sepsis has reduced by more than 50% and morbidity in emergency departments as a result of sepsis has also reduced.
Data are also being collected from several thousand observations on a daily basis, which means that CMFT can see how different wards are responding to patient needs and all sets of patients’ observations are maintained for the duration of their stay.
Ms Ingleby says: ‘6 months ago we reviewed our mortality over the 7-day week. There was no difference between weekdays and weekends, and we believe this is due to the fact that we now have systems working 24/7 to pull nurses and doctors to patients’ bedsides whenever they are needed.’
Ms Ingleby says she has no doubt that electronic observations will be introduced nationwide in the near future.
Bedside observations still vital
‘We have made such a big difference to the patient experience and to patient outcomes, you could never take it away. And when you speak to nurses, feedback is always “We love it. We know that patients are safer because they are always responded to quickly".'
Ms Ingleby, however, does not think that nurses are going to be replaced by machines any time soon. ‘There has been some talk about automatically uploading blood pressure results, but I am not in favour of this,' she says.
'We should be at the bedside with our patients to check their pulse rate, to see if their skin is clammy. When you are doing clinical observations the hands-on bit is important so that you hold on to that level of understanding about your patients.’
* According to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) published in November 2015.
UK Sepsis Trust's six most common signs
Slurred speech or confusion
Extreme shivering or muscle pain
Passing no urine (in a day)
Patients saying: 'I feel like I might die'
Skin mottled or discoloured
Alison Whyte is a freelance journalist