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04.08.15

Mobile technology in action – ‘It’s like having another person with you’

Camden & Islington NHS Foundation Trust says the big grant it won from the Nursing Technology Fund is enabling a “technological revolution”. NHE spoke to the mental health trust’s director of nursing and people, Claire Johnston.

Camden & Islington NHS FT (C&I) won £750,000 from the Nursing Technology Fund – one of the highest awards to any mental health trust – which it says will benefit thousands of people with mental health conditions.

The cash will help fund smart devices, tablets, software and laptops for staff, improving the quality of service they can provide and ensuring they can spend more time overall with patients, the trust said.

The award comes at a great time, because the trust is about to shift from using the Rio electronic patient record system to Carenotes instead from early September. Trust director of nursing and people, Claire Johnston (pictured), who is also one of its ‘champions’ for IT, called the timing “serendipitous” and “wonderful good fortune”.

Claire Johnston V1 resize 635736147035761691 crop 635736147164507013She told NHE: “It means that we will be able to purchase for our nursing workforce – though we also work in multi-disciplinary teams with social workers, occupational therapists, with psychologists, and of course our medical staff – the relevant iPads and technology that they need to be able to do their jobs much more efficiently.”

She said such efficiency is vital, because the trust is coming under increased pressure and facing rising patient need.

She described “a significant growth in patients we’ve not had any experience of working with before”, linked perhaps to the trust’s geography near several major London railway stations and the Channel Tunnel, and new patients coming from abroad. “Whatever the motives for those people, the change in patterns means there are more people who currently seem to have mental health problems, so our staff are at full capacity – as we expect them to be.

“So the only way we can be more efficient, and to take the burden from them, is through investment in technology, which we know will be a significant time-saver.”

Teams in the field

The technology will be especially useful for community teams working out in the field. “It’s like having another person with you, almost,” Johnston said. “You can co-produce sound decisions and ensure at the same time that risk and safety is considered, because you’re creating that care plan with someone. You can be very clear about the medication they’re going to be taking, the extent of those risks. Once you’ve created that care plan, it’s then available for the wider mental health community who may be looking after that person, at the push of a button.”

That will be particularly useful for patients in rehabilitation pathways for mental health, who often live in housing projects and programmes that are not run directly by the trust. It will also mean that staff working with service users can give advice or ideas and be precise about details by checking them online – for instance, locations and opening hours of drop-in facilities, reasonably priced places to eat, or therapeutic activities on offer.

Staff working on inpatient wards will benefit too from the new technology and software, Johnston added.

Enthusiastic staff

C&I involved its staff in the original bid to the Fund, ensuring its case was “watertight”.

The trust’s deputy director of nursing, Dr Fiona Nolan, was “pivotal” in creating the energy for the bid, Johnston said. “Her specialism is R&D, and unusually for a trust she has a team now of eight nurse researchers – they’re all people who are absolutely at the cutting edge of what technology can do, and we were able to draw on their ideas.”

Other staff also had input, from infection control to educational programmes.

Enthusiasm levels remain very high, with more than 150 ‘champions’ who’ve self-nominated as part of the trust’s EPR (electronic patient record) programme.

Johnston explained: “I don’t mean that all of the workforce sees all of the possibilities quite as much as I do as a leader, but there are enough who certainly do, and who have got that commitment. That partly builds on our history: we’ve had EPR for a long time, but the changes we’re making and the particular product mean that we think this will be much more intuitive.

“That’s critical for our clinicians: that they have a tool that enables them not just to record notes – that’s yesterday’s news, and what you expect to be able to do with such a tool – it’s more the co-production. So that there’s a decision-making tool at your fingertips, and you’re able to take that mobile tablet or iPad out to the community.”

She said a community team member could be working with a homeless person on Hampstead Heath in a sleeping bag, and talking their care needs through with them. “I know that sounds quite extreme, but there’s no reason that somebody who lives in that way wouldn’t be just as interested in understanding their health and working up a joint care plan as somebody in a more traditional facility.”

‘Quantum leap’

The trust’s associate director of ICT, David Jackland, said: “This is a quantum leap forward for our service provision. This news could not have come at a better time for us as we prepare to go live with Carenotes on 7 September. This new technology will have an incredibly liberating effect on our staff and help us enormously in our work with partner agencies. This is nothing short of a revolution in our capabilities.”

Among the tech purchases being made by the trust are more than 300 iPads, which will allow more work to be done without the clinical teams needing to return to base.

The grant comes from the second wave of the Nursing Technology Fund, originally set up in 2012, which was extended to mental health trusts more recently. C&I’s bid was called ‘Enabling Excellence through the eNurse project’ (see below).

The software being used is called iNurse, created by Advanced Health & Care – which is also the company behind Carenotes.

Barriers

Johnston said one issue that still needs solving when doing work in the community that might have previously been done ‘back at base’ in producing a copy of the care plan. “It’s very important that they then have that record of the things that you’ve agreed,” she said, adding that email was a possibility but not for all service users.

“We will find a work-around. That’s how we work in mental health,” she said.

The trust has a “fair but reasonable” policy on non-work use of the tablets, recognising that they can be used for research and even for things like educating service users on how to do online shopping, for example. Anyone abusing the trust placed in them would find the trust coming down hard though, she said.  

Johnston talked NHE through the patient privacy and information governance safeguards in place, as well as the work being done to ensure staff use social media in appropriate ways – as raised by the Nursing & Midwifery Council revised code.

She said: “We’re running some workshops for our nursing staff on that – not that they would ever be thoughtless, but sometimes it’s a case of giving a helping hand and describing some scenarios, so that they can think about their own practice in the light of that.

“A lot of this can be done, I think, with good common sense. Health professionals are absolutely steeped in boundaries about confidentiality, and the sharing of information. While I know that we’ve got to be ever-vigilant, I really don’t think that those must be barriers to the real benefits that we will have with the scope of technology.”

Enabling Excellence through the eNurse Project

The project focuses on making our workforce more agile through the use of tablet devices and the iNurse application to monitor and manage physical health for our service users. Under the project we also want to improve access and interoperability of health care records with our primary care partners through a portal and bringing in a feed from our pathology labs in the acute sector to our existing electronic patient record system.

Source: Camden & Islington NHS Foundation Trust project description given to Nursing Technology Fund.

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