On a mission to become the safest hospital in England
I recently sat down with Helen Carter of Salford Royal NHS Foundation Trust (Salford, United Kingdom) to discuss how electronic patient records (EPR)* have resulted in positive changes for nurses.
In 2008 the Chief Executive of Salford Royal NHS Foundation Trust set forth a goal to be the safest hospital in England. “That was a very brave statement,” observed Helen, Corporate Matron, with 19 years of nursing experience in the coronary care unit for cardiac patients. “We’re on our way to achieving that goal because of our EPR,” Carter said.
It started with “baby steps” in one ward
Helen Carter has a unique perspective on Salford Royal’s journey from paper prescriptions to electronic prescribing EPRs. She was the Ward Manager for the 10-bed coronary care unit that piloted the first system, starting in 2007. It was a smaller controlled environment, which made it easier to test the new system.
A paper-based system was labor intensive for doctors in this unit. For example, they would have to handwrite drug charts. The hospital took a phased approach to implementing electronic prescriptions and then further expanding nursing and medical documentation.
“We started with baby steps…just e-prescribing in one ward,” said Carter. Now she estimates that approximately 85% of Salford Royal’s nursing records are electronic, covering all of the inpatient ward areas. This includes nursing admission, evaluation of care, transfer and discharge documentation.
“Now we only have two pieces of paper at the patient bedside, one for clinical observation and one for intentional rounds,” said Carter. “I think staff recognizes the advantages of electronic records. It has really changed our culture.”
3 ways EPR has advanced safety and quality at Salford Royal
In 2013, Salford Royal activated Allscripts Sunrise Clinical ManagerTM, three months ahead of schedule and on budget. Helen Carter shared three examples of how electronic systems have improved patient safety and quality of care at Salford Royal:
1) Instant access to organized information.
“Paper seems so accessible because it’s right in front of you. Electronic records are structured and organized, therefore it makes it so straightforward and better than having to physically go through paper to look at patient notes.”
2) Best practice reminders at the point of care.
“The system states exactly what you’re supposed to do and when. It has helped standardize care using best practices.”
3) Accountability through documentation.
“More than anything, the audit trail is changing our culture. Look at medications as an example. Say a patient misses a dose of an IV antibiotic, before it was hard to see what went wrong because there was no way to track it. Now we can see who requested the dose, when the pharmacy received it, if the pharmacy dispensed it, and so on. It’s all very clear.”
What’s next for Salford Royal: Seamless patient journey
Now Helen Carter is part of a team that hopes to improve the patient experience across acute and community services. “We want the patient’s journey to be seamless,” she said. “So whether the patient is in the hospital or out in the community, staff have the same access to those patient records.” The main challenges to overcome include access to devices and Wi-Fi.
After observing the transition from paper to electronic records as a nurse on the floor and a nurse manager, Carter said, “I’ve been to at least five different organizations; and it is fair to say that SRFT has a more structured and extensive EPR system.”
*Editor’s Note: Electronic Patient Record (EPR) is another term for Electronic Medical Record (EMR) or Electronic Health Record (EHR).