Dr. John Sandham responds to the findings of the HSIB’s report on access to critical patient information at the bedside. Leadership, training and investment in up-to-date technology are key to driving improvement, he argues...
The HSIB report found that misidentification and limited access to critical information at the bedside, delayed treatment and led to a Patient not receiving CPR. The core conclusions of the report point out the risks of poor data recording and the need for better technology and policy making, to help improve practice, and ultimately improve care.
Technology supporting identification: ‘Staff told the investigation that handheld devices, via the electronic observation system, had a handover function. However, this was not used as staff preferred paper’. A core component of this report is the discussion of how ‘verifying CPR recommendations at the bedside’ must be achieved, but there appears to be a wider issue highlighted; how can any data be verified as true if staff are recording data in their preferred way (on paper) and not in accordance with the Trust policy via the electronic patient record? If there is a policy, it must be understood and audited.
Equipment issues: ‘Equipment issues related to the amount available, faulty equipment, poor battery life, and small screens making reading information difficult. The fixed positioning of desktop computers and limited availability of laptops also meant staff were not always able to have a computer with them at the bedside to access the EPR’. Most of the NHS hospitals I visit have issues with under investment in technology. In private industry, the companies that invest in good quality technology reap the benefits. The Government needs to recognise that there must be a significant investment in technology if they are to achieve a step change in the way the NHS operates. There has been limited investment in technology, but nowhere near enough to deliver on the Government’s aspirations. The NHS needs billions of pounds – just for technology, but it is only worth spending this money if the clinical staff expected to use it are trained and fully understand the benefits.
Display of patient information: ‘Low-technology displays of patient information seen by the investigation included whiteboards, laminated paper, and posters. The investigation found variation in where and how these displayed information at bedsides. Variability included position, visibility, readability and legibility. The investigation observed situations where they were unable to read information’. This is another example of some NHS organisations still operating in ways that they did 20+ years ago. Management and policymakers are responsible for ensuring that their Trust operates efficiently. Poor practice can occur where there is poor policy; or lack of adherence to policy – i.e. poor management.
Policy delivery and training: ‘The investigation reviewed 12 resuscitation policies and 8 patient identification policies from hospitals in England. None of the policies directed staff to check patient identity during CPR, although one did note the importance of establishing identity at the earliest opportunity. Each resuscitation policy referred to the need for a ‘valid’ CPR recommendation, but did not clarify what a 'valid’ CPR recommendation is.’ Although this report focuses on the risks of what can happen if a patient is wrongly identified, there are many other points that can be picked out if one reads between the lines. The NHS has problems with: policy making, policy delivery, under investment in technology, and lack of training in technology.
Until we have managers that are trained to deliver in accordance with ratified policies, and investment in up-to-date technology, with users that are trained to use it, then we can expect the level of clinical care to be less than it could be and the NHS to be less efficient than it should be.