Technology and Data in Nursing

There has been a noticeable acceleration in the adoption of digital technology across health and care in recent years, with more nurses involved at every stage than ever before. The use of technology and data can transform the delivery of care by making data and metrics visible to healthcare providers about their services in formats that can be interrogated in numerous ways, for example, to evaluate effectiveness or analyse trends. This can increase understanding of outcomes and lead to improved care and/or increased efficiency. This award is open to individuals and teams working in the NHS or independent sector, and recognises initiatives that have used technology and data in a truly innovative and patient-focused way to improve healthcare provision. Entrants must be able to demonstrate the benefits of their initiatives in terms of improved health outcomes, patient experience or service effectiveness.

Chelsea and Westminster Hospital NHS Foundation Trust
CCOT Advanced Clinical Practice – it's impact on improving the recognition and escalation of deteriorating patients in adult in-patient wards

Failure to recognise and respond to deteriorating patients is a global challenge that can lead to adverse health outcomes (Burke et al.,2022). Within our trust, inadequate monitoring of patients' physiological observations resulted in delays in detecting acute deterioration, putting patients at risk. In response, the Critical Care Outreach Team (CCOT) spearheaded a quality improvement project, the Recognition and Escalation of Deteriorating Patients(REDP), aimed at enhancing the performance of ward staff in monitoring and escalating patients' physiological observations and adherence to Trust National Early Warning Score (NEWS2) guidelines. This initiative facilitates the prompt recognition and escalation of acute deterioration, thereby increasing the chances of survival and improving the patient experience, leading to other positive health outcomes.Driver Diagram and PDSA (plan-do-study-act) cycle were utilised to implement 1)the 'Observations Rounds', 2)the efficient utilisation of a digitalised real-time 'Deteriorating Patient Dashboard', and 3)the cultivation of collaborative culture in developing effective strategies through CCOT partnerships with the senior and ward nursing staff. The key metrics/performance indicators used were 1)improved compliance with the Trust's NEWS2 and Escalation Protocol and 2)reduced cases of failure in recognising and escalating deteriorating patients, With the gaps in clinical practice identified and limited resources encountered by the team, thorough planning and employing CCOT’s advanced clinical practice were crucial to achieving the target outcomes. As a result, adherence to the Trust's NEWS2 and Escalation protocol and clinical performance in recognising and escalating acute deteriorations improved from 55% to 89%. The electronic incident record also indicated a notable decrease in cases by 50%. The REDP delivered other positive outcomes, underscoring the effectiveness of the project in enhancing patient care.The next phase is focused on sustaining the improved clinical practice in patient monitoring and developing new innovative digitalised tools for detecting and escalating patients' deterioration.

Leeds Community Healthcare NHS Trust
Love to learn

Learning and development opportunities across the trust are sporadic and not very well publicised. Love to Learn aims to bring every aspect of learning and development into one place for all staff in the trust can use. I undertook a scoping exercise exploring all the different training and development opportunities across the created a page on the trust intranet page to ensure that all aspects of training and development are showcased and accessible in one location. At first it was a massive task to do and undertaking it singlehandedly was not going to be the way forward, collaboration with all departments has seen the page grow and gain traction. In addition to this, the ethos of the project has gone nationwide and Sutton Health and Care / Surrey Downs Health and Care/ Epsom & St. Helier NHS Trust have launched their own site "The Learning Academy". We are hoping that we can grow the site further and incorporate a dedicated platform for students who are on placement with us so that they can have access to the training and development opportunities whilst with us. I definitely couldn't have got to this stage without the help and support of the Queen's Nursing Institute. I undertook a Community Nursing Innovation Project with the QNI which has definitely enhanced the page and offered a new perspective whilst in the creative stages of this process.

LloydsPharmacy Clinical Homecare
Utilisation of technology and data in nursing

We have forged a collaborative partnership with Careology, aimed at bolstering patient support within the realm of oncology care. Specifically, our focus lies in integrating this technology to facilitate the delivery of personalised care plans by clinical nurse specialists, tailored to the unique needs of each patient. Through this collaboration, we have integrated Careology's digital platform to empower patients in their oncology journey. Utilising the UKONS toxicity assessment triage tool, patients are prompted to input their current physical and emotional state, enabling them to receive tailored guidance on the level of support or advice they may require. This real-time data not only assists our oncology nursing teams in preparing for patient visits but also aids oncology nurse advisors in acute oncology triage and assessment, alongside clinical nurse specialists (CNS) in their care planning endeavours. The CNSs benefit from a comprehensive overview of patients' well-being prior to scheduled interactions, enabling them to proactively address symptoms such as fatigue by disseminating relevant, credible resources and these are sent our as a push notification to the patients. Furthermore, by incorporating holistic needs assessments into our pre-CNS visit protocols, we not only enhance patient care but also gather valuable internal data for performance metrics and service enhancement initiatives. While initial adoption presented challenges, particularly among patients less accustomed to digital applications, comprehensive education regarding the benefits of this platform within their individualised care pathway has significantly increased uptake. Looking ahead, our endeavours will extend to the publication of data showcasing the tangible benefits of digitalization in optimizing care planning processes. Through ongoing research and refinement, we aim to further underscore the transformative potential of technology in enhancing patient outcomes within oncology care settings.

NHS Blood and Transplant
TransplantPath

We identified a critical bottleneck in the organ donation process: the pace was hindered by outdated email and paper systems. With the growing complexity of donor information and the increasing need for organs, a streamlined solution was imperative to expedite the process. So, we teamed up with the tech wizards at Apadmi to create ""TransplantPath,"" a nifty web app that makes sharing transplant information a breeze, keeping it secure and at our fingertips.Switching over wasn't a walk in the park. We had to ditch a costly, clunky system and engage with thousands of stakeholders across the UK. TransplantPath brought everything under one roof, cut down on the phone calls, reduced risk, increased productivity and made our workflow smoother. In the first two weeks, it helped share over 550 top-notch organ pics and clips.Looking to the future, our ambition doesn't stop here. We are committed to further improving organ donation and transplantation practices, aligning with NHSBT's overarching goals and the 2030 strategy. Our focus is on maximising the utilisation of donated organs and overcoming any obstacles that may arise. One of the most promising aspects of TransplantPath is its scalability. It's constructed to be adaptable and shareable, not only within our borders but potentially on an international scale, contributing to the progress of global health. In a nutshell, TransplantPath has been a game-changer for organ donation and transplants. It's made decision-making faster and safer, and that's a win for everyone. It's a testament to what happens when nurses lead the charge, we focus on the users, and everyone pulls together.

North Bristol NHS Trust
Safe to Respond – Preventing deterioration with technology and data


Royal Wolverhampton NHS Trust
Virtual ward remote monitoring

The aim of the Virtual Ward was to support patients who would otherwise be in a secondary care bed, to continue the acute care, remote monitoring and treatment they required within the comfort of their own home or usual place of residence. Providing a 7 -day service, 24 hours a day, the Virtual Ward itself working 08:00 - 22:00, with out of hours cover delivered by community urgent care. It would be to act as a step down and step up service, to avoid unrequired hospital admissions and allow for earlier discharge home. The Virtual Ward was initially set up and implemented just before Covid, however as it's potential and need was noted, the team recruited 2 Digital Nurses to the Virtual Ward team. By doing this, it allowed for dedicated staff to review and streamline the pathways and care provided, ensuring that it was tailored exactly to patients needs and expectations, and was an easy interface for staff to implement and utilise. As with anything work was required to engage staff with the importance of digital and technology use in remote monitoring of patients, through education with staff and competencies, staff have grown in confidence and competence, and can now encourage patients to utilise the technology available. There is also the issue with equity within the local area, and taking into account digital device availability for patients, however we have managed to source phones for patients to use to utilise the App for their remote monitoring. Education is also provided to patients on their initial assessment to the Virtual Ward on how to use not only the medical equipment, but also on how to use the smart devices to document their observations. We already have several pathways on our Virtual Ward and our aim is to develop more.

Serco Group, Mental Health Innovations UK and Unify Business Solutions
SHOUT for prisoners

The National Audit Office report on mental health (2017), calls for an urgent ‘step change’ in efforts and resources to support mental health in the community and in prison. In the community, patients are increasingly able to access family and other support in ways that are unavailable to prisoners, e.g. online applications. Now more than ever, being in prison has a major impact on prisoner wellbeing. It is therefore incumbent upon us to support the most vulnerable prisoners with innovative methods and tools. Historically, a text service to support mental health in prison has been impossible as phones/technology are not readily available or have limitations in a custodial environment. However, Serco, alongside Mental Health Innovations and Unify have collaborated to scope, build and develop a technology to enable such access to SHOUT.SHOUT is a confidential mental health text service that supports people in crisis with issues such as suicidal thoughts, abuse or assault, self-harm, bullying and/or relationship challenges. On reaching out to the service, individuals receive help to move from a moment of crisis or distress to a place of calm, and then further support to create a joint safety plan to mitigate future crises. Serco, MHI and Unify developed the service to ensure viability within a prison. Prisoners are able to access the service 24/7 from their in-cell devices. To ensure prisoner safety and access to emergency services when using SHOUT, we developed an Active Rescue Standard Operating Procedure (building on the established MET police process). Through this process, for anybody displaying signs of crisis, an emergency call is placed to the prison to initiate an in-person welfare check on the individual. Due to the success of SHOUT, the pilot has been extended to additional prisons and is now offered to our staff for additional mental health support.

South Tyneside and Sunderland NHS Foundation Trust
Enabling effective learning environments amongst nursing, midwifery and allied health professionals using virtual reality technology

Integral to the NHS Long-term workforce plan is recruitment and retention. A key point of the plan is to increase the undergraduate nursing student capacity in university and in clinical placement areas to develop a larger future workforce. South Tyneside and Sunderland NHSFT Education Team for Nursing, Midwifery and Allied Health Professional students have acknowledged this requirement and has strived to develop a virtual reality project to aid in clinical placement expansion. The team obtained a grant from NHS England to purchase virtual reality digital equipment to enhance student placement experience and aid in increasing clinical placement capacity amongst all Nursing, Midwifery and Allied Health Professional students. The use of this equipment is enhancing student education, knowledge and placement experience. The benefits of this could potentially lead to student recruitment post-graduation due to the positive experience experienced during placement. The virtual reality equipment consists of the Microsoft HoloLens 2 and Microsoft Real Wear headsets. The HoloLens 2 headset covers the head with clear glass in front of the eyes. It immerses the student into a real-life environment in which different scenarios can be created to enhance, critical thinking, rationalisation, communication, inter-professional working, assessment and evaluation. This device enables students to practice in a safe learning environment in which mistakes can be easily rectified and discussed without potential patient safety issues. RealWear device live streams clinical procedures over a secure network via Teams. It is streamed to students in a classroom on trust property. This allows hard to view placement areas to be more accessible. Therefore, enabling students to view different real-life cases and potential issues. It also allows students to view a wider range of potential working areas post-graduation, therefore potentially increasing the workforce of the trust.

West Hertfordshire Teaching Hospitals NHS Trust
Self-rostering using employee online

Introducing self/team roster provided assurance of the Trust’s commitment to flexible working by responding to feedback on the staff survey “you said, we did” where staff wanted more input into their roster. Staff highlighted the want for flexibility and it was a key priority for both clinical and non-clinical staff. Current practices around flexible working included applying for a flexible working agreement which very few staff had done or had approved. Also, all staff only had a maximum of 4 requests per roster (for full-time staff).As a Trust, we were able to implement this through maximising the use of Employee Online, our existing rostering application that staff were already familiar with for booking leave. By offering self-rostering we hoped to see an associated improvement in unused hours (as staff can see their balance on the app and can query any discrepancies) and an improvement in sickness rates due to a better work-life balance. A QI approach was used to implement the project using a series of PDSA cycles. A task and finish group was set up consisting of heads of divisions, matrons, corporate workforce team, HR and the QI team with regular meetings working through a timeline and agreed action plan. The rosters were reviewed to ensure skills, rules and patterns were up to date - this allowed for managers to have safety measures in place to help with ensuring patient safety and fairness. The maximum number of requests were increased to allow staff to choose their own shifts. We held focus groups and did walk-abouts to ensure staff were aware of the project and address any concerns they might have. Wards with high vacancy rates proved a challenge with uptake as they were sceptical self-roster could work. Robust rules on rosters ensured well-balanced requests which alleviated the situation.

West Hertfordshire Teaching Hospitals NHS Trust
Surgical virtual hospital for elective colorectal patients

Our clinical lead for surgery delivers one of the largest volumes of robotic surgery in the country and promotes regional and national robotics strategies. Our robotics and Enhanced Recovery After Surgery (ERAS) programmes have contributed to a successful colorectal service at WHTH. How could we improve the service and reduce our post-operative stay even further? Could we improve patient satisfaction and experience while challenging the status quo? To do this, we constructed a surgical virtual hospital model for elective colorectal patients. The Trust operates a pioneering medical Virtual Hospital (VH), so we collaborated with them to add elective surgical patients. We met weekly with VH service leads and a project management team. We held stakeholder focus groups and consulted a patient representative throughout. A retrospective audit revealed that in six months we could have saved 22 beds. We established robust guidelines, pathways and policies to ensure the safety and effectiveness of the project. Hub nurses, ERAS nurses, and a colorectal team clinically managed patients to deliver integrated care under ERAS nurse supervision. The ERAS nurse would identify suitable patients pre-operatively and reassess post-operatively to ascertain if they met the strict inclusion criteria. Engaging the colorectal team in decision-making and sharing our data and experiences helped us overcome our key barrier, which was engagement from the wider team. Patient buy-in was also initially challenging however our comprehensive patient information leaflet helped to remedy this and we quickly gained patients' trust. Our data shows that we have saved 30 beds since November 23, surpassing our original target. 100% of patients felt comfortable and 100% believed VH was a better option. Our long-term goal is to do same-day discharge colectomies, which may be achievable because of our VH. We also intend to expand our service into other surgical divisions, followed by emergency care.