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Keeping nursing procedures up to date can be a tedious and neverending task. For the past three years, however, the five Midland region DHBs have been using a ‘Kiwified’ online nursing procedure service that is shortly to go live across the South Island. FIONA CASSIE finds out more.

It’s not unusual to see new graduate nurses on Waikato Hospital wards pulling out their iPhones to do a quick double-check on IV procedures.

That is just one of about 1,200 DHB-endorsed nursing procedures they can tap into online via a service they’ve had access to since they were students at the region’s nursing schools. And if their nursing careers see them shift to a rest home in Waihi, a hospital ward in Tauranga or a Waikato hospice, they can still access the same procedural protocol and service.

This is all thanks to a Midlands project led by Waikato DHB, with seed funding from the Ministry of Health, which evaluated and then selected a United States guide, Lippincott’s Nursing Procedures, to be delivered online to the region’s five district health boards. (The Midland region covers the Bay of Plenty, Lakes, Tairawhiti, Taranaki and Waikato DHBs).

After reviewing and customising some of the procedures to reflect New Zealand practice, the guide went live online in May 2012 to nurses and midwives at the five DHBs and also to nurses in non-DHB services, from hospices to rest homes.

Soon afterwards, the region’s nursing schools came on board. Three years later, an entire cohort of smartphone and tablet-savvy graduates who have been trained using the standardised online procedures platform are now out in the workforce. 

One step closer to national standardisation

Cheryl Atherfold, clinical nurse director for professional development at Waikato DHB, says Midlands is now excited that the South Island DHBs, nursing schools, rest homes and community nursing services are also coming on board from 5 May this year with what is now called the Lippincott Procedures New Zealand instance.

With 10 out of 20 DHB regions now involved, it is a step closer to the long-term vision of having a nationally agreed platform for nursing procedures. Angela Broring is the Waikato DHB librarian who was part of the initial project team (with project leader Michael Bland, the then-clinical director for Waikato DHB, and John Clayton of Wintec’s Emerging Technology Centre) and she manages the editing of the procedures and systems support. She is very supportive of the New Zealand instance going national and providing streamlined nursing procedures everywhere and for everyone.

That is no easy task, with the five Midland DHBs involved in the pilot each rolling out access to the procedures at their own pace over the past three years and one DHB still only selectively using some of the online procedures.

Significant advantages

But the advantages to having a common online platform for procedures are seen to be multifold both by Atherfold and by Kate Rawlings, a former nurse and programme director of the South Island Regional Training Hub, who facilitated the contract on behalf of the South Island directors of nursing.

For one thing, standardisation means patients should be able to move between the community and hospital and receive the same evidence-based clinical procedure. Similarly, staff can transfer between services without having to familiarise themselves with a new procedures regime.

Then there is the time saved by having an outside provider do the donkeywork of reviewing procedures. When changes are made, procedure folders across the hospital don’t need to be manually updated – it all just happens online and any procedure can be checked via a desktop computer or mobile app (initially only on Apple products but an app for Android products will be available from June).

Rawlings says standardisation of evidence-based procedures across the South Island will increase patient confidence, ensure ‘optimum patient safety’ and save time spent duplicating the updating of procedures across the five DHBs.

Atherfold says the main value for Midlands has been that all procedures are constantly under critical review. “And before this there were so many outdated procedures,” adds Broring.

Seismic perception change

The move to the new platform has required a “big shift” in thinking, says Atherfold – switching from a “this is the way we do it around here” mentality to ascertaining best practice for a particular clinical procedure.

The provider, Lippincott, regularly reviews its 1,200 procedures against evidence-based research and sends out quarterly updates to the New Zealand instance, making recommendations for any changes.

The local review team can then discuss the recommendations and decide whether to ‘switch on’ any changes or add additional notes to the New Zealand procedure or put there commendations aside as being only relevant
to the American context.

The DHBs’ directors of nursing make the final sign-off for any changes. Initially, 200 medicines management procedures (including intravenous therapy) of the total 1,200 clinical procedures provided by Lippincott were customised for the New Zealand environment by the Midlands medicines management team. Some of those 200
customised procedures were required because Lippincott did not initially provide metric measurements but now
the procedures have been metricised and have reduced to just 30. “It is an evolving piece of work as we get better at it and trust the mechanisms,” says Atherfold.

“So where it aligns [New Zealand and US protocols] we use the Lippincott procedure and if it doesn’t we use the New Zealand procedure,”

says Atherfold. But all procedures are accessed through the same New Zealand instance platform.

Broring says the other areas where the New Zealand instance continues to supply its own procedures are wound care and infection control, with about 34 New Zealand-developed wound care procedures and around 30 New Zealand infection control procedures up online.

These procedures are developed and reviewed by New Zealand nurse experts in the field, which will shortly include those in the South Island. To date intravenous therapy procedures are the most commonly accessed on the platform;

they are readily available via a glance at a smartphone at the bedside, a quick check at a nursing station or by printing a copy for handy reference.