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JODIE and PETER WOOD report on how a Whangarei Hospital orthopaedics ward developed a customised electronic whiteboard to give nurses patient details at a glance and help free up more time for direct patient care.

Too often the modern administrative demands of health care, result in less time actually spent at the patient’s bedside.

The orthopaedic nursing team at Northland District Health Board's Whangarei hospital wanted to change this and demonstrate how using an electronic whiteboard could improve ward efficiency and show their passion for patient-centred care

A 2011 initiative had seen Whangarei Hospital medical wards get electronic patient information boards (displaying data from the TrendCare patient acuity system) but the orthopaedic ward still had a handwritten whiteboard for sharing patient information.

Updating the handwritten whiteboard was time-consuming for nurses and there was always the risk of transcription errors. The white board ink would also often fade during the day so there was the additional risk of information being accidentally wiped-off.

The opportunity to replace it with an electronic whiteboard came with Northland DHB implementing the Care Capacity Demand Management (CCDM) programme.  The CCDM programme –developed nationally by the joint DHB and NZNO Safe Staffing and Healthy Workplaces Unit using TrendCare data – includes a wholeof hospital electronic display system known as the 'Hospital at a Glance' (HaaG) screen which is viewable in every hospital ward and unit.

Developing icons and visual triggers

After successfully implementing the CCDM programme, the orthopaedic ward's next key quality project was developing an electronic whiteboard. The ward's process was very methodical including a multi-modal education process to help staff with the principals of the TrendCare data feed, which flowed on to enhancing the patient information board developed. Also developed were symbols to represent different patient pathways and the multidisciplinary team. Theward floor staff's clinical input helped in areas like the discharge planning process. A number of icons were created as 'triggers' supporting Ministry of Health initiatives for elective and acute orthopaedics as well as National Quality and Safety Commission initiatives, like reducing patient falls.The DHB's management information systems (MIS) staff developed the actual electronic display boards that draw on information from TrendCare and the DHB's Patient Management Information System.

Nursing staff can now get a picture of the patient’s status “at a glance” by viewing the clinical information displayed on the electronic whiteboard. The new whiteboard still displays basic demographic data like surname, age, sex and domicile as it was initially developed to replicate information recorded by the multidisciplinary team on the manual board.

 

More specifically the whiteboard now also includes the:

• named responsible shift nurse
• responsible consultant  (the non-specialty consultants,  or “outliers”, are coloured purple instead of black)
• estimated date of discharge (EDD)
• domicile – this is automatically populated from the Patient Management Information Systems (PMIS) data to assist with discharge planning and enhanced use of the aligned peripheral hospitals where indicated
• falls risk
• pressure injury risk – including if they are on any particular pressure-relieving mattresses
• specialised diet requirements – this enables prompt identification and referral to the ward dietician  i.e. Red Tray (assistance required or food chart recording); Nil by mouth (NBM); Enhanced recovery after surgery (ERAS – specific diet supplements to support early nutrition and reduced “starving”)
• specific clinical pathways – THJR / TKJR / #NOF
• tissue return – bone or tissue that is removed from patients in surgery and available for collection by the patient before discharge.

 

The data entry field within TrendCare (that populates the electronic whiteboard) allows free text so the board can also display planned interventions/investigations such as USS / CT / X-ray / PICC and when they are booked for.

Ward quality initiatives – relevant to discharge planning and clinical care coordination – are also on the electronic whiteboard. For example:

• A pill icon that represents that the patient's medications have been stored safely in the medication room utilising the “Green Bag” initiative
• A bed icon coloured either yellow or blue to indicate the patient is being managed on a specific pressure mattress related to their identified pressure injury risk

 

Further enhancements:

• An ACC icon is automatically populated for the patients on ACC claims.
• Patients admitted from private residential care facilities (private hospital or rest home) are identified by colour blocking the domicile code.
• Patients accepted for rehabilitation have an icon to highlight rehabilitation goals while waiting for a bed in the rehabilitation ward.
• Identification of baby boarder or adult caregiver staying on the ward with the patient.

 

The education plan for the roll out of the electronic whiteboard was based on monthly updates through the ward team meetings (which doubled as the CCDM local council for the ward); 1:1 teaching which included staff signing-off on the education received; development of staff quick cards; and development of business rules.

 

Evaluation

The content displayed on the orthopaedic electronic white board has probably now reached capacity as the ward nurses want patient information to remain clearly visible so they can still  review a patient's details at a glance. Nurses  used to spent up to 30 – 60 minutes each 24 hours updating the detail on the old physical whiteboard. They also used to separately update their patient information on the electronic TrendCare acuity system as there was no interface between the two systems. Now the electronic white boards updates itself by taking the data feed from TrendCare, so inputting the Trendcare data becomes more meaningful and is done on a more regular basis. This has also been identified by the SSHW unit who indicated that TrendCare data makes nursing work visible and that by using this data as part of decision-making actually makes the difference,.

A staff survey is planned at the 6-month and 12-month period to determine whether the electronic white boards remain effective and that the display captures the required information.

*Jodie Wood RN MSc(N) is clinical nurse manager of Whangarei Hospitals orthopaedic ward and her husband Peter Wood RN, Bsc(Hons), PGDip HSc is the hospital's emergency and medical services manager