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It is 750 kilometres from Farewell Spit to Bluff (as the crow flies) but the five South Island district health boards are getting closer by the day. NURSING REVIEW looks at two South Island-wide health information systems projects...the first  an electronic risk management system that brings speedier incident reporting, analysis, and feedback.

Patient Safety 1st

Putting pen to paper to report patient falls to unsafe staffing on the ward will soon be a thing of a past across all South Island DHBs.

No longer will paper reports and responses have to travel through people's ‘in’ and ‘out’ trays before feedback gets to the people at the bedside.

Currently, only two of the five DHBs – Southern and Nelson-Marlborough – have some form of electronic risk management system, and in the case of Southern DHB, their Invercargill site is still paper-based. But before the end of 2015, all DHB sites will be using Safety 1st – an electronic incident management system using the updated RL6:Risk software by RL Solutions. An earlier version of the same software is already being used by eight DHBs across the country, including Nelson-Marlborough.

Sue Wood, the quality and patient safety director at Canterbury District Health Board and a former nurse leader, has been closely involved in the South Island project. She says it is safe to say that currently the majority of incident reports are filed by nurses, but the projects team hopes there will be more reporting by doctors and other health professionals once electronic reporting is possible using a smartphone app.

The electronic incident report will go directly into a hospital’s server and alert the relevant person, such as a charge nurse manager of a ward. Some DHBS are choosing to let the software calculate the SAC (severity assessment code) for the incident, and others, the manager, but in both cases, it is the manager who confirms the code level given and what further action is needed. SAC 1 and 2 incidents – the most serious adverse events – need to be reported to the Health Quality & Safety Commission. The commission also encourages boards to consider reporting ‘near misses’ and SAC 3 or 4 events that could help prevent similar incidents from occurring nationwide.

Wood says under Safety 1st, investigating an incident should be easier and smarter as witnesses, managers, and experts can view and add comments or input to the same electronic report file. People making the report, like a nurse reporting unsafe staffing levels, can also request direct feedback on the outcomes of the investigation.

Electronic reporting and processing will also mean that trends in reporting, incidents, and responses can be viewed and analysed at a ward, service, hospital, and South Island level, from pressure injuries to falls and patient complaints to equipment failure.

The island-wide system includes incident management reporting as well as modules for root cause analysis, patient feedback (complaints or compliments), hazard register, patient restraint incident register, and a risk register.

"This (new system) will be slicker, faster, and more people will be able to see (information), so there is more transparency," says Wood.

With the system, a nurse, for example, who reports an unsafe staffing incident will be able to see whether their report has been investigated, closed, and ask for electronic feedback.

Wood hopes the system will not only make it easier for people to report incidents but also more likely to do so once the streamlined system leads to more direct feedback and more change happening as a result.

"It is all about learning, isn't it – and changing the underlying systems (to reduce the risk of incidents)."