Technology


acute hospital setting can be readily and reliably accessed at a patient’s bedside.


6. The Resuscitation Council UK should clarify and promote expectations around the sharing, presentation, and language of cardiopulmonary resuscitation recommendations in hospital ward environments in line with the findings of the investigation.


7. The British Standards Institution, with support from relevant stakeholders, should provide symbology to standardise how information relating to a patient’s resuscitation status can be displayed in electronic healthcare records and systems.


8. The Royal College of Nursing should develop guidance for ward-based nursing handovers with consideration of the following: how handovers are organised, their content, the environment in which they take place and the technology needed to support them


Nick Woodier, national investigator, commented: “Our reference case was a distressing reminder of what can happen when treatment is delayed because staff are not able to easily see the critical information they need in an urgent situation. Across the investigation we heard about multiple contributing factors that can have an impact – from poor lighting to the variation in CPR recommendation words and symbols – when clinical staff are having to make quick decisions in pressured and fraught environments. What became clear to us is that a number of recommendations were needed to ensure the many gaps and safety issues our investigation found are addressed. National organisations should be ensuring the accessibility and visibility of information, so that staff can provide the best levels of care to patients at the bedside, many of whom could be in a critical condition and may need life-saving treatment.” Responding to the report, Parliamentary and Health Service Ombudsman, Rob Behrens, said: “Improving and prioritising patient safety must be a top priority. HSIB’s report highlights a tragic case where things have gone wrong in the application of DNACPR, and we need to see meaningful changes to prevent this happening again. Clinical staff should always be able to access accurate, critical patient information so patients get the best possible care. This report is a step in the right direction, and I welcome its recommendations, particularly on improving guidance to staff and ensuring patient information can be readily and reliably accessed.” To download the report, visit:


www.hsib.org.uk CSJ March 2023 I www.clinicalservicesjournal.com 41 COMMENT with DR. JOHN SANDHAM


Training & investment key to safer care


Dr. John Sandham, chair of EBME, 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 found that misidentification of the Patient, and limited access to critical information about the Patient at the bedside delayed his treatment, and this led to him not receiving CPR. The core conclusions of this 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.


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