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Clinical Updates

Hospital trust develops ‘WhatsApp-style’ flu alert

Staff can now receive instant alerts to inform them if a patient has tested positive for flu and which strain they have.

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An initiative ‘Whatapp-style’ app alerts healthcare professionals when a  patient tests positive for influenza.

Clinicians at Southampton’s teaching hospitals now receive instant alerts to inform them if a patient has tested positive for flu and which strain they have via a new ‘WhatsApp-style’ messaging app.

Previously, infection specialists testing patient samples in the laboratory at University Hospital Southampton NHS Foundation Trust would spend up to an hour calling wards to provide results.

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Now, IT experts at the trust have pioneered the development of a ‘bot’ which uses the Medxnote messaging app to send flu alerts along with a downloadable PDF of the results in detail.

As a result, staff are able to ensure prompt isolation and management of those affected to speed up access to appropriate treatment and reduce the spread of the virus to other patients.

Thousands of deaths a year.

Flu and the complications associated with it cause an average of 8,000 deaths a year in England, with around 6,000 of those people with heart and lung disease.

“The introduction of the flu alert and the level of detail it provides instantaneously is a significant development which has the potential to vastly improve the management of patients with influenza in hospital,” said Dr Ben Marshall, a consultant in respiratory medicine at UHS.

“Prompt management and, where necessary, isolation of patients suffering from flu and an understanding of the type of virus is essential in ensuring both their own safety and that of others, so any development that speeds up the process is much-needed.”

Once a clinician is signed in to Medxnote on their own smartphone, they are able to securely contact colleagues with questions about individual patients and share confidential information and images.

They then log out at the end of their shift and no data is saved or stored on their device.

Replacing a bleep system.

Medxnote is designed to the replace the traditional bleep system and, during a pilot at UHS within two surgical teams last year, 400 messages were sent each day which saved clinicians 26 hours of time in the first week of use.

“The main issue clinicians experience using bleeps is that they don’t know if the bleep is a request for a simple update or for an urgent task, so they treat them all as urgent which prevents them from prioritising,” said Helen Harrison, Medxnote project manager at UHS.

“With Medxnote, clinicians are able to send instant messages to colleagues so they are able to instantly see what the communication is about, no matter where they are, and prioritise and respond appropriately.”

She added: “Above all, we needed to provide modern and versatile ways for staff to communicate quickly and securely across increasingly complex working patterns.

“Medxnote has already transformed communication in the trust and, with advances such as our custom-made flu alert, it could prove to be the start of a revolution in communication across the wider NHS.”

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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