Nurses pen trial of new digital pathways

A nurse-led trial of a digital pen that captures data at the point of care is up and running at Frankston Hospital in Victoria to see if it can improve the care of patients with a fractured head or neck of femur.

The digital pen, distributed in Australia by the Print Media Group, uses an in-built camera to capture and convert handwriting into a digital format. The point of care data in this trial is being sent to a separate server to allow real-time analysis of clinical pathways and to allow faster interventions, with the aim of improving length of stay and patient outcomes.

The project manager of the trial, Virginia Plummer of Monash University's School of Nursing and Midwifery, said the digital pen was a practical and cost-effective tool that nurses could easily use to improve clinical outcomes.

Dr Plummer said while there are other products out there for point-of-care use, such as PDAs, iPads and tablets, in reality, nurses don't have access to them in most large public hospitals.

“Digital pens are easily carried in the nurses' kit and from patient to patient as they are going around the ward and they don't need to be docked until the end of the care round,” Dr Plummer said.

“In large public hospitals, access to computers is not easy – there may be one or two computers in each ward but there is lots of competition for computers. People are competing for access to the pathology system, to the radiology system, to send emails – the reality is that nurses don't have PDAs, they don't have iPads, they don't have access to the computers when they need to and with the digital pens, they can carry them with them from the beginning of the shift to the end.”

While the digital pen is able to capture data and relay it immediately back to the server, they also function like a normal pen, she said. Paper forms are still routinely used, so nurses and allied health professionals can use the pens both on digital paper forms and on ordinary paper.

The trial, officially called the Enhancing Patient Management at the Point of Care Using Electronic Clinical Pathways (or the Digital Pen and Paper) project, will run for the next three months in Ward 5GN at Frankston Hospital on the Mornington Peninsula. Funded by an Australian Research Council (ARC) Linkage grant, the trial also involves NEC, which has designed the database dashboard through which the data can be seen.

Frankston Hospital, part of Peninsula Health, sees on average 30 patients a month with fractured neck of femur, predominantly in elderly patients who have had a fall. Clinical pathways for fractured neck of femur have long been in use, as in elderly patients the condition often leads to extended stays in hospital with resultant risks of infection and pressure wounds. It is one of the main reasons the frail elderly are forced to leave their homes and enter residential aged care.

Dr Plummer said the type of data being captured by the digital pens includes the key information related to length of stay as well as time to surgery, level of pain, heart rate and temperature and events that are likely to change the patient's course of treatment.

“They are predominantly elderly people so we are interested in this particular pathway because these are people who tend to have lots of co-morbidities,” she said. “This ward has about 30 patients per month with this condition and it is a clinically important pathway because we are looking for patients to return to their pre-accident state if we can.

“Clinical pathways have been around for a very long time and they have not only been used by nurses but by allied health teams and medical practitioners, particularly specialists, for many years in the context of the case mix environment, and they have been used for variances that have arisen in patient care.

“They are hard to analyse because of the paper format – some times it is much later, six months or even 12 months later, they are analysed and this isn't very useful. With the data captured by the digital pen, you know the variance in real time. If you don't know and only find out six months later you can't intervene.

“Now with real-time access we can do lots of things. We can analyse the care instantaneously, so both for the clinicians and for the operations managers, they can make a lot more use of it for the clinical care of the patient and for bed management.”

Dr Plummer said the team intends to compare the outcomes of patients with data collected in the digital pen and paper format with that of outcomes for patients with data written on paper forms.

“We are anticipating that the outcomes for patients in the digital pen and paper project will be that their care will be enhanced and that there will also be cost benefits as we expect to be able to improve the length of stay by being able to intervene earlier. However, this will be analysed fully at the end of the data collection period.

“We think the cost of the pen will prove insignificant compared to the cost of patient care for additional days, as well as costs to the patients, which might be ongoing pain or infections for example. It certainly is a practical approach. There is pressure on hospitals in Australia and internationally to become more efficient and this is a condition that is commonly occurring in our ageing population, therefore improving costs and quality of care for this group of patients is very timely and very relevant.”

Posted in Australian eHealth

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