Feature: Babywatch keeps an eye on the prize
As a midwife, Natasha Oglesby has seen her fair share of mix-ups in the hospital setting. Human error is largely to blame, mainly due to overstretched staff and the hectic nature of most maternity units.
It was after one particularly fraught episode, when she was working a 12-hour shift in the isolation room in a neo-natal intensive care unit and the midwives were so busy she could rarely find someone to do the necessary double checks, that Ms Oglesby decided she'd had enough.
She had previously been on shift when a baby had been administered the wrong medication – or more correctly medication was administered to the wrong baby – and over 20 years as a midwife had often encountered problems with misidentification.
“At the end of shifts like that, you know something has to change, just because of the sheer frustration of constant misidentification issue with regards to labels,” Ms Oglesby says. “As a midwife, we are responsible and when we go to do a transfer, say from the birth suite to the ward, we are supposed to check with another midwife to then double check the identification of that baby.
“But what I found really frustrating is that the identification is only being checked against a surname and a file number. A file number belongs to the baby, not to the mother, so when you think about it looks like we are doing something but in actual fact we are not really doing a great deal.”
She thought that clinicians should be able to uniquely identify the mother and the baby as a couple, not just from a surname. “And if you don't have the baby's chart with you, you can't even check if you have the right baby,” she says. “You can already see these massive holes unfolding. There are flaws in the system that are so silly.”
So, rather than suffer in silence, she decided to do something about it. In 2009, Ms Oglesby began designing the Babywatch system, which in December last year successfully completed a trial in the maternity ward at Sunnybank Private Hospital in Brisbane, part of the HealthScope hospitals group. Sunnybank has signed a contract for the system and another hospital in Sydney is about to try out it as well.
Not having software development experience herself, Ms Oglesby worked with CMO Global, a software developer specialising in compliance, document management and action and issue tracking. Together, Ms Oglesby and CMO Global developed a software package that enables users to track, verify, monitor and log all actions and procedures involving newborns during their stay in hospital, from birth to discharge or transfer to another hospital.
Babywatch is a wristband barcode system that works in conjunction with hand-held PDA scanners, and at the back-end logs that an action has occurred and charts the information. It enables real-time documentation and comprehensive records management of information, data collection and verification, as well as synchronisation of information between hospital departments and sites when transfer is required.
Babywatch is a web-based solution that can be hosted or can sit on a dedicated server. It can also be used in evacuations to ensure identification is correct.
“The main component is the identification,” Ms Oglesby says. “Everything that we are doing to the baby, whether we are giving them medication, immunisations, IV fluids, whether we are moving or returning the baby, transferring the baby – before we do anything we do an identification check, which is done from the hand-held.
“Once we have done an identification check, which we call the match, we are then able to do transfers etc. We are logging within the system where the baby is going to, whether the baby is removed from the mother and if it is removed from the mother, why.
“If a baby is born in theatre, some hospitals take that baby to special care regardless. So, you would then check the identification before you leave theatre, tell the system 'transfer to special care', 'removed from mother' and where it says 'why' you'd put 'post-section' and this is provided by drop-down menus. Then you press save and that will then log the user so it would be traced to the person who is using the hand-held.”
The key to the system is its dual tracking – both the mother and the baby are matched. The mother is given a wristband upon admission, and when the baby is born, the mother's wristband is scanned along with the one created for the baby. Only when there is a match is the wristband attached to the newborn.
“The identification checks start before the baby is even labelled. It then maintains the identification through every step that we do with that baby.”
The barcoding system is also used for milk management. If a mother has to express milk it is labelled and given a barcode unique to that container of milk. All of the information about that milk – who it belongs to, when it was expressed, where it is being stored and when it should be used by – is recorded through the system.
“When you admit the milk in, when you tell the system it is going to be stored at room temperature, automatically the system will only allow you to scan that for the next four hours. If you scan it past that allocated time, then it will tell you it has expired and must be disposed of.
“So we are not only checking that we are not giving the wrong milk but also we are verifying all of the details with regard to where it was stored and when it was expressed so we are not giving out of date milk. The system also provides stock control – it is telling us how much milk is still available, where it is located and all of that can be pulled up on the hand-held at the bedside so you don't have to go down the corridor to the fridge.”
If the mother is not in the hospital and is bringing milk in for the baby, the system can alert her via SMS if stocks are running low. The system also allows for a report to be produced that can be electronically sent to a general practitioner once the mother and baby leave the hospital.
Babywatch has been a couple of years in the making and in that time Ms Oglesby and her company have developed partnerships with a few close suppliers. These include Peacock Bros of Melbourne, a hardware supplier which has set up a healthcare-specific branch of its business to supply consumables such as barcoders, scanners and hand-held devices predominantly to hospitals.
Babywatch has also partnered with Motorola for hand-held devices, although the software is device-agnostic and has been designed to run on any Windows platform. It can also run on the iOS platform so can be used with iTouch and iPhone devices. If hospitals wish to use Apple products, Babywatch has partnered with an Apple specialist to customise the software.
The software at present is a stand-alone product but can be integrated with hospital systems if required, and it has been designed with a view to eventual integration into the PCEHR.
“It has been designed so that the back-end is available for integration, but at this stage it is not integrated and is just a stand-alone,” she says.
“We would certainly anticipate integration to medical records at some stage, but I believe that our system would prove more beneficial in risk management system integration as it ensures all actions, procedures on or to the newborn are correct, therefore reducing risk and liability to the hospital.”
For the Sunnybank Private trial, Ms Oglesby was first contacted in May last year, she says. “They dropped me an email saying they had seen the information on our website and could I come and present it to them. They knew that no else had tried it at that time and they were prepared to be the first. The contract to do a trial was signed, in two weeks, but obviously they needed to finalise their IT requirements so we went into the site on November 6, and the trial ran until the 21st of December.”
The trial involved 12 hand-helds, both Motorola and Apple, and 11 trial midwives. The hospital wanted to test four modules within the system: basic identification to track removal and return of the baby to the mother, milk management as described before, and documentation for the hepatitis B vaccination and the administration of vitamin K.
The other modules in the system are medication management, immunisation management, pathology management and care management.
“We had 28 days in theory to reach that target but we actually met the requirement within seven days, so we just continued it,” Ms Oglesby says. “Every night I printed off a report of all actions that were happening during the day from the server and after about nine or 10 days I would print them off and laugh because I could see them finding all of the other modules too.”
The equipment was pulled out over Christmas and due to the holiday period Ms Oglesby had to wait for confirmation, but the midwives were so keen to have it back that the contract was signed quite quickly. The Babywatch licence is per bed, so at Sunnybank there are 27 licences and eight hand-helds in use, which is the maximum number of staff per shift, she says.
With the first contract signed and under way, Ms Oglesby is now hoping to roll it out to other hospitals, including a tertiary hospital's neo-natal intensive unit in Sydney, the name of which she is unable to reveal at present.
Then, the sky's the limit. Ms Oglesby sees a number of other departments where an identification system like this would be useful, particularly paediatrics. “All we would need to do is change a couple of wordings, like 'baby' to 'patient'. I'm very keen to expand into paediatrics because again these are areas where the mothers are often not present and these children can't really identify themselves necessarily, so they are another area that need to be protected.”
She is also shortly to launch MaternIT, a mobile application for midwives designed for the iPad. The idea is to allow midwives to provide Medicare-funded services to women throughout the pregnancy, birth and post-birth periods. It will include patient demographic data, access to lab and scan results, record prescriptions and handle the many reporting requirements for Medicare and for midwife standards reviews.
Posted in Australian eHealth