Digital solutions will improve patient monitoring

Two pioneering technology projects developed at Oxford University Hospitals NHS Trust have been awarded a £750,000 funding boost.

An iPad-based early-warning system for patient monitoring and an 'electronic prescription' service that will allow patients to leave hospital sooner both won funding from the Safer Hospitals, Safer Wards NHS Technology Fund.

The £550,000 allocated to the System for Electronic Notes Documentation (SEND) project will allow the iPad-based patient record system to be rolled out across all adult wards at the Trust.

The project replaces paper charts and means medical staff use computer tablet technology to record and evaluate patients' vital signs. The system alerts staff to early signs of patient deterioration instantly and reliably, and allows patient data to be shared with specialists across the hospitals.

A further £200,000 has been awarded to the 'end to end electronic prescribing' project, which will speed up the preparation of prescriptions for those ready to leave hospital.

The system will link electronic patient prescriptions  directly to the hospitals' pharmacy robot via the usual clinical pharmacist safety review. This means that a when a doctor on the ward, or in outpatient clinics, prescribes medicine for a patient to take home, it will be prepared, packed and dispatched automatically by the robot, while still ensuring vital pharmacy safeguards. It is estimated the system, the first of its type in the UK, will cut prescription turnaround time by an hour, meaning patients can leave earlier and beds become available sooner.

The £260m Safer Hospitals, Safer Wards NHS Technology Fund was created by the Department of Health to support digital innovation in hospitals.

Oxford University Hospitals will also play a major role in a third project, to further develop the Oxfordshire Care Summary, led by Oxfordshire Clinical Commissioning Group. This summary gives GPs, doctors and other medical professionals access to both GP and hospital records in one integrated system. It supports clinicians to deliver care for patients with long term conditions and also those who need emergency help either from the GP out-of-hours service or a hospital emergency department. 

Oxford University Hospitals NHS Trust chief executive Sir Jonathan Michael said: "Digital technology is revolutionising all areas of modern life, and healthcare is no exception. In Oxford, we are combining academic excellence and clinical expertise to harness the full potential of digital technology both on our wards and in the community.

"The two projects supported by the Safer Hospitals, Safer Wards NHS Technology Fund are excellent examples of developing leading-edge technology to improve our care and the way we deliver services. The funding will allow us to fully implement the technology across our hospitals." 

iPad-based track and trigger system

The SEND project uses the latest computer tablet technology to record and evaluate patients' vital signs, replacing traditional paper charts. It will help alert medical staff to early patient deterioration quickly and reliably, and allow that data to be shared with specialists across the hospital sites.

Medical staff will take regular readings of a patient's vital signs such as heart rate and blood pressure according to current practice, but instead of writing the information on an observation chart, they will input it into a computer tablet. Using specially developed software, an Early Warning Score will be calculated and displayed instantly. Clinical staff will use this score to help them decide whether further medical intervention is needed. 

Oxford University Hospitals' Critical Care Medicine clinical researchers Dr Peter Watkinson and Dr Tim Bonnici, have worked in close collaboration with the University of Oxford's Institute of Biomedical Engineering (IBME) to develop and trial the system. The team had previously developed a paper-based Early Warning Score system.

Dr Watkinson said: "Bringing together experienced clinicians and  biomedical engineers has allowed us to develop an ergonomic, intuitive early warning scoring system where information is shared in real-time with staff, wherever they are in the Trust, enabling improved patient care."

Lionel Tarassenko, (pictured left, with Dr Peter Watkinson) Professor of Electrical Engineering at the University of Oxford, who leads the project, said: "The new system will help nurses, who work in busy, high-pressure environments, care for patients more efficiently and effectively."

"The traditional chart-based method of recording vital sign data is susceptible to errors in both recording and analysis of vital signs. The new electronic system automatically calculates the hospital's Early Warning Score, a scoring system which we have developed from extensive statistical studies of patient data."

"We see the new system as a major step towards the 'digital hospital' in which all sources of patient information are interlinked and all healthcare staff are interconnected. This can only have a positive impact on patient safety."

The SEND project is supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, a collaboration between Oxford University Hospitals and Oxford University to translate basic science into patient-benefit and foster innovation. The Research Council UK's Digital Economy Programme, which is led by the Engineering and Physical Sciences Research Council (EPSRC), funded the team's research underpinning the system.

End to end electronic prescribing

The 'end to end electronic prescribing' project will cut prescription turnaround times by an hour for those waiting to leave hospital. This will speed up the patient discharge process and make beds available sooner. It has been awarded £200,000 from the NHS Technology Fund.

The new system will link electronic patient prescriptions  with the hospital's pharmacy robot - which picks, labels, verifies and packs medicines ready for collection or dispatch to the ward. All the usual safeguards are still maintained as clinical pharmacists will be involved in the safety check that currently exist.

At present, prescriptions are manually transcribed into and out of the Electronic Patient Record system and into the pharmacy computer system, by the prescribing doctor and then pharmacy staff. But the new project will link the computer systems, so when a doctor enters a prescription at the bedside, it will automatically be processed without the need for any other human input, once the usual safety checks are completed by the clinical pharmacist. This will cut processing time, reduce transcription error and improve the recording of patient care.

By allowing patients to return home earlier, it will increase inpatient capacity and help the hospitals' emergency departments manage demand.

John Skinner, Director of Information Management and Technology at Oxford University Hospitals, said: "This is project is an excellent demonstration of the potential of digital technology to improve patient care, both for individuals and for the entire healthcare system.

"By cutting prescription preparation time we not only help patients leave our hospitals at the right time, we reduce pressure on bed numbers and improve services in the emergency department."