Wye Valley NHS Trust and IMS MAXIMS have worked together since 2015 and went live with the first phase of the core MAXIMS EPR in 2017. Since then there has been a planned and continual roll-out of additional clinical solutions including Electronic Observations (eOBS).

In line with many NHS Trusts, patient's clinical observations were recorded on a standard paper NEWS2 chart with the NEWS2 score calculated by the observation taker. There are known limitations with the use of paper observations charts in healthcare with numerous studies highlighting issues such as legibility of handwriting, inaccurate recording of scores and reliance on a manual escalation processes. Auditing observations and any associated escalations is also a difficult and labour-intensive exercise.

One of the key drivers for the Trust to use MAXIMS eOBS was to improve the communication flow between internal teams and streamlining the documentation of patient care, this provides a clear audit trail of timeframes, tasks, notifications and intervention. MAXIMS eOBS provides the Trust with real-time notifications of deteriorating patients based on their latest early warning score (NEWS2). MAXIMS eOBS also provides visibility of pending tasks and reminders e.g. a patient’s vital signs are due to be recorded in 10 minutes. All clinical responses are documented directly against the patient’s electronic record, and also available for audit & reporting.

THE WYE VALLEY APPROACH

The Trust and IMS MAXIMS undertook three pilots in parallel with the continued use of the manual collection of observations:

1. STAFF - Ward staff recording and scoring observations

2. NURSING - Clinical escalation within the nursing team

3. MEDICAL TEAM - Clinical escalation to the medical team

The pilot phases went very well and enabled the Trust to go live with the scoring and escalation to nursing staff. The staff on adult wards were able to use MAXIMS eOBS quickly and efficiently. As a result, the change was seamlessly embedded into their day to day working.

Face to face training was delivered in less than 20 minutes, within this time staff became familiar with the handheld device (tablet and mobile phones) and how to use MAXIMS eOBS to support the delivery of high-quality patient care. A MAXIMS champion was identified on each ward to support the change in practice.

Training was further supported through e-learning, videos and online fact sheets. However, the Trust found that face to face training supported all levels of learning and could be tailored on a one to one basis. Wye Valley have now trained over 400 people.

The IMS MAXIMS team initially provided on-site support to the Trust for the initial ward pilots. However, due to Covid-19 IMS MAXIMS successfully transitioned in supporting the Trust remotely with the complete roll-out of MAXIMS eOBS across the hospital.

THE OUTCOME

Recording
The Trust now use MAXIMS eOBS to record a patient’s observations, to notify staff of any increase/change in patient need and offer clinical advice such as, increased frequency of observations.

Observation
They now have clear and legible observations and consistently calculated scores available in one place.

Accessible
The clinical teams can view observations from any location, allowing quicker informed clinical decisions and actions, than previously possible using the paper-based charts.

Time-saving
Having this information digitally means the Trust can access a variety of reports, to access all metrics and undertake audits saving time over manual paper data collection. For example, this would include the collection of associated CQUIN and SEPSIS information.

Communication
The Trusts internal communication has improved through the availability of task allocations, notification response and acknowledgments that actions and tasks have been performed.

Consistent
Clinical advice is now consistent from accurate calculation of early warning scores and the standardisation of information.

Clear audit
The Trust have clear and complete documentation of tasks/actions encouraging best practice and contributing to clear audit.

BENEFITS

Quicker nurse interaction
It has encouraged quicker nurse responses, and escalations of a patients deteriorating condition – thus improving patient safety.

Improved patient outcomes
Quicker responses to a patient’s deteriorating score have resulted in more positive clinical outcomes.

User friendly
The easy to navigate functionality allows clinical staff to carry out eOBS tasks efficiently and effectively.

Eliminates paper
The NEWS2 eOBS process is now paperless, facilitating medical escalation wherever required. 

Real-time Reporting
The Trust now have a digital solution providing real-time reporting enabling them to review and improve processes.

WHAT NEXT

Linking the Critical Care Outreach team to allow remote overview of patients NEWS2 scores across adult wards.