Rolling out a digital clinical system during a pandemic

Digital Pioneer Fellow, Khoosh Seewooruttun, is Digital Health Lead Nurse and Digital Clinical Safety Officer at South London and Maudsley NHS Foundation Trust. In this blog he shares his experience of implementing a new electronic recording system for physical health observations during the Covid-19 pandemic.

During the pandemic, what could not be achieved for some time, was being done at pace and scale! The pandemic has forced us to think, work and live differently. Despite all the challenges brought upon us by Covid-19, it has also accelerated the uptake and adoption of digital tools in clinical settings. The eObs rollout was not any different.

Introducing eObs

In a previous role as Nurse Advisor and Lead for Deteriorating Patient, I led on the introduction of NEWS charts (National Early Warning Score) as a replacement of MEWS (Modified Early Warning Score) and was involved in supporting the development of the eObs system (electronic recording of physical health observations). Although my involvement in eObs was limited at the beginning, I was becoming more attracted and excited by the prospect of supporting frontline staff to work differently by using technology to support their practice and improve patient safety. When the opportunity came to take on a full time role working in digital services, I did not hesitate.

At this point, eObs was being used on a handful of wards in the Trust. Informal feedback received from end users indicated that the system needed some improvement to make it usable at scale and some of the functionalities did not fit their clinical workflows. End users, clinicians, technicians and suppliers got together, gathered formal and constructive feedback and identified solutions together as a team. It was also apparent that the frontline staff was apprehensive to use technology in their clinical practice. Although we’dd had an EPR (electronic patient record) for several years, frontline staff were not used to walking around the ward with mobile devices (iPads), on mental health wards.

The impact of the pandemic

When the pandemic hit and we went into lockdown, this all changed and very quickly as well. One of my first tasks during the first lockdown was to support several hundred members of staff to work remotely, to use VPN and Trust issued devices or their own devices to access clinical systems. I also supported staff on the ward to understand how to work virtually, to allow ward rounds and therapy sessions to continue. Additionally, I supported patients to use mobile devices to keep in contact with their families or attend sessions on the ward. The benefits of using digital clinical systems quickly became clear but it was also a necessity. Clinicians working remotely on wards using eObs were able to access patients’ physical health information and support decision making and treatment planning, especially as Covid-19 infection rates were spreading at speed.

Seeing the benefits and the appetite for eObs, others were keen to adopt it as well. However due to restrictions in place, it was difficult to go on to the wards or to hold classroom training sessions. But this allowed us to be innovative and maximise the use of digital tools to support wider roll out. Microsoft Teams was quickly becoming the common communication tool used across the organisation. We started delivering eObs training on MS Teams and the uptake was far larger than what we would get in the classrooms. Staff didn’t have to travel around South London to attend training and we were not restricted by classroom availability. We also used MS Teams to support the roll out by using screen share to direct users and for them to show how they were navigating and using the system. We had technical colleagues available on hand who could be called in on MS Teams to rectify any issues with the system and we had colleagues on call on-site who were available to drop in on the wards if there were hardware or connectivity issues.

Looking forward

Having worked in the organisation for many years, I knew all the clinical services, how they function and many of the frontline staff. This allowed me to support the remote deployment of eObs with more confidence. Lessons learnt from this project has been beneficial on another project I am working on now including implementation of the ePMA (electronic prescribing and medicines administration). ePMA will be rolled out to the inpatient services initially, followed by community services, and it will bring together various paper and digital systems, with the aim of improving safety and efficiency. Knowledge and support gained from facilitators and peers on the Digital Pioneer Fellowship has influenced how we are developing and rolling out the ePMA.

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