The Nurse Manager in the Mental Health and Vascular Wellbeing Team at North Staffordshire Combined Healthcare NHS Trust (NSCHT) led a programme of work to introduce a digital application (app) into the care and treatment plans for service users at high risk of developing mild cognitive impairment (MCI). The app was designed to digitally link the nursing and medical staff with the service user, enabling care closer to home, empowering service users, families and carers to have greater control and input into planning their treatment and care and improving service user experience and outcomes.
Where to look
The Watcher report (2016) indicates that the transformation of services and care delivery includes changes in culture and workforce, as well as shifts in approaches to improvement and training. The report suggests an information rich healthcare system is also about ensuring that all carers have the information they need to support a service user to be cared for closer to home or at home. Increases in service user access to information via the internet or social media places a demand on the NHS to review and transform the way they support service users, cares and families. Gemert-Pijnen et al (2011) advocates the use of e-Health technologies, as they can consider the complexity of healthcare and the personalised needs of service users, carers and families. It is widely accepted that Technological Enabled Care (TEC) has the potential to reduce healthcare costs and improve outcomes. Supported self-management of multiple, complex conditions can support a reduction in incidents such as unplanned admissions to hospital, and can possibly delay the need for more intensive or permanent care (e.g. moving into a care home).
The Nurse Manager identified that within the Trust there was a limited use of technology as part of care and treatment pathways. This was especially apparent for those within hard to reach cohorts such as the elderly. This was unwarranted variation and indicated an opportunity to lead change.
What to change
North Staffordshire Combined Healthcare NHS Trust is a provider of mental health, social care and learning disability services in the West Midlands. The Mental Health and Vascular Well-being Team support service users at high risk of developing dementia to self-manage the onset of mild cognitive impairment (MCI) through lifestyle changes and therapeutic interventions.
Preceding evaluations and focus groups helped inform the nurse manager on how service users with MCI and early stage dementia have benefited from using Technology Enabled Care (TEC). This cohort of service users are often considered “digitally hard to reach”. Building on these recommendations, and in alignment with the Trust’s digital exemplar improvement programme and the NHS digital roadmap, the nursing team developed a programme to introduce an app to support service users with mild cognitive impairment due to early onset Dementia. The app supports service users, carers and families to manage their condition, reduce incidents such as unplanned admissions to hospital, and minimise potential delays for changes in care provision.
How to change
The nurse manager investigated with staff and service users the opportunities for utilising an app in practice. This included how the users – both service users and staff – would use the app and how this could fit into daily activity and day-to-day care delivery. Using this information, the nurse manager worked with a local digital provider to develop the app ready for trialling within the service.
An aim of the app is to support clinicians to upload personalised information to a service user’s records, such as information sheets, links to further reading and support. Nurses led on informing the development of the app, including adding evidenced based interventions, service user treatment goals, service user medical management and care pathways plans.
The app includes a “my condition management plan” which is accessible to service users, allowing easy access to their treatment goals and agreed activities needed to meet those goals, as well as allowing them to add queries or concerns to discuss with their nurse at their next face-to-face contact. A Question and Answers section on their condition and a ‘digital assistant’ is also available to allow easy navigation of the app.
A plan for roll-out was developed to ensure the training and support needs of staff and service users were considered with the digital provider hosting workshops. A pilot of the app was conducted with a small group of users to ensure the product met expectations and needs. Clinician and service user feedback informed a review of impact.
Better outcomes – Service users in the pilot group reported ease of use in terms of app navigation and ease in switching from one tab or screen to another. They also reported the app content has supported them in actively managing their health condition effectively.
Better experience – The pilot group of clinicians and service users have welcomed the new app and approach to care. Examples of feedback include how the app “served as a useful reminder on my condition as you do forget stuff and then you read it and may find a nugget of information which helps” and “helped support and prompt me with condition management”.
Better use of resources – The pilot group of clinicians reported the app provided them with an easy platform to support service users to manage their condition. This is anticipated to have positive impacts on use of resources going forwards. During phase 2 of the app development, a further analysis of use and its impact are being explored.
Challenges and lessons learnt for implementation
Nurses at the forefront of care are well placed to develop effective technological solutions.
Service users must be involved in a meaningful way as co-producers. Evidence shows that reduced levels of engagement from the end user in the development phase often increases the incidence of usability problems or high attrition rates.
It is important to ensure technology initiatives meet General Data Protection Regulation (GDPR) guidance.
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