What was the aim/problem?
Imperial College Healthcare NHS Trust maternity service provides care for around 10,000 babies and their mothers each year throughout pregnancy, labour, and the postnatal period. The Trust introduced the Cerner electronic patient record system including a maternity module for clinical documentation in 2014.
Contractions and foetal and maternal heart rate are monitored using cardiotocograph (CTG) devices. Previously, the readings were printed out on rolls of paper. Midwives added handwritten clinical observations to these ‘foetal strips’ and used them to make critical decisions about the management of labour. These paper records were hard to share to quickly get a second opinion. They were prone to fading over time so did not always provide a permanent record. And they were not integrated into the electronic patient records for our patients.
What was the solution?
Maternity staff needed the capability to view foetal and maternal vital signs and contractions across our labour wards so that concerning results could be recognised and acted upon sooner. And cardiotocograph readings needed to be captured in a way that would provide a reliable long-term record. The solution was to connect the cardiotocograph machines to our electronic patient record system. That would eliminate the need for paper and make the results an integral part of the patient record.
What were the challenges?
This represented a significant change in ways of working for midwives. It involved breaking new ground from a technical perspective for both Imperial and our supplier. And there were a broad range of stakeholders in the project including teams from medical equipment and estates. Getting the equipment set up in ways that work for staff in different ward environments was a learning process.
What were the results?
Maternity staff can now view electronic graphical displays of heart rates and contractions for all mums and babies on all our labour wards right across the Trust –midwives at the bedside and the midwives desk, and consultants from elsewhere in the hospital. They can spot signs of distress and take action quickly, improving patient safety. Maternal blood pressure, temperature and oxygen saturation are also collected. And all the data is recorded in the electronic patient record.
‘It’s good for handover, good for follow up, and alerts us to problems immediately. If we see something concerning on the CTG display we can go straight to the labour room to assist even before the emergency bell has been pulled.’
Paula Beckles, Midwife
Easy access to digital readings alerts staff that they need to enter the room, check the patient and document a second opinion.
Now there are always two pairs of eyes on CTG readings
Nicola Sale, Midwife
For twins and triplets, clinicians can hide or display readings if they want to focus on an individual baby’s heart rate.
I like the way it displays multiple pregnancies. Each baby’s reading is clearly shown as a different colour on the display.
Miss Muna Noori, Consultant obstetrician
The process has removed duplication of record keeping on paper and the electronic patient records. This has released up to 20 minutes of time per birth for midwives to spend on caring for their patients.
What were the learning points?
Make sure that all contributing stakeholders are fully involved from the outset. As well as the maternity service and the IT team, this project required involvement from the medical equipment team for the cardiotocograph devices and estates for wiring and wall mounting of equipment.
Understand the working environment thoroughly. Test the new equipment and how it is going to work in practice in a labour room. And if existing kit is used, ensure that it is fit for the new purpose. Ensure there is sufficient bandwidth for all of the new transmission of data
A significant risk identified in the early planning stages was the process of using the equipment with the next patient. The previous patient has to be ‘dissociated’ before the new patient is associated to ensure that data goes to the correct patient record. This has to be managed carefully.
Equipment that takes advantage of wireless connectivity is more expensive but can last longer and give better patient experience – there is less risk of damage from wires being pulled out, and the patient can move around more freely
The approach will be introduced on antenatal wards and in antenatal triage. The team have had contact from a lot of different Trusts including a number of visits. The blueprint approach is making it easier for other interested Trusts to get the information they need.
Want to know more?
To request access to the blueprint of this project, please email: firstname.lastname@example.org