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Mobile working: providing community nurses with a guiding ComPAS

Around 18 months ago Northern Devon Healthcare NHS Trust (NDHT) armed its community nursing team with tablet computers and encouraged clinicians to ‘take the office with them’. Here community nurse manager, Michele Baxendale-Nichols, describes the journey she and her team have been on.

In a nutshell ComPAS, as the project is called, involves giving 800 community nurses and healthcare workers tablet computers to access and update patient information on the move. This creates real-time patient records which can be accessed by multi-disciplinary teams.

The Trust defined the overall aims of the project as helping to deliver excellent community care and to ensure the Trust is compliant to the Department of Health’s CIDS directive which requires clinicians to collect data sets on their activities and is worth around £250,000 a year to the Trust.

Naturally, it’s been a learning experience for the whole team but a year and a half down the line, I’m confident the project delivers from a clinical perspective. Over half a million appointments have been created and my team and I have more time to care, are able to demonstrate excellent clinical standards and have a robust audit trail.

IT initiatives and the NHS don’t always have the happiest outcomes but I’d put the success of this project down to the practical way in which the project was implemented, the efforts made by clinical and technical staff to work together and, perhaps most importantly,  the fact that the project was answering a real clinical need. Another important aspect was the level of support offered to nurses who were less IT savvy.

The project got off on the right foot with the IT team taking the time to talk to the individuals who would be using the software on a day-to-day basis. From this, it became clear that we needed a system which dovetailed with our way of working so they worked with a specialist company called NDL which essentially produces toolkits to build bespoke apps. From our point of view this was much better than ‘off the shelf’ products which would mean us changing the way we work to fit in with the technology.

Important considerations – such as the fact that 3G signal can be non-existent in rural areas – were taken care of by NDL’s software as apps continue to work on the device with records automatically synchronised when signal becomes available. Other ‘carrots’ to encourage uptake were included such as work email, diary and satnav functionality. It’s this kind of practical, people-centred thinking which warms people up to what amounts to a significant change in working practices.

When it came to getting the team up to speed we took a phased approached with training initially carried out by the IT team, followed by self-directed learning. The next stage was peer support where team members who were more confident mentored those who were self-confessed ‘IT phobes’. This approach helped bring the more reluctant members of the team on board, to such an extent that I’d say 99% of users are now active advocates, no mean feat!

In terms of the benefits I’ve seen, both for the team as a whole and for me personally, they range from making everyday operations more efficient and patient-focused to shaping the strategic delivery of community care.
When attending appointments the tablets are also proving useful – nurses are able to use the camera functionality to track patients’ progress, for example by showing them how a wound is healing, which in turn has led to patients complying with our advice more carefully.

The tablets’ connectivity also means nurses have accesses to useful apps such has BNF, BMI and pressure sore trackers , while being able to access the internet and show patients examples of support networks or equipment available is also valuable, particularly with older patients.

From a management perspective ComPAS has helped to break down communication barriers between town-based and rural-based teams, improve loan worker safety and, by the same token, provide a robust audit trail. Excitingly, we are starting to see how the data collected from ComPAS can be used to identify trends and make predictions about future care needs and this is an area where we’ve got high hopes for the future.

Patients have certainly noticed the tablet computers and their reaction has been overwhelmingly positive. Patients don’t seem overly concerned with security and, if the issue does come up, we are able to explain that data is encrypted and tablets can be automatically wiped if need be – something which was never possible with handwritten notes.

It’s still relatively early days for ComPAS and we’ve got further developments in the pipeline but so far the signs are excellent. No nurse goes into the profession wanting to spend their time doing paperwork and any system which frees up time to care and improves standards has to be a positive thing.