Lancashire Care NHS Foundation Trust

Improving mobile working practices for district nurses and early intervention teams

Lancashire Care NHS Foundation Trust wanted to improve quality and the efficiency of its community services. To do this it has introduced mobile working, using NDL Digitise, for its district nurses and early intervention teams. As a result, clinicians can spend more time with patients, providing a higher-quality service, while central data is far more accurate and detailed, supporting the production of critical performance data. Lancashire Care is now starting to roll out the solution across all its teams of community-based staff.

The Challenge

Lancashire Care NHS Foundation Trust serves a population of around 1.5 million people. It delivers inpatient and community mental health services and also provides community nursing, health visiting and a range of therapy services. It employs over 7000 staff across more than 400 sites.

In 2011, the Trust took on a range of new community services and inherited a range of ad-hoc systems, which in itself created data challenges. At the same time, it wanted more robust performance data to help plan services effectively.

With increasingly severe budgetary constraints, it also had to be more agile: in short, it needed to do more and spend less.

To do this, it set strategic aims which would lead to a smaller estate, more accurate data and staff who would spend more time out of the office. It recognised that one key way of doing this was by mobilising its community staff.

The Solution

Lancashire Care had specific requirements for a mobile solution: it needed to work offline and synchronise when a signal is available; it had to be fully secure and encrypted as well as easy to develop, maintain and adapt; integrate seamlessly with its central patient database, and work on a range of devices. It chose NDL Digitise as it met all these criteria.

Digitise is part of the NDL Evolve Transformation Platform and corporate server platform which allows users to design, deploy and manage multiple bespoke and secure mobile applications across different device types, including Windows 8.1 tablets and phones. Using these applications, mobile workers can operate on or offline, taking information from back office systems with them and updating it from the field.

Over 350 district nurses and some of their early intervention services staff are now using a mobile application built with Digitise. Each morning they receive their appointments for that day; during the day they record what they have done, search for patients, make notes and plan future appointments. The application links back to the central in-house Electronic Care Record (eCR), which runs on .NET with a SQL database and provides one single shared electronic record with powerful reporting facilities across all the Trust’s activities.

Staff at the central office can view and update diaries in real time using an electronic allocation board: the next time the community staff synchronise their devices and update the central eCR, any new appointments appear on their mobile devices. Users have access to the British National Formulary (BNF) online and are also able to take and store photos and videos.

The Benefits

Staff no longer have to return to the office to enter notes, update diaries or receive their appointments for the next day. Interestingly, this has not been translated into reduced travel time. Users aim to see more patients in a day, but find that they are using this extra capacity to spend more time with them, supporting the Trust’s aim to deliver even better services and improve quality outcomes.

The work they do benefits significantly from being able to take extra time talking to patients and understanding their needs and problems even more effectively.

According to Chris Anderton, Clinical Systems Manager at Lancashire Care, “One of the most important things was that we were able to develop the application in exactly the way users wanted. District nurses sat down with our developers as they produced it, inputting directly into how it was designed: after all, they’re the experts.”

This has led to very high levels of take up and the new way of working has been very popular. Users have stated it has changed the way they work for the better.

A key benefit of using Digitise was that it can be developed and enhanced in-house without having to resort to expensive external skills. Central data is now more robust and accurate, supporting the production of better performance data, while recording of whether visits have taken place has improved.

What's Next?

Lancashire Care is now intending to roll Digitise out more widely across mental health services and children’s services, with the aim of bringing the entire workforce into mobile working within two to three years.

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“Having a mobile solution is key to achieving our strategic aims of reducing our estate costs, having more accurate data and reducing the amount of time staff spend in the office. Digitise is flexible, easy-to-use and can be changed really quickly. Critically, you can get users directly involved in the development, which means they can have some control over it and therefore end up with exactly what they need.

Chris Anderton, Clinical Systems Manager, Lancashire Care NHS FT