The Patient Safety Congress 2008 looks interesting; wonder if they’ll be anything on shift handover systems? A quick use of the search pulled up a few items, though nothing 100% specific? Maybe I missed it in the rush, though.

“This important event scheduled for 22nd – 23rd May 2008, ExCeL London, featuring presentations from policy leaders and the leading figures in the patient safety movement, represents a call to action for everyone in the NHS to take work around patient safety to the next level.”

Interesting story in Medicexchange on how communication of abnormal test results in the outpatient setting is prone to error, but using information technology can improve communication and increase patient safety, according to a study led by Hardeep Singh, MD from the Baylor College of Medicine, Houston. The results appear in the Journal of the American Medical Informatics Association (JAMIA).[1]

If there was a case for adequate (shift) handover systems in the NHS surely today is an excellent example, as 30,000 junior doctors start on the same day.

Shift handover related reading

‘Concern about USB sticks used for handovers‘ article from E-Health Insider.

And as importantly the comments themselves, so you can make up your own mind:

26 Jul 07 20:16 (mary.hawking@nhs.net)

Risks in handover times

Dr Daunt is to be congratulated – and so are the Trust and the junior doctor whose USB stick was stolen for facing the problem. This is bound to be a universal problem: handover – when the care of a patient is transfered from one individual or team to another (handover in hospitals: discharges – and admissions – between secondary and primary care) is recognised as a time when mistakes are particularly likely to occur. That being so, it is inevitable – and desirable – that any new method of making the handover process more efficient will be used. I haven’t heard this particular risk – authorised or unauthorised use of removal media such as USB sticks or floppy discs to facilitate handover in Trusts – discussed before. Do any Trusts have policies on this? If not, why not? “Don’t do it” is not a policy..

26 Jul 07 22:40

And on hospital PC is worse?

Last Saturday I walked onto a ward in my hospital. The first PC was logged on as “Ward X” – there were about 25 desktop items, which were Word, Excel and Notepad files of Junior Doctors “handover sheets” – full info – name, number, diagnoses, to do lists etc. Two clicks and “print” and it would all have been in anyone’s hands – or plug in the USB stick and there it all is in portable format. Yet all the Juniors believe in patient confidentiality, and our hospital has a password protected PAS that allows storing and printing of this data. So why do they not use it? Why do they compromise patient data?

I think we need to use some disciplinary muscle to stamp this out.

27 Jul 07 03:54 (mikehitchens25@btinternet.com)

Secure Biometric USB Reader

The LME Bio biometric fingerprint reader allows for secure storage of patient identifiable data for a number of registered users and optional secure remote access to a work-based clinical system from anywhere.

(post edited by EHI)

27 Jul 07 05:26 (swilson@lockstep.com.au)

Why is anyone using USB sticks to CARRY data?

I would have thought that using USB sticks to convey patient data between healthcare workers at changeover would be deprecated on a number of grounds, not just the risk of losing unencrypted information.

Why isn’t this data available to all staff concerned on a central EHR/EMR? What needs to be copied to a stick that isn’t already available online through a terminal? If data is replicated in an uncontrolled way, the biggest risk isn’t that it could fall into the wrong hands; rather, it is that the portable data is modified and comes to diverge from the ‘original’. It is supremely important that at no time is there any doubt about the primacy of a given piece of health data.

At changeover, carers should be using a secure key (ideally a smartcard) to access definitive data online, not swapping data on an ad hoc basis through portable media.

Cheers,

Stephen Wilson Managing Director Lockstep

www.lockstep.com.au

27 Jul 07 10:04

Thats the whole point

Quote: Why isn’t this data available to all staff concerned on a central EHR/EMR?

Because the currebt solution is so awaful, too slow and does not provide the information needed in this manner.

The use is common, best plan would be to offer a FREE encrypted sotware utility and insist on its usage.

Because of the size and manner of usb drives, its impossible to ban them, so pointless. better to secure them.

Of course this is a totally irrelevant arguement when I see the consultant orthpaedic surgeon staggering to his car with 15 kilos of patients written notes, locking them in his unsecure car boot and driving to the private hospital to update patients who have opted out.

It’s a regular occurence and thiefs can open that car model in 6 seconds

27 Jul 07 10:43

Only the medium has changed

Thirty years ago – when I was a house officer – I kept a small notebook with to-do lists for patients identified through attaching to the page one of the stickers for putting on lab request forms. So did nearly all my colleagues.

This was neither more, nor less, secure that the use of USB sticks.

27 Jul 07 13:08

good point about the paper note book

The ex-house officer makes a good point about the historic use of written notes for hand over, but I expect his hand writing was so illegible that only another doctor could read it.

The latest answer to [shift] handover in the NHS, thanks to E-Health Insider:

iSoft chosen as reseller of mobile clinical assistant

Motion Computing have chosen iSoft to be the first UK-based reseller for the C5 Mobile Clinical Assistant, a rugged and washable tablet-PC style device specifically designed to provide doctors and nurses with access to updated patient records and the ability to document a patient’s condition.

Incorporating Intel’s latest wireless technology the MCA features a built-in bar code reader to enable patient wrist bands to be read, a digital camera and an RFID scanner enabling clinical users to be securely identified of drugs to be verified before being given to a patient.

Barcode scanning and RFID should directly help with improved patient identification and safety helping reduce medication errors. Bluetooth connectivity meanwhile will allow the MCA to link to patient diagnostic devices.  

The device was first launched in February when prototypes were tested at three pilot sites in North California, Singapore and at England’s Salford Royal NHS Foundation Trust. iSoft was involved in the UK trials at Salford.

Marc Horowitz, iSoft’s group business development director, said: “We have seen that mobile devices achieve high levels of user satisfaction among doctors since they support decisions at the point of care. Mobility transforms care by helping doctors and care providers deliver the highest quality of care, which is beneficial for them and for patients.”

Trials of the MCA in the UK were first reported by E-Health Insider since October 2006. In the UK, Connecting for Health have been involved with development and iSoft now aim to offer the device to its 8,000 customers worldwide, both in the NHS and globally.

Horowitz added: “MCA is a major advance in mobile healthcare computing and puts computer technology into care environments safely. Having real-time clinical information to support decisions at the point of care will reduce errors and save valuable time, which are significant benefits to clinical staff and patients alike.

“To improve the quality of healthcare and staff workflow, it is vital to have timely and accurate information at the point of care.”

Motion Computing say that iSoft’s commitment to mobile technology makes them an “excellent partner.”

Motion Computing’s head of EMEA, Nigel Owens said: “iSoft has vast experience and market presence and its applications are proven and ideally suited to the MCA platform. Jointly we provide exactly what customers require by capturing information at source, reducing errors, increasing productivity, and cutting costs.”

The news has been welcomed by Connecting for Health who say the Mobile Clinical Assistant is the “missing link”.

Dr Mike Bainbridge, NHS Connecting for Health’s clinical architect, said: “It is the one thing clinicians having been looking for. The fact that we can get information with greater ease and genuinely collaborate for the first time is a major breakthrough. MCA’s features, tailored to clinical use will show some real benefits.

“The MCA is optimised to reduce risk, which is especially vital during the handover of care and at the point of administering prescriptions. With in-built barcode and RFID readers for patient identification and to validate medications, the process is simplified and the risks reduced dramatically.”

“Today technology comes to the aid of those who help others,” said Paul Otellini, Intel president and CEO.

“The mobile clinical assistant was defined and shaped by the clinicians who will use it. They have told us it will improve their decision making and patient care while easing overall workloads. This is a great example of putting innovative technology to work solving real needs.”

Motion currently charge $2200 for the unit, and iSoft anticipate selling at the retail price of £1100 or around Euros 1570.

Looks like a useful new book by Robert M. Wachter on patient coming out later this year [taken from Amazon]:

Understanding Patient Safety is the essential book for anyone seeking to learn the key clinical, organizational, and systems issues in patient safety. Written in a lively and accessible style by one of the world’s leaders in the fields of patient safety and quality, Understanding Patient Safety is filled with valuable cases and analyses, as well as up-to-date tables, graphics, references and tools – all designed to introduce the patient safety field to medical, nursing, pharmacy, hospital administration and other trainees, and to be the go-to book for experienced clinicians and non-clinicians alike.

Features:

• Concise coverage of the core principles of patient safety
• All the key insights to help you understand and prevent a broad range of errors: including medication errors, surgical errors, diagnostic errors, errors at the man-machine interface, and nursing-related errors
• A focus on how reporting systems, teamwork training, simulation, the malpractice system, and information technology can impact patient safety and quality
• A practical overview on how to implement an effective safety program in both hospital and ambulatory settings
• Realistic case studies that illustrate key points and clarify pivotal concepts
• A detailed glossary, key references, and useful tools, websites, tables, and graphics.

Is great to know money is being ploughed into research into shift handover systems for healthcare. But what about right now in meeting healthcare needs at a ward level? I was inspired, thanks to support from Lee at Headshift, to blog on a UKUPA presentation on shift handover systems by the Centre for HCI Design at London’s City University. And I also saw from my own research experience in the NHS how valuable a tool it was; a fact later backed up by the recent WHO report on patient safety. And so I looked at devising some kind of a solution, and was advised by Ross Mayfield at Socialtext to first get a prototype together.

I came up with a social software approach to the problem, and with the help of some great people including my entreprenuerial cousin James (based at Invensys) put a proposal together. However, this first attempt sadly failed to go any further. But thanks to blogging on this site on the issue Dinesh from Works Software based in Cambridge, with the Lifetrack product got in touch with their tried and tested shift handover solution, which is already being used in the power generation industry. After a meeting I decided to help see if I could find a route for their product into the healthcare market, drawing on some of my more recent experience at Medicexchange.

After a bit of thinking on how best to do this it’s now been submitted to the NHS National Innovation Centre (NIC). I should stress it uses none of the ideas from my initial proposal, which is still covered by a ‘NDA‘!

Anyhow I hope I can help Lifetrack succeed, and if I get chance to visit the NIC it will be great to say hi to my former chair at the HDA, Dame Yves Buckland, who is head of the NHS Institute for Innovation and Improvement, which runs the NIC.

Our evaluation of your idea has resulted in our investigating the strengths and weaknesses of the current hand-over protocols on wards, and discovering that your concept is not new to them – they have seen similar products and evaluted their use on wards previously, with uniformly unsuccessful outcomes.

Since those evaluations the DH Connecting for Health programme has developed the Patient Admission System which to a large extent provides staff with details of a patients progress – the key details that are needed at shift hand-over.

For this reason, we suggest that you contact the Local Service Providers (LSP) for the CfH programme to evaluate interest in incorporating your product in their suite of tools.

Details of LSPs will be found on the CfH website.

Best Wishes,
Operations Manager,
National Innovation Centre.