Q Exchange
Patient Safety at your Fingertips: An Innovative Mobile Application
- Proposal
- 2019
What is the challenge your project is going to address and how does it connect to your chosen theme?
Patients can feel dis-empowered to provide real-time feedback on their clinical care. Causes for this may be lack of opportunity to provide feedback or that the patients do not want to upset care providers and so do not always raise issues. There is variability in the level/quality of communication, given this is dependent on both the patient and healthcare professionals.
We know that key safety concerns can sometimes take a day or several days to address – timely action can reduce harm to patients.
There is currently no formal channel or forum for patients to escalate patient safety concerns. This is often communicated after discharge. Moreover, we do not currently have a method to evaluate patient perception of safety.
We are seeking to introduce an opportunity for true patient participation in delivering safe care. We aim to co-develop an app with patients, for patients.
This will provide staff with opportunities to make things right whilst patients under their care.
What does your project aim to achieve?
Our objective is to develop a mobile phone application (app) for patient and/or carer use in the inpatient setting. This app is currently being developed by the Patient Safety & QI team, in partnership with the University of Northampton.
The app can be used daily by patients and will ask them key questions relating to their safety in hospital. Questions include allergies, knowledge of their medical plan, observations and whether they have the correct wristband on. The final question posed to patients each day is whether they feel safe today. If a patient records ‘no’ to this question or other key questions, then this will be escalated to a staff member on the ward via the app. Appropriate escalation has been designed into the app to ensure a staff member discusses these concerns and rectifies problems (e.g. no wristband) in a timely manner.
We hope that through the app we will see an improvement in the proportion of patients who feel safe as well as a reduction in safety concerns.
How will the project be delivered?
We are working in collaboration with Professor of Computing at the University of Northampton to develop the application and back-end system. This is to ensure a robust, secure system is developed to protect data information.
The project is led by a Patient Safety & QI Project Manager. Working in partnership with our in-house patient representatives as well as current inpatients, she is co-designing the aesthetic of the app (to ensure ease of use) as well as the questions themselves. Patient interviews, focus groups and surveys are conducted to underpin this.
A timeline to develop the questions and app and pilot the app is in place, with support from the organisation and management teams in place for the pilot.
What and how is your project going to share learning throughout?
Data is captured in real-time and will be analysed and reported frequently by the Data Analyst in the Patient Safety & QI team. We will be reporting progress to a bi-monthly collaborative meeting with the university (as a form of assurance and governance).
Data will be reported via statistical process control charts and if there is interest, we would be happy to upload these to our hospital webpage.
Once the pilot is complete, we hope to share our findings with the wider Q network, through various forums and conferences. We are keen to develop a poster on this, which we will share, as well as publish our findings in a Quality or Safety journal.
This app lends itself to further roll-out to other organisations and we would be keen to support this.
How you can contribute
- We are co-designing the first version of the application with patient representatives - this will include critique of the design / aesthetic but also more importantly the questions themselves. We encourage additional input from other patient representatives as well as from healthcare staff - so please get in touch with your ideas.
- Our vision is that this app will be spread to other organisations once we have developed a working prototype. Please let us know if you are interested.
- Suggestions on the successful pilot and roll-out of this application (considering its logistics) would be welcome.
- If anyone has conducted previous studies or projects relating to patients' evaluation of their in-hospital safety, then please get in touch.
Plan timeline
| 31 Jul 2019 | Complete patient interviews and qualitative data collection |
|---|---|
| 9 Aug 2019 | Test paper version of patient survey prior to upload on app |
| 20 Sep 2019 | Refine questions and upload to app |
| 18 Oct 2019 | Pilot app on small number of wards |
Comments
Jacqueline Morton 4 Jul 2019
Sid I really like the concept and how it engages our patients in real time.
What feeling safe is will vary from patient to patient. Whilst prompt questions are great its being mindful that they don't define the response. Would you consider free text?
In relation to your escalation arrangements could you involve another member of the wider team as opposed to the just the Nurse in Charge? I think that this would provide a more open and transparent environment for the management and coordination of responses.
How will you communicate the opportunity to family, carers and patients?
Sid Beech 4 Jul 2019
Hi Jacqueline,
Thanks ! We've gone back and forth on the questions we want to ask (e.g. do you know how often your obs should be taken and why?, have you informed a doctor or nurse about any known allergies? do you understand your diagnosis?). We're still refining the choice but felt open questions would be extremely difficult to manage (in terms of reporting and evaluation). We're still refining our questions based on what our patients and representatives say.
Our thought process is that "negative" responses will be addressed by staff and anything that would have been put in the free text can be discussed with the staff-member. We have considered some form of patient feedback on these interactions with staff - it may be built into the 2nd version of the app as this requires more complete IT!
Escalation will vary dependent on the question. Some may go to the ward iPad (which is used by RNs and HCAs), and if this isn't addressed in a timely way it would go to the charge nurse or matron as required. These wouldn't be the first port-of-call. We expect we will need to adjust this as we test it!
We are going to pilot on a few wards (although it may spread with patient ward moves etc). We'll be using volunteers initially to support the trial as well as posters at the bedside to encourage patients / carers to download and use the app. We've just had free public wi-fi installed in our Trust. We may look to have the app information on the wi-fi log-in page but this will only be suitable once it is hospital-wide!
Let me know what you think about this - what you would change etc.. I'll pass it on to Clare (project lead)
And as I said above - if you think this should be funded, please 'like' the idea! Thanks,
Sid
Helena Durham 4 Jul 2019
Hi Sid and Elizabeth
What an innovative idea.
On the one hand, it'd be great if nurses were checking these things via conversations, on the other there is a shortage of staff. Also, patients might really appreciate being more engaged and autonomous, and feel better able to flag up 'mistakes and omissions' via the app.
I'm a patient representative - a Patient Safety Partner with the Patient Safety Team at Nottingham University Hospitals NHS Trust. A couple of years ago we did a major revamp of PS information. Perhaps you've discovered the same as we did, that potential and exisiting patients don't understand what the NHS means by Patient Safety and 'feeling safe' - we had answers dominated by themes of being safe from assault and theft. Have you found similarly and if so, how are you addressing this, including in your question?
We are looking at changes to our in-patient survey questions around 'Did you feel safe' to include the word 'mistakes', something along the lines of 'Do you feel your care in our hospitals was free from mistakes?' We also think this represents the Trust's commitment to being open. Would be v interested to hear your findings from scoping the question.
Sid Beech 4 Jul 2019
Hi Helena,
Thank you for getting in touch - and thanks - we think so too!
I agree that we should still encourage our staff to pick up on this through daily conversations with patients. Our hope is that the app will supplement these interactions whilst also picking up on safety issues that staff (and patients themselves) may not have identified. As you have said, the app may also offer an opportunity for patients who would otherwise not feel empowered to have these conversations in person.
We have found the exact same thing - safety means very different things to patient and healthcare professionals. Our aim is that we can evaluate 'safety' using our prompting questions before the final 'do you feel safe?' question. I like your approach ref 'do you feel your care in our hospitals was free from mistakes?'. This is an interesting take.
If possible, would you be able to contact qi@ngh.nhs.uk? Clare Rogers is the lead for the app in our organisation. She is not a Q (yet!), but she would like to discuss this with you in more detail, if you are interested.
And also please like the idea if you think it should be funded!!
Thanks,
Sid
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