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Getting kids hands on for their heart.

Improving patient safety utilising digital technology hand held ECG monitor, in initiation and monitoring of prescribed medication in children with Intellectual Disability.

Read comments 23
  • Winning idea
  • 2022

Meet the team

Also:

  • Jacqui Boyd - ID CAMHS Senior Nurse Practitioner

What is the challenge your project is going to address and how does it connect to the theme?

NICE Guidance recommends that ECG is completed for initiation and monitoring of certain medications to monitor and prevent any potential adverse effects.

Not tolerating ECG results in

  • difficulties in prescribing medication that is required
  • difficulties monitoring prescribed medication
  • Increased risk of potential adverse effects.
  • Non-compliance with NICE and Prescribing guidance
  • Potential Patient safety concerns
  • Increased patient distress in repeated attempts to obtain ECGs for monitoring

We have been working with Paediatric services, Cardiac Investigations and exploring and utilising a variety of visual aids and desensitisation techniques to improve the experience of the child having an ECG.  However we still have approximately 30% of children that as yet have not been able to tolerate an ECG, raising patient safety issues.

Use of the handheld device would be a clinical indicator of any potential adverse effects improving prescribing adherence to monitoring and reducing patient safety fears.

What does your project aim to achieve?

ID CAMHS plan to provide quality improvement utilising digital technology improving the health of the children by utilising the Kardia Mobile hand held device as a clinical indicator of their heart function in those that are not able to tolerate the 12 lead ECG.  This will improve patient safety by early identification of any potential abnormalities and appropriate treatment can be implemented reducing the likelihood of long term health conditions.

This project aims to

  • improve patient safety regarding initiation and monitoring of prescribed medication
  • adhere to NICE and other clinical guidance through improved clinical monitoring of the heart, where 12 lead ECG is not tolerated.
  • utilise digital innovations in quality improvements and reduce health inequalities.

“Poor quality healthcare causes health inequalities and avoidable deaths.” (Mencap 2018).  Monitoring for prolonged QT is especially important in children prescribed anti-psychotic medication and these children often experience significant challenges with the ECG procedure.

How will the project be delivered?

ID CAMHS have developed a medication monitoring service in a multisensory environment with use of interactive projector and various communication aids and therapeutic interventions to improve compliance with clinical procedures.  Staff have completed training to be able to offer ECG at the clinic rather than at the acute hospital which has improved compliance with ECG monitoring to approximately 70%.

A combination of

  • Audit of current adherence to clinical monitoring
  • Patient/family feedback on possible alternatives to ECG
  • Review of digital innovations utilised in other areas of practice

Has lead us to introducing hand held devices for ECG monitoring when ECG cannot be tolerated.

Outcome measures

  • Co-production of implementation of the quality improvement
  • Patient/family feedback
  • Staff feedback
  • Audit of compliance with clinical monitoring required to meet NICE and prescribing guidance
  • Audit of abnormalities identified and early intervention to reduce serious adverse effects of medication

How is your project going to share learning?

The project will be shared with the Q Community through updates on the online platform.

We will also promote the project through regional and local QI forums including the Northern Ireland Regional HSCQI Website and Southern Trust QI annual events.

We will also take opportunities to share findings through professionals’ forums; present at relevant webinars or conferences such as the Registered Nurse Learning Disability Professional Development Forum, the All Ireland ID CAMHS Network along with other forums and service development networks the team are involved with.  Information regarding service developments and quality improvement s will also be shared widely via various social media platforms and forums.

How you can contribute

  • The experience of any Q members who have implemented similar technologies
  • Are their additional technologies we should be considering?

Plan timeline

7 Nov 2022 Evaluation report and share findings at local and regional forums
21 Nov 2022 Engage key stakeholders to identify their needs and expectations
21 Nov 2022 Establish baseline to gather current compliance with clinical observations (ECG)
5 Dec 2022 Establish project evaluation requirements - Including Monitoring
5 Dec 2022 Share and support implementation with other services.
9 Jan 2023 Purchase Kardia Mobile Equipment
16 Jan 2023 Commence Staff Training
6 Feb 2023 Pilot and test Kardia Mobile with children at clinic/home settings
10 Apr 2023 Conduct further PDSA tests to refine solution
4 Sep 2023 Review audit and data gathering detailing compliance with ECG monitoring

Comments

  1. This is an excellent idea that plans to deliver a much needed improvement in the quality of paediatric care - driven by digital health technology.

    1. Guest

      Jacqui Boyd 1 month ago

      Thanks, we are keen to look at different methods to improve health monitoring and health outcomes for early intervention and long term health improvements for our children and young people.

  2. Guest

    Jacqui Boyd 1 month ago

    We have included staff to implement audit and the practical activity of desensitisation of the patient to the monitor and coordination of the reviewing of ECG readings. Just having the product is very useful but needs support to utilise it in a service.

  3. Great idea - would be good to see it tested & evaluated

    1. Guest

      Jacqui Boyd 1 month ago

      Thanks, we plan to audit before and after implementation of the project including review of use of the technology and patient outcomes.

  4. Am not sure why you don't just buy half a dozen of these from Amazon, my understanding is the machine works?

    https://amzn.to/3wuEitg

    1. Guest

      Jacqui Boyd 1 month ago

      Apologies my reply was posted as a comment. Having the equipment is only a small part of the project.  To ensure effectiveness and provide information for other services we require the staff to support the technology.

  5. This is a great idea.

    I work as the new Head of Physiological Science Transformation at NHS England and would love a conversation to hear more about the technology behind this and its potential applications etc.  This might be something that could b supported through our Community Diagnostic Centre programme in England.

    1. Guest

      Jacqui Boyd 1 month ago

      We would welcome contact with your service and plan to share our outcomes in a variety of platforms to further improve patient safety in medication monitoring.

  6. This is a great idea; really practical and could address some of the many inequalities faced by people with learning disabilities

    1. Guest

      Jacqui Boyd 1 month ago

      Great opportunity to utilise technology to aid our population and improve health outcomes.

  7. I like the simplicity of this idea. Have you approached AliveCor to talk about your plan? They're quite an approachable company and I have a feeling that they might find the insight useful in developing Kardia.

    1. Guest

      Jacqui Boyd 1 month ago

      Thanks, I have contacted the company directly and awaiting response.

  8. Guest

    Nichola Tally 3 months, 2 weeks ago

    Totally support this idea, young people with Intellectual Disabilities need to have the most appropriate care for them and this proposal, if successful, would go a long way to helping to overcome any potential risks associated with the prescribing of medications.  Good luck to all involved!

    1. Guest

      Jacqui Boyd 1 month ago

      Thanks for your support.  Our service strives to implement safe prescribing and promote the principles of STOMP/STAMP. Having improved health monitoring will aid early identification of any adverse effects and reduce any long term effects.

  9. Guest

    Sharon Daly 3 months, 2 weeks ago

    This is an excellent idea that plans to deliver a much needed improvement in the quality of paediatric care that is driven by digital health technology.

    1. Guest

      Jacqui Boyd 1 month ago

      Thanks Sharon. We are looking forward to using technology and digital innovation to improve patient safety and outcomes.

  10. Guest

    I think this is an excellent proposal. I have experience of taking my son for numerous clinical procedures including ECGs. It is wonderful to see this team coming up with innovative and creative alternatives to ensure all children can benefit.  I love your child centric approach. All the very best with your project.

    1. Guest

      Jacqui Boyd 1 month ago

      Thankyou. Our service strives to be flexible and child centred and look forward to sharing outcomes of the project with others to further promote and ensure people with additional needs receive the care they require.

  11. Yet another great idea to tackle another challenging problem.  Ensuring appropriate monitoring of patients and service users through their treatments can create great challenges.  I hope this work is successful as those who use the ID CAMH services would greatly benefit from this work.  Best of luck to all the team.

    1. Guest

      Jacqui Boyd 1 month ago

      • Thanks, our aim it to continue too ensure patient safety and meet the needs of a client group using reasonable adjustments when appropriate.  We look forward to quality improvement and promoting the technology for other environments and services.
  12. Engaging with Health and Social Care colleagues can be challenging for young people with intellectual disability and their families. This project will reduce inequalities and have a real impact on patient safety and quality of care by improving access to services that we all take for granted and that young people with ID struggle with.

    The team have a great QI background and can do attitude and we are very proud of all they have achieved.

    1. Guest

      Jacqui Boyd 1 month ago

      The use of digital technology has lead to a variety of innovations in health care in all services and we aim to continue to implement these where appropriate to meet client needs. We are excited about the improvements in patient safety and health outcomes by implementing the Kardia mobile ECG devices in our service.

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