Quality and safety assurance has always been a priority at RWH. Learn how disparate data from numerous systems and spreadsheets have been rapidly brought together to create improved governance and assurance both at the board level and at front line level with dashboards which integrate qualitative and quantitative data to ensure the full picture is always in focus.
"..we've had really positive user feedback, ward managers really like it. It saves them time and they've got all their data in one place. It;s driven some really healthy competition between wards."
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I just want to share with you this morning, how we have used InPhase to develop an interactive Nursing quality dashboard. So, before I do anything else, I am going to show you some graphics that we have used to roll out throughout the organisation.
We are pleased and excited to announce that a Nursing quality dashboard has been designed to enable trust staff at any level to use selective data sets relating to the quality of care. Easy access and availability to this data will enable us to target key areas to drive up improvement where required. Data is accessible by InPhase - a web-based oversight system. We have imported a number of data sets derived from different sources to allow visibility for all information in one place. This system correlates a number of data sources to enable an effective triangulation of data, which helps provide a better picture.
The information can be integrated at different levels - Trust, Division, Directorate and Ward. The aim is to roll out an interactive Nursing quality dashboard to all relevant staff over the coming months. The data sets to be used are described on the next slides: Nursing Workforce, Patient Voice, Pressure Ulcer, Falls, Deteriorating Patient, Infection Prevention, Nutrition Hydration, Medication, Ward Safety, End of Life and Discharge.
How to use...
For InPhase, the login page can be found on the login site, select it and it will appear on the list. Once selected, you can log on using your username and password. On first login, you will be prompted to change your password. Once logged in, select the interactive Nursing quality dashboard. To set this as your home page, go to the icon shown and there will be an option to select home page”. Select this. To ensure you are viewing the most important data, change the date at the top right-hand side of the screen to the last date of the previous month. For example if it's November, change the date to the 31st October 2020. Once you have changed, this you will see the date on the table. You can view the data at different levels as per our structure - Trust, Division, Directorate and the Board level. To do this, select what is shown here.
To view information about our metric, pick a performance card as shown here, and the detail will appear on the right-hand side of the screen. There is a graph that will show a trend and SPC. The table below will show a graph with last imported information. If you want to drill down for more levels for more detail on a metric, select the green arrow which is located in front of each metric name, as shown here. You can drill down by Division, Directorate or Board level as the screenshot shows. On the table, it will provide details of how area will select the metric performance. For example, green is good but amber or red means "needs improving". A tick means "improving" and a cross means "deteriorating". DOT is "Direction of Travel". This will indicate if in previous months if there is improvement or deterioration. Some of the selected nursing audit data has been uploaded into InPhase who are able to draw down into Ward level, and the answers for those questions will appear.
By having all the available data in one place, it will enable us to measure how we are doing, identify areas of best practice and where we can drive up improvement. All this to provide a higher quality of care for our patients.
That is the infographics that we use - the dashboard for our organisation. We did not use our data as effectively as we could, and what this InPhase dashboard helps us to do is correlate all our data and triangulate our data to give us a better picture, so we can identify the areas we really need to focus on and improve. It enables us to drill down to specific Ward areas, but we can also see everything about the trust division and our director level as well, so we really know how we are doing and where we need to improve and areas where we are doing well, so we can celebrate its success. So overall, it really does give us increased transparency across the organisation because we are putting all our resources into one.
So the next slide demonstrates it shows you where we get all our data from. So the data that falls into the main dashboard is all our indicators with all our audit results. It pulls together all our infection prevention, environmental results as well, which has been very important during the current pandemic. Ward Managers like it, because everything is in one place, so they have all their workforce data, their budgets, their sickness, vacancies, their mandatory training will be in the same dashboard as all their other indicators, so this includes their patient data. So we have an observation system, how many ops are on time and cardiac arrest data, our patient feedback data on our complaints and complements also comes into the dashboard and medication data and our infection prevention data. So it's all correlated in one place. So previously we may not have compared our nurse indicators against our ward data - this dashboard allows us to do it.
So, if we go onto the next slide and talk to you about the four dashboards that we have developed with InPhase. The Interactive one we have just seen a video about, which shows how we can drill down into all our key areas in little types of tablets as you go down. We also have our Ward entrance dashboard, so this is the interactive dashboard which we have already talked about, but as you can see, very easy to use, colour-coded very simple. We also have our printable quality dashboard, so this is for our Chief Nurses to record or change dates and we can see its coloured-coded. So this is printable, so we don't actually do any manual reports. All our safety is now pulled from source. It drills down to ward, so it gives us the ability if a ward is performing and to share the information across the organisation.
We can also use the same data to go into the ward dashboard, which is printed and placed on every ward on every month. This just helps our transparency to relatives or visitors to the ward under normal circumstances. This is a dashboard that is printed - we have some very key indicators that must be transparent with our visitors and information on how busy the ward is, through our sensitive indicators a specific ward is with beds on a monthly basis. We pull together our infection prevention data, our hand hygiene and our environmental audit. Another key risk for us is our medication errors along with our audit about medication storage, our patient voice and also our audit on positive opinions on our nursing care, when our patients care. We have our workforce indicator, also our falls and deteriorating patient's indicator as well, and it is on the entrance to the ward.
We are also working on a trust-wide trend report, so instead of having any recent reports at all, all the information is pulled into this, so our Patient Experience Lead can look at the data, to write directly on here what her analysis is of the data and any actions that we are taking to improve. Again, this is called the different measures, which is then printed and sent to ward. So all our reporting will be sent through our InPhase dashboard, which is pulled directly from source.
So as we said, the dashboard correlates all that information. We also use the dashboard for one-to-ones with our Head Nurse to see where we need to check good practice and where we need to drive improvement. The Head Nurses use it with their Matrons and then subsequently Ward Managers. We also use it widely across communities.
We have had really positive user feedback. The Managers really like it - it saves them time and all their data is in one place and everybody can have a look to see how everybody else is doing, and we feel this will really help us guide through it.
What it has done as well, because the data is so visible, there is a real emphasis to get the data right, so this will improve the quality of our data.
We have identified a clear correlation between wards with increased incidents with falls and poorer compliance with the audit data to really target those wards with a real focus to drive improvement.
We are about being selective about the data we are putting into our dashboard and the right quality of data and that's ongoing.
How has InPhase been able to help during this pandemic, which is useful - thinking about added data requirements. InPhase have been invaluable. I am sure everybody is aware of the latest guidance to open additional capacity in the second wave, with indicators for the extra capacity wards we are opening. So very quickly we have been able to put those wards on the InPhase dashboard and we can clearly capture the workforce within those areas and the audit data within those areas. We will have that in our dashboard so we can see where we are. And if CQC want to see our data, we have it captured. Also, in the pandemic, our infection prevention data and environment data is available to all. So when we are doing any meetings, we are using the InPhase dashboard to look at hygiene levels and environmental audit within those areas as well, so it’s been really helpful actually.
We have had another question, which I think is a good one because it's across systems in general:
"How do you manage to get your users to update the system on time?"
So it is a challenge. We set the work with the users at the beginning - we have set a clear base with data cut-off that is stretched sometimes, but we are going back to the users. But it is very simple for them to be able to do and I think it’s really working with the users. I think people seeing that the data is used and is visible there has been an increased emphasis for people to get the data, but it is ongoing and it is a continual cycle really.