Going Green with Obstetric Follow Up 

Introduction: 

Epsom and St Heliers NHS Trust is made up of two district general hospitals, both equipped with obstetric led delivery suites. In total they have approximately 3000 deliveries annually. The format of obstetric anaesthesia follow up involved a mixture of electronic and paper documentation. It became apparent that there was a duplication of workload occurring whereby the exact same information was being documented both on paper and electronically. The question then arose - could the paper documentation be eliminated?

 

Method:

The system used for electronic documentation is called BadgerNet. Anaesthetic assessments and interventions,  post-op visits, high risk antenatal clinic visits and specialist reviews are all documented on this system alongside obstetric and midwifery documentation. Paper anaesthetic charts are also uploaded.

Midwives already use the iPads to access BadgerNet via an app to add and edit patient records. One of the first steps to encourage use by anaesthetists was to obtain a dedicated iPad they could use at the patient’s bedside while conducting follow up visits on the post-natal ward.

This was followed by a series of individualised and group engagement meetings to encourage use of the system while moving away from paper based patient follow up documentation.

Due to significant involvement of trainees on the maternity units, their involvement in this transition was key to its introduction and eventual long term sustainability. At St Helier Hospital, the trainee obstetric induction included a short presentation detailing how follow ups could be completed using the BadgerNet application on an iPad. A few weeks later, all paper follow up forms were removed from the delivery suite at St Heliers hospital. Contact numbers for troubleshooting “champions” were provided so that anyone encountering difficulty while using the BadgerNet app on the iPad could receive immediate assistance. At Epsom Hospital, a short video presentation was shown at the morning departmental teaching explaining how to perform follow ups using the iPad. 

Four months following the initial rollout, an anonymous electronic survey was sent out to all grades of anaesthetists at both sites requesting feedback on their experience using the iPads for electronic documentation of anaesthetic patient follow ups.

Results:

 

Conclusion:

The project came about due to early identification of workload duplication. The previous system involved having both a paper and electronic based system which recorded the exact same information. What made this project successful was two fold: firstly the use of iPads which enabled truly mobile freedom; and second, the BadgerNetapplication for the iPad. This allowed clinicians to simultaneously input information whilst being at the patients bedside, as opposed to having to see the patient first and then document on a computer terminal away from the patient. It also avoided having to carry loose pieces of paper which could be left in open areas and breach patient confidentiality. A natural consequence was faster, clearer and more complete documentation; easier access to records; and less duplication of information.

As a result of the positive uptake, an iPad was purchased for each site, for the sole use of anaesthetists. This removed any barrier to submitting follow up information away from the patient bedside or justifying the need for paper forms.