Safety first: VitalPAC helps hospital staff to measure vital signs

The Learning Clinic has developed VitalPAC to help staff record patients’ vital signs and take action if they are deteriorating. Shrewsbury and Telford Hospital NHS Trust has seen the benefits.

And because the company is working closely with Microsoft’s NHS Common User Interface Programme, other NHS organisations will get the benefit of its experience, too. Sally Whittle reports.

Almost a fifth of deaths in UK hospitals are avoidable, according to research conducted by the National Patient Safety Agency and the National Institute for Health and Clinical Excellence. So improving the care that hospital patients receive could save as many as 10,000 lives a year on some estimates.

“The reality is that the care of deteriorating patients is, in many cases, sub-optimal,” says Peter Greengross, medical director of The Learning Clinic, a company that specialises in developing technology systems for hospitals.

Picking up vital signs

One of the reasons that deteriorating patients might die unnecessarily is that hospitals fail to measure their basic vital signs effectively – or fail to recognise the significance of particular measurements and symptoms.

For example, a patient with a rising temperature might deteriorate to a point where they become vulnerable to secondary problems; or an unobserved fall in blood pressure might be a consequence of a reaction to mediation. 

Even where records are taken and issues are recognised, there may still be problems, says Greengross. “A nurse may escalate a patient’s case, but often we see delays in getting the request for consultations to more senior colleagues, which can cause problems for the patient,” he says.

VitalPAC is a clinical system designed by The Learning Clinic to help address this problem. VitalPAC runs on handheld computers, which can easily be carried to the patient’s bedside. There, the software prompts the nurse or healthcare assistant through the process of taking a full set of observations, ensuring nothing is missed.

Traditionally, taking observations has been a low-status task that is often delegated to junior staff or bank nurses. “What the software does is act like a more senior colleague looking over their shoulder, because it makes it impossible for them to forget to take a measurement,” says Greengross.

A second feature of the software is that it stores and analyses data over time, so that if a patient’s oxygen level is declining alarmingly, or a rise in temperature is above what might usually be expected, the software can alert the clinician.

Once the data has been entered, VitalPAC analyses it to produce a risk score out of 100, with recommendations for changes or action that should be taken. For example, it might recommend increasing the frequency of observations, or request that a senior member of staff be consulted.

“This information can be tailored to the hospital’s protocols and algorithms, but it ensures that staff are supported, and senior staff alerted as early as possible,” says Greengross.

Picking up risks

“When you enter the observations, the risk score out of 100 means it is very easy for junior members of the team to interpret what they see,” says Carol Tune, lead nurse with the critical care outreach team at Shrewsbury and Telford Hospital NHS Trust, which has been using VitalPAC for three years.

“More than that, it can issue messages and alerts, to tell you that you need to inform a consultant of your findings, or you need to re-check the data you’ve entered and confirm that it’s correct if it’s very different to a previous reading.”

“The best thing is that VitalPAC ensures you do a full set of observations, and that’s something that traditionally hasn’t always been done well,” she adds. “By electronically calculating the risk score, you also know patients are less likely to deteriorate unnecessarily, because the trends are always being recorded and analysed.”

All data entered on the VitalPAC system is transmitted wirelessly to a central hospital-wide database. This means other clinicians can see observations almost immediately, instead of waiting for paper notes to be updated.

“That can be a big problem if someone is moved from one ward to another in the hospital, because the notes might not necessarily be updated immediately,” says Greengross. “With a wireless system, that’s instantaneous, which can only be good news for patient care.”

Greengross admits that deploying a wireless patient-information system in a clinical setting does present  challenges. For starters, hospitals are large buildings and there are inevitably “cold spots” where reception is weaker, particularly as systems are expanded to support more concurrent users.

The Learning Clinic also worked hard to protect patient confidentiality while making sure that the system is easy to use. Every handheld computer running VitalPAC is protected by a user PIN code, and data is encrypted on the device and during wireless transmission. In addition, if an unauthorised user attempts to access the system more than three times, the hard drive is wiped of all data.

Shrewsbury and Telford’s paperless wards

Shrewsbury and Telford Hospital NHS Trust worked hard to reassure staff that the new system was secure, robust and reliable. All staff were provided with information booklets and training. Some employees also completed e-learning about the system.  

“We ran the electronic system in parallel with the old paper-based system for a while, because there was some resistance, particularly from some of the older doctors,” says Tune. “However, we found most staff picked up the software in five or ten minutes and within a few weeks, people were asking us if we could get rid of the paper charts completely. We now have three wards that are completely paper-free.”

The hospital is also planning to roll out a bolt-on VitalPAC system to monitor infection control and flag up actions such as checking canulas.

Doctors can access VitalPAC data through their own Windows Tablet PCs, which can also be used to access x-ray images and other clinical data. “It means someone has absolutely reliable, current data when they see a patient, no matter where in the hospital they are,” says Tune.

Patient care has improved substantially through the use of VitalPAC, she believes. “I think it’s absolutely fantastic. Because the system prompts people and gives them advice and messages, we have absolutely found that we have earlier recognition of a patient who might be deteriorating.”

VitalPAC also allows nurses to be more efficient by directing their time and resources where they are most needed. “Sometimes VitalPAC will analyse the data and suggest a patient doesn’t need such frequent observations, while another patient might need to be checked every hour.”