Liverpool Care Pathway - And The Mechanisation of Medical Diagnosis

According to -

Consensus Statement: Liverpool Care Pathway for the Dying Patient(LCP)

The Liverpool Care Pathway:

 Requires staff ensure all decisions to either continue or to stop a treatment are taken in the best interest of each patient. It is not always easy to tell whether someone is very close to death – a decision to consider using the Liverpool Care Pathway should always be made by the most senior doctor available, with help from all the other staff involved in a person’s care. It should be countersigned as soon as possible by the doctor responsible for the person’s care.

Any decision to embark a patient upon the LCP must involve senior staff as part of a concensus group...

Wardware will permit and prompt a nurse to do so...

Nurses use handheld devices to enter standard observations electronically and a score is calculated.If the score is within a dangerous range the trust response policy is displayed and the nurse is prompted to acknowledge it and say what action they have taken. Staff can be graded to take different actions such as putting a patient on the Liverpool Care Pathway.

This is ehi ACUTE -

King's rolls out Wardware

11 March 2013   Rebecca Todd

King's College Hospital NHS Foundation Trust has rolled-out an open source nursing observations system, Wardware, to 12 wards.

The trust worked with Tactix4 to develop the software, which can be used on any device to record patient observations and calculate their National Early Warning Score.

King’s started testing Wardware two years ago and began a trust-wide roll-out in August at the rate of one ward every three weeks.

Twelve wards are using the software and more than 220,000 observations have been entered into the system, each taking on average 80-90 seconds.

Consultant renal physician at King’s Dr Hugh Cairns said failure to identify deterioration in patients increased their mortality by 10% for every one hour of delay.

Between January 2012 and June 2012 there were 55 incidents involving adverse deterioration at King’s and many of those were because of staff failing to do observations or to recognise deterioration.

Wardware was developed to combat this problem. The original version used the Early Warning Scoring System to identify deteriorating patients, but a new release uses the National Early Warning Score.

Nurses use handheld devices to enter standard observations electronically and a score is calculated.

If the score is within a dangerous range the trust response policy is displayed and the nurse is prompted to acknowledge it and say what action they have taken. Staff can be graded to take different actions such as putting a patient on the Liverpool Care Pathway.

Nurses can view all patients on their ward and see when their observations are due. Other staff can see a colour-coded summary over a week or an individual day.

Wardware can also be used to manage devices such as catheters by allowing staff to enter data around fluids going into and out of a patient.

Dr Cairns said data entry was now much easier and the system vastly improved accuracy of calculating NEWS, which was previously calculated incorrectly in 20% of cases.

Dr Cairns explained that Wardware had become the most up-to-date source of information on bed state. The EPR admits people to a ward, feeds that information into Wardware and a nurse then uses the software to admit the patient to a specific bed.

He said there was ongoing discussion at King’s about how much information should be recorded in Wardware and how much in the trust’s EPR.

King's deputy director of IT Clive Stringer added that the trust was working to allow information from Wardware to be captured in its EPR.

Wardware runs over N3 and is open source so comes with a nominal charge of £1. Tactix4 provide a full support service for King’s and Luton and Dunstable Hospital NHS Foundation Trust, which is starting full roll-out of the newest version using NEWS from this month.

Tactix4 managing director Rob Dyke said that because Wardware was open source it could send and receive information from any system that would allow it.

Trusts could develop modules that were then shared with the rest of the customer community.

At a King’s open day last month, he told visitors from other trusts the system was highly configurable depending on their priorities.

King’s nurse Gail Burgess told EHI she had been using Wardware for four weeks. She said the technology was good, but the iPod screen was too small and she would often enter observations on a desktop.

“In the morning when you handover all the information is there, nobody’s worried about the chart being missing,” she said.

Burgess believed Wardware had made her more aware of patient’s NEWS scores and more alert to possible deterioration in their condition.