Nursing Clinical Content: the currency of clinical systems

What do we mean by ‘clinical content’?

Clinical content refers to the components of nursing records that both structures care processes and provides information at the point of care, supporting clinical decision making.  Examples include templates (for data collection – supporting nursing to make high quality assessments), risk assessment frameworks (to bring evidence to care processes for example PU risk assessment) and care pathways (to support clinicians in making optimal decisions about care plans with patients).  They may also include alerts and warnings, where professionals’ attention is brought to a particular aspect of a patient’s condition for example an allergy.

Why is clinical content important?

  • Expertise of workforce

We know that the experience in the nursing workforce is set to fall as the older more experienced nurses leave the workforce.  Clinical content can be used to guide staff through care processes and build their nursing knowledge and expertise.

  • Efficiency

Implementing electronic systems does not always make work more efficient on its own and only by judicious professional review can we make sure that the paper systems that we might convert to electronic are robust and not wasteful.

  • Improving quality

Providing staff with the best information at the point of care helps to make sure that patients receive high quality evidence based care.  It also allows us to robustly review our performance in a structured way; for example, we need to be able to measure pressure ulcer incidence.  In order to understand how we might be able to improve and to investigate if we are outliers from a performance perspective we need to be able to compare ourselves with others, so we need data collection that is common.  This leads us to conclude that common data collection templates should be important.

  • Safety

If we collect consistent evidence based information and use this to deliver care we can improve safety, for example, well structured and common handover documents as patients move across the systems can help to maintain continuity of care and avoid safety incidents.

  • Information overload

In the new information age there is almost too much information available for staff to integrate into their practice.  Well governed and managed clinical content can help staff to be as up to date as possible.

Is Clinical Content just about electronic records?

Clinical content is commonly referred to as a component of electronic records but actually all record keeping systems have a component of clinical content.  If you visit any ward or department you are likely to find assessment frameworks and templates for collecting information, as well as possibly local standardised care plans.  Sometimes these have strict governance applied but paper records have a tendency to proliferate, for example, in Nottingham they found that they had around 600 pieces of paper to be used in nursing records.

Why should we be concerned about this?  Doesn’t the system work we have now work?

As the world we work in becomes more and more electronic so nursing is likely to evolve to catch up with the world around us.  We can of course just turn our pieces of paper into electronic versions of the same, but this would represent a huge missed opportunity.  Experience of implementing electronic records in the US shows that just making paper electronic, while a low complexity approach, adds the lowest value in terms of quality, efficiency and safety.  We have a huge opportunity to improve things but we need to grasp this now, and we need professional leadership to make it happen.

Isn’t this about IT and, therefore, not a professional issue?

This is definitely not about IT.  When any clinician starts using a new system it will come as an empty vessel, a bit like a show home.  In order to make it useful, and contribute its potential, it needs clinicians to make it work for them through adding high quality well governed content.  Also professionals need to work out how it will work for them, to continue with the show home analogy they need to make sure the sofa fits into the room and that the colours match.

Why don’t systems come with content already in place?

Some systems will come with some content from the system supplier or a third party.  If anyone takes this content they are likely to find that it perhaps is not fit for their organisation (most content is from the US) and requires a lot of review to make it fit for purpose.

Should we be developing our own content now?

It is a good idea to start to develop nursing content and to streamline existing records now even if you are not planning an electronic record.  If this is done carefully it can ease the way forward for implementing electronic records.  The downside of this is that it is expensive and time consuming and if every organisation has to do this alone it may represent large sums of NHS funds.  The downside is nursing is already behind the curve professionally.  The medical profession is already making strides forward to enable standards such as discharge summaries to be used across the service.  Nursing has a tremendous track record of innovation and with good leadership clinical content development could contribute to other priorities such as QIPP and the productive initiative.

What needs to happen to make this a reality?

The first step is senior clinical leadership and ownership by the profession.  In order for this to happen we need to be clearer about why this is important and what any activity can offer.

Governance, ownership and risk will be key issues to be explored.

Anne Cooper

Nov 2011

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