Fran Beadle is the National Clinical Informatics Lead (Nursing) in Wales and Assistant Head of Clinical Informatics in Wales

The Welsh Nursing Care Record was created by Digital Health and Care Wales and nurses and colleagues across the Welsh health system to create a digital process with standardised nursing documentation. The Record went live in 2019 and won ‘Best Healthcare Project’ at the UK IT Industry Awards in December 2021.

The Journey from multiple nursing documents to a standardised digital record to

In 2017 it was identified that the level of standardisation in nursing documentation across Wales was limited with poor nursing documentation cited in hospital audit reports. In addition, there were copious amounts of paper and digital nursing documentation, which led to preventable errors and duplication across the system.

How could we reset this situation and bring about improvement through changing the balance between too much documentation and too little?

We identified that technology was the key component that could help us begin   the journey to transform nursing documentation in Wales.

Understanding requirements

It was important to understand what we wanted from our nursing documentation and digital systems to ensure that whatever we standardised and digitalised was fit for purpose and met the practical needs of our staff and patients.

This required extensive engagement with our nursing and technical teams and pivotal to its success was the introduction of new nursing clinical informatics roles in every health board and trust in Wales who were the conduit to and collaborators within the commissioning? health boards and national teams.

How did we achieve a Welsh Nursing Information Standard?

National nursing information standards were necessary to address the document duplication and inconsistencies in Welsh nursing records. It was also identified that with digitally shareable and easily viewable patient information, patient safety on admission to hospital would be improved.

Key to the development of these standards was organisational and multidisciplinary collaboration across the Welsh health system.

All standards were supported by a governance assurance process, which incorporated end to end nursing governance that included the specialist nurses delivering care to patients advising on current best evidence recommendations from multidisciplinary specialist groups. The recommendations for information standards were?  then considered by the Chief Nursing Officer for Wales and Directors of Nursing & Quality for approval, with the issue of an All-Wales Welsh Health Circular.   

Getting the technical architecture right

As described, new clinical roles were introduced. However, these positions didn’t require experience in technically managing digital health systems. As such, our specialist clinical and technical digital health teams applied their expertise to support these clinical roles by translating the digital language, abbreviations and acronyms used in systems to standardise and digitise nursing records.

In tandem, the nursing clinical informatics leads were able to support our technical colleagues to understand clinical requirements to ensure the technology was aligned  to nursing workflow and processes for patients. The project supported a safe space for bi directional communication to ensure a fit for purpose digital system that met the needs of those using it.

Implementation

The Welsh Nursing Care Record(WNCR) has been live since the 19^th April 2021 and is now live in 5 (by the time this is published it will be 7) health boards and trust in Wales examples of feedback from our staff include:

“It’s changed how I work because everything is in one place; you never lose a bit of paper and you don’t have to run around the wards looking for something.” – Staff Nurse 

“If I can use it, anybody can use it. I am getting very old now. It saves me a lot of time.” – Staff Nurse 

Moving forward we will continue to rollout WNCR and listen to what our end users are telling us to create more content aligning with the “Once for Wales” vision. We will continue to work together to develop more nursing standards, which provide the foundation of the WNCR, giving nurses more time to care and creating safer patient outcomes.

“It’s better to capture all the information with the patients so you can go through everything in one go, so it definitely saves time and I think it’s better for patient care because it means we can spend more time with them than completing paperwork.” – Staff Nurse

The PRSB is currently working on a new nursing project, having been commissioned by NHS England Transformation Directorate to determine what’s needed from a new nursing standard for use across all health and care settings in England. The team have worked collaboratively with the Welsh Nursing Care Record team to share best practice and learnings from both projects.