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eWW: patient information at your fingertips

eWW: patient information at your fingertips

What is an electronic ward whiteboard (eWW)?

The electronic ward whiteboard is an exciting innovation replacing our longstanding whiteboards on medical and surgical wards with large electronic touch screens displaying key patient information from multiple clinical information systems.

The information displayed on an electronic ward whiteboard is automatically refreshed every 10 minutes, providing ward staff with ‘real-time’ information for their ward including:

  • the patient’s name, bed number and gender
  • the name of the patient’s nurse and doctor, and allied health involvement (e.g. physiotherapists, social workers, etc.)
  • the patient’s diet, current length of stay, expected discharge date, alerts, infection control measures, medical diagnosis and planned procedures

The electronic ward whiteboard also flags if there are multiple patients with the same surname on a ward to help reduce misidentification, and highlights when a new patient is due to arrive or a patient is expected to be discharged that day from the ward.

What are we trying to achieve?

Waitemata DHB Value: Better, Best, BrilliantThe main aim of implementing an electronic ward whiteboard is to have a ‘real-time’ single source of patient information that provides clear and easy access to overall picture of patient activities/treatments, health status, etc. at a glance.

Some of the key benefits of having electronic ward whiteboards are that:

  • patient status information is automatically updated and can easily be read and understood by staff on the wards, replacing the current manual whiteboards
  • information from multiple clinical systems can be displayed together
  • information from allied health workers (e.g. physiotherapists, social workers) and other services is readily accessible on the ward
  • expected patient admissions and discharges can be viewed, allowing us to manage available beds across the organisation in a more timely manner

What did we find?

Until recently there was no standard format for traditional whiteboards across the organisation. A project was carried out to present consistent information on whiteboards and this was rolled out to most medical and surgical wards in the organisation.

There were issues with the traditional whiteboards including:

  • maintenance of information – staff were responsible for updating the whiteboards, however there was no ability to audit when, what and by whom
  • whiteboards were only visible on the ward – information was not easily available to staff involved in bed management

The electronic ward whiteboard was a proven solution as it was already being used by a number of District Health Boards, including Northland, Taranaki and Waikato.

What have we done?

The electronic ward whiteboard allowed us to include information not previously available - we were able to draw from the benefits of two new patient and bed management systems, TrendCare and CAAG (Capacity at a Glance), to add to key information available from our patient management system.

Systems that feed into the eWW
Systems that feed key information or have links with the electronic ward whiteboards

What is Trendcare

TrendCare is an electronic system that allows:

  • nursing staff to categorise their patients’ acuity (level of care required), enter information about the patients’ diagnoses, interventions and handover notes, and order diets for their patients
  • allied health staff (e.g. physiotherapists, occupational therapists, etc.) to enter details about their time spent with patients and notes about their treatments
  • kitchen staff to access ‘real-time’ information about patients’ dietary requirements to ensure appropriate meals are provided

TrendCare is currently being used in over 36 departments across North Shore and Waitakere Hospitals, and the Forensic Mental Health and Inpatient Detox Units by ward clerks, nurses, allied health workers and kitchen staff. The information from TrendCare automatically updates the electronic ward whiteboards.

What is CAAG (Capacity at a Glance)?

CAAG is an electronic board displaying information about bed availability on our inpatient wards, Elective Surgery Centre (ESC), Emergency Departments and Assessment & Diagnostic Units (ADU). CAAG boards give an overall view of bed availability however there is minimal patient information.

CAAG colour codes for specialtyThe CAAG boards are colour coded for the specialty (e.g. surgical, medical, etc.) that the patient has been assigned to. Each block displayed represents a bed that is available on a ward (see example below). The empty or white blocks for each ward are available beds. Other key information that is indicated for each bed are for patients who:

  • are expected to be admitted or discharged from the ward that day
  • have a length of stay greater than 10 days
  • have specific isolation needs

Example of CAAG board for Waitakere Hospital wards
Example of CAAG board for Waitakere Hospital wards

The CAAG boards are accessible to staff through our internal website, and staff are able to log in to view further information at a ward level. Bed capacity information for both the CAAG and electronic ward whiteboards are automatically updated from TrendCare.

Electronic ward whiteboard implementation

We piloted the electronic ward whiteboard on four wards and identified enhancements such as displaying dispensing information from our pharmacy system and allowing ward staff to generate Allied Health Inpatient referrals directly from the whiteboard.

We have since implemented electronic ward whiteboards on the remainder of our medical and surgical wards.

An Electronic Ward Whiteboard installed on Ward 11 at North Shore Hospital
An electronic ward whiteboard installed on Ward 11 at North Shore Hospital

What information is available on an electronic ward whiteboard?

The following information is currently available (see example of information displayed on an electronic ward whiteboard below):

  • a list of all patients on the ward according to room and bed order, with new patients highlighted in green [1, 5]
  • alerts about patients, e.g. alerts entered into our patient management system, infection control status, multiple patients with the same name on the ward, etc. [2, 3, 6]
  • names of the doctor and nurse looking after the patient [7]
  • patient acuity information (level of care required) [8]
  • key clinical information about patients, e.g. length of stay, expected date of discharge, dietary requirements [9, 10, 11]
  • medication information from our pharmacy system, including flags when medication is due or overdue [12, 13] (this function is currently under development)
  • allied health electronic referrals and rehabilitation referrals [4, 15]
  • booked Cardiology and theatre procedures for the patient [14]
  • patient diagnosis and additional notes [16, 17]

Example of information available on an electronic ward whiteboard (eWW)
Example of information available on an electronic ward whiteboard (please note that the information displayed is not for real patients) [click to see full screen]

Allied Health electronic referrals

The Allied Health Inpatient eReferral module of the electronic ward whiteboard is a key tool in streamlining our patient care. Nursing staff are able to create a referral for their patient to any of our allied health teams (such as physiotherapy and occupational therapy) via the electronic ward whiteboard, and this is immediately shown on the whiteboard.

Allied health workers who are ward based or who work between wards are able to pick up their referrals by either viewing an electronic ward whiteboard or by checking their referrals via a report on the internal website. Any update made about the referral by the allied health worker is automatically shown on the electronic ward whiteboard.

eWW Allied Health electronic referral form
Allied Health electronic referral form

Ward 11 Charge Nurse using the eReferral function on an Electronic Ward Whiteboard
Ward 11 charge nurse using the Allied Health electronic referral form on an electronic ward whiteboard

Did we make a difference?

  • Ward staff have easy access to a range of information in a single place.
  • General feedback has been very positive. Staff indicated that the electronic ward whiteboard is an improvement on the traditional whiteboards – they are clearer and easier to read.
  • Feedback from the staff who manage beds for the hospitals has also been positive. With the electronic ward whiteboard they have immediate access to information about patients currently on the wards that they would not have had previously without phoning or physically going to a ward.
  • The introduction of Allied Health eReferrals means that we can track the time from when a referral was logged until the patient is first seen. We can see at a glance the current numbers of referrals, patients being seen and who has been cleared by allied health for discharge.

Where to from here?

The next phase of electronic ward whiteboard implementation will involve understanding the requirements for our Child Women & Family wards and Mental Health inpatient units, and customising the system to meet their needs. A customised electronic ward whiteboard for paediatrics is due to be installed in December 2014.

We will continue to make improvements to the electronic ward whiteboards, for example:

  • the ability to view booked Radiology procedures
  • adding information from our Electronic Prescribing system
  • improving the quality of information provided on the electronic referrals