The amalgamation of the four hospitals to form Barts and The London NHS Trust resulted in the formation of one of the largest renal units in Europe.  I work within the Peritoneal Dialysis Unit, which currently treats approximately 340 patients. The Peritoneal Dialysis Unit is split between 2 hospital sites:

• The Royal London Hospital which has all the renal in-patient beds and the Accident & Emergency Department.
• The Peritoneal Dialysis(PD) out-patient department which is situated in St Bartholomews Hospital, where the PD training takes place.

PD patients were treated on two sites, but the nursing records were kept on one of these sites, therefore nurses' valuable time was spent retrieving, photocopying, faxing and sending relevant information across sites. This was not only time consuming, but also disruptive and potentially detrimental to patient care.

Discussion was initiated at this early stage regarding the possibility of computerising the nursing records. A decision was made by the Renal Unit's computer expert, the hospitals' nurse computer specialist and myself, that it would be possible to computerise nursing records using the Hospital and National Standards for record keeping as guidelines for the project. The Cardiac & Renal Head of Nursing supported this initiative.

There was a computerised renal clinical information system already in use in the renal unit, patient demographics and modality of treatment were recorded on this system and the data was used primarily for funding purposes and audits, it was felt this could be expanded to include nursing records.

The aim of this project was to make nursing records easily accessible to all staff, on all sites, at all times, to ensure continuity of care and also to safeguard standards of practice. It was felt that computerisation of nursing documentation was required to achieve this goal.

The process

The project team was formed, consisting of computer staff, a PD nurse who was computer literate and myself, the departmental nurse manager.

Hancock in 1994 advocated that nurse managers need to be able to empower clinical nurses and give them a sense of ownership over change, to help the process and reduce resistance. It was for this reason that open discussion sessions were held within the Peritoneal Dialysis unit, to obtain views and ideas on how to take the project forward. The nursing team supported the project as they could see the benefits for their patients and themselves.

It was identified that computer skills were a weakness within the nursing team. All staff were given training and actively encouraged to use the hospital internal e-mail system. It was hoped that these skills could be improved by practice in preparation for the transfer of nursing documentation onto the computer in the future.

Other departments and hospitals that were already using computerised documentation were visited, in an attempt to learn from their experiences.

The computer expert within the project team was able to advise on how and what information could be accumulated and retrieved, she ensured a system was in place so any information input to the system could not be lost, even if the computers mal- functioned, she was a knowledgeable resource for any query during the project.  Computer Screens were then developed that mirrored the paper work currently used.

The United Kingdom Central Council for nursing, midwifery and health visiting, have issued guidelines for records and record keeping. They recommend that any entry made is clearly identifiable, therefore staff were issued with passwords so that it would be possible to identify the member of staff who input the data to the computer.  Individual training sessions were carried out, to demonstrate the new documentation system. The staff then practised using the system, any comments were given to the project team so appropriate changes could be made.

Computer network points were installed and new computers were purchased, as nurses required access to computers in each clinic room where they were reviewing their patients, so that information could be input directly onto them.

An information guide was written to support the use of the new screens and issued to each staff member.  The staff continued to support the project so a date was set to transfer all documentation over to the computer system in October 2000.

The process for implementing change required time for training, some staff were frustrated during this period until their knowledge and skills developed, and they became confident with the new system.  Resources were required to purchase new computers. The total cost for equipment was £2600.00.

This development has been positively evaluated by the staff. It is felt that non- nursing duties such as faxing, photocopying and filing have been minimised.  Patient information is now accessible on both sites and also easier to read.  Computer skills have improved. 

The loss of computer experts familiar with the system created a few problems, however, training was given to a designated member of nursing staff so the system could be managed.

The future

Additional computer screens have already been developed, including pre-dialysis assessments and community support staff information, requests for further screens have also been made.  

The transfer of information to and from lap top computers for use by the PD community nursing staff, and the wider use and dissemination of information from this system to the multi-professional team.

The merger of hospitals to form Barts and The London NHS Trust a few years ago has many benefits, but also created some problems due to the size and geography of the departments.

The difficulty in maintaining effective communication between members of the multi- professional team, patients and carers, often on different hospital sites was highlighted.

The solution to this problem would be to transfer all services to one site, however this is not a feasible option at the present time.

A project to Computerise Nursing records has demonstrated benefits; patients can be nursed on different sites knowing that vital information is always available and there has been a significant reduction in non-nursing duties. IT skills for members of the Peritoneal Dialysis team have improved, this is significant, now that so much information is sent and retrieved electronically. This new found confidence has allowed nurses to access the internet, where literature can be reviewed easily, this could result in further changes in practices and help improve patient care.

This is a start, hopefully in the future it will be possible to computerise all documentation within the department.