Posted on Tuesday November 25 2014 by RIG Healthcare
The current climate of the National Health System is to ensure high quality care is delivered with greater productivity and at lower costs. Such demands compel services to seek better ways of working. Mobile technologies have been predicted to bring about more efficient work practices, which in turn may bring widespread savings to health services. In the United Kingdom, mobile working has been trialled with community nurses, allied health professionals and emergency care providers.
Mobile working is the practice of carrying a mobile device such as a smart phone or tablet that has an application to allow access to an electric health record system. It involves using the functions of a device to support patient assessment, health education and treatment. In the context of community health services, mobile devices provide clinicians with real time access to valuable information and to be able to document at the point of care.
I recently particulated in a mobile working project. I wish to share a clinical scenario I faced and how the technology helped me to manage a critical situation.
I arrived at a client’s home. It was my last visit for the day. I found the client in bed and poorly. He was in pain, including chest pain. He reported that he had used his Glyceryl trinitrate (GTN) spray three times throughout the day. I knew that the client had a medical background of coronary heart disease. I suggested to call an ambulance straight away, however the client declined. I explained that the ongoing pain and discomfort might be a sign of a heart attack. I recommended again the need for urgent medical attention. The client continued to refuse an ambulance to be called.
The client allowed me to call Rapid Response Nursing for advice. Using my tablet I selected the loud speaker option so that the client and his wife could hear the advice. The nurse explained they would not accept a referral to see someone at home with chest pain and that they would only recommend calling an ambulance. Hearing this from the nurse, the client agreed for me to call an ambulance.
Using my tablet I called the London Ambulance Service (LAS). Again I used the speaker phone so that the client’s wife could hear the conversation. I was able to use the mobile working app to access the client’s health records to provide LAS with the details they needed. Information such as date of birth, address, past medical history and current medications.
While waiting for the ambulance the client described further symptoms of head ache, feeling flushed and nausea. Via the tablet I was able to use the internet to research the side effects of the GTN spray. I feedback that this was possibly the result of using the angina spray multiple times.
The paramedics arrived and carried out an assessment. I was able to share the information I knew about the client by using the mobile working app because it enabled access to previous electronic assessments. The paramedics advised the client to go to accident and emergency for further investigations to rule out a myocardial infarct (MI). The client refused.
With the paramedics I was able to make a plan that they would contact the client’s GP, the client’s wife would contact the hospital where he was due for dialysis the following day. Using the mobile working app I was able to document this event at the point of care. I then knew that this information would be available on the clinical system in a matter of minutes for other teams involved in the client’s care.
If I did not have a mobile working solution, I would have had to travel back to the office after hours to document this critical situation, or worse leave it to the next working day. This would have left me extremely vulnerable from a medico legal perspective if the client did have a further cardiac episode. As I left the client’s home I was able to contact my senior using my tablet’s mobile phone function and report the situation and my safety.
The provision of mobile working allowed me to:
- Communicate with other services
- Involve the client and his wife in seeking advice
- Access essential patient information remotely
- Research signs and symptoms on the internet
- Document the situation at the point of care
- Communicate with senior management
This real clinical scenario highlights how the advances in mobile technology are providing opportunities to improve the outcomes for patients whilst making clinical practice more efficient. I hope to see more Trusts invest in mobile working.
By Melissa Andison, Interim Team Lead Community Rehabilitation/ Occupational Therapist / Mobile Working Champion
This is part of our OT series.