Get Inspired: Learnings from the MedsIQ Champions Network – December 2015

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Welcome to the Whiteboard

Dr Yincent Tse, Consultant Paediatric Nephrologist, Great North Children’s Hospital, Newcastle Upon Tyne, UK.

Our project started in Summer 2013. The new children’s hospital had been open 3 years. There were small whiteboards built onto the walls of each cubicle and bed space. But they were never used, empty and purposeless. Until we saw them….

Our ward rounds are like your ward rounds. Every round in the country are similar, if not the world. A parade of doctors senior and junior and eager medical students, the nurse who usually have just met the patient and a smartening of MDT personnel. Everyone has an agenda and everyone is frantically writing in their own notes in their own encrypted code – our Caldicott Guardian should be delighted. And the most important skill, everyone knows surely the others can read their mind. If not, a non-verbal glare should do the trick. Isn’t that what the Calgary Cambridge course taught us?

So the idea of our QI project was to write agreed tasks for the child that parents can see. In the first two weeks nothing happened. We didn’t have any wipeable pens. So we downed tools.

When the pens came, we ploughed on. Our ward sister Joanne wrote at first. Names first on the left. Everyone’s names were written: consultant, registrar, SHO, dietician, nurse, physio. It was a revelation as I could never remember what my rotating SHOs were called – finally no more embarrassing glances at tiny name badges. For those being graced by multiple teams the list got longer and longer, but the families loved it. This was our #hellomynameis moment.

Next the tasks. When did we write it – well it varied. Often during the chat around the bed Joanne would be writing on the board. Everyone in the MDT had their turn at adding to the list. Just like a tag team we chipped in seamlessly and openly checked each other’s details: ‘Did we really want bloods on Thursday morning when they were going off for a head scan?’

It was a great leveller. Anyone can and did write. The board just evolved organically, people including parents ticked off tasks as they were completed and with every patient it always felt like there was momentum to getting home.

What about measuring outcomes, the fundamental basis of QI. Luckily we bumped into Claire on our ward, a Newcastle medical student. The first and most important variable was ‘Did it get used?’. The 10g marker pen sure carried a lot of inertia in getting to the boards. She surveyed staff and parents for feedback. Every time we talked about the whiteboard people would ask about patient confidentiality. Interestingly the question never arose from families, only from other health professionals.

Since then writing on the whiteboard is just what we do on our rounds. A philanthropist has donated to manufacture purpose designed child friendly boards which are currently in production.

The video came a few months later. There was a grounds up movement made up of QI enthusiasts ‘network Q’ who opened for entries to a video competition in Salford. I remembered these adverts using a computer generated whiteboard and pen. Dr Google came to our aid (http://www.videoscribe.co/) and we came runner up. Later the RCPCH 2014 meeting was the first time the college put QI high on its agenda. The energy in that packed room was electrifying. I hoped our small project helped in a small way to spread how QI can connect people.

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NeoMate from idea to market

Dr Chris Kelly, Kings College London

It was every new paediatric junior doctor’s nightmare – attending a crash neonatal resuscitation during a night shift, and the moment of panic when the mind goes blank. My registrar had asked me to prescribe a drug infusion for an unwell newborn baby, and I found myself frustratingly unable to think straight. Routine tasks can become inexplicably difficult in stressful situations, resulting in mistakes, delays or prescribing errors. Not wishing to repeat this experience, I started to create a free smartphone app to put critical information in the pockets of future junior doctors and nurses working on neonatal intensive care.

I designed eight logos and asked the nurses on the unit to vote for their favourite: “NeoMate” was born. The app itself was created over the next few months, and I spent six months testing and refining it while working on the neonatal unit. There was one particularly difficult delivery during this period, and I was excited to find that the app helped me to remain focused where I had struggled before.

The first version of NeoMate was quietly released on Android in July 2013 and received a warm welcome. Apple however refused to approve the app for iPhone, citing a new policy that required all drug calculator apps to be published by a hospital, university or pharmaceutical company. Despite many appeals, the app would not be accepted.

I decided to approach the London Neonatal Transfer Service (NTS) – the specialist intensive care ambulance service that is responsible for transferring unwell babies between hospitals in the south east of England. The NTS team was very enthusiastic about the project, and we agreed to develop the app further together.

A rigorous quality check process began, with the help of two fantastic neonatal pharmacists from the Royal London Hospital, who went through the app carefully, and made many excellent suggestions. Decimal points were removed, infusions were simplified, concentration checkers were added, and unnecessary information was removed. The result was an app that we could be confident about, with much less chance of confusing users or information being misunderstood.

A new checklists section was created, facilitated by a volunteer group of junior doctors, transport registrars, consultants and nurses. Designed to complement existing hospital guidelines, the checklists were designed to help remember critical steps that can sometimes be forgotten.

Finally, we applied for MHRA approval. For medical apps, this is only a self certification process, but does give assurance that a quality process has been followed during product development, with appropriate governance and oversight throughout.

A series of institutional, legal and administrative burdens hampered our ability to publish the app. However, the winning of an NHS Innovation Challenge Prize in February 2015 gave the catalyst to finally submit the app for review to Apple, with approval a week later.

The app has been well-received worldwide with almost 20,000 downloads across 169 countries, and 300 active users every day. We look forward to continuing to develop NeoMate into the future, and to help doctors and nurses provide the best possible care for unwell newborn babies.