Christine Aberson temporarily back at bedside
Usually, as Chief Nursing Information Officer (CNIO), Christine Aberson translates nurses' work requests into intelligent IT support in their work processes. When after the COVID-19 pandemic broke out, she didn't think twice. She put her work as a CNIO on hold because she knew she was needed at bedside. We spoke to Christine shortly after – what appears to be - the COVID-19 care peak in the Northwest Clinics (NWZ) and this is what she had to say.
Was going back to the nursing floor a no-brainer?
Yes, it was definitely a no-brainer. I immediately signed up at the COVID-19 Planning Bureau. I was quickly stationed in the Intensive Care Unit, where I have worked several shifts already. It's been about 1.5 years since I was involved in patient care, but being a nurse is just like riding a bike. It took some time to get used to everything again but thankfully the team works together very well and everyone does their best to support each other. That makes it a lot easier when dealing with all the heavy work.
What are the greatest challenges for NWZ nurses at the moment?
The biggest challenges are reassessing processes and task distribution. We have to take good care of our nurses because this disease will for last months. Working in a cohort department wearing personal protective equipment is quite challenging and calls for better support for the nursing staff. We've deployed helpers where possible. The pharmacy, for example, also contributes by supplying as much ready-to-use medication as possible. We also had to consider carefully about how best to reintegrate former nurses. A great challenge regarding our patients was figuring out how we could best connect patients with their families. Their families are not allowed to visit the patient. Personal contact, however, is essential for the healing process. Fortunately, in cooperation with our IT department, we were able to quickly set up a video call system using iPads.
Could you give an insight into the registration processes that came with it?
The Early Warning Score (EWS) is critical when treating COVID-19 patients. The clinical picture is very erratic and one of the first signs is an increased respiratory rate. The EWS system helps the nurses to alert the doctor in time. Clinical reasoning also plays an important role here.
How important is it that you have an EHR available and how does it support you?
Very important. First of all, HiX supports patient handover with a medical profile so nurses immediately have a clear picture of the patient. This relieves some of the administrative burdens in the PDMS department because all values are fed directly into the EHR. The nurse only has to validate the values. As I just mentioned, the EWS plays an important supporting role especially in the general departments. I was very happy with the overview in which you could immediately see the patients in your department where their penultimate and last EWS values differed the most. This way, you can monitor patients even more closely or discuss the patients with the doctor at an earlier stage.
What are the moments where HiX supports you the most?
The HiX app supports us when treating patients in isolation, because there is no computer on wheels (COW) in the room. Of course, you do have to take the measures into account that need to be taken for infection prevention and control, such as cleaning the device. We have also developed a COVID treatment plan template that supports nurses with the daily patient treatments. I also find it very helpful that the 'COVID positive' icon is now clearly visible at the top right of the record.
How does the collaboration with other hospitals work?
We're learning a lot from the hospitals in Brabant. We keep in contact regularly to exchange and use each other's solutions. I am also in contact with the CNIO network where we exchange ideas and support each other when issues arise.
What could be improved?
There is still a large list of issues I would like to improve for the nursing department. Concerning HiX, support for clinical reasoning in the EHR would greatly help nurses optimise their patient care. Within the Nursing user group, we are working together with ChipSoft to resolve this issue. It is a quite complex feature to set up properly within HiX.
How is the collaboration to quickly implement these improvements progressing?
For many items on my list, the collaboration is working smoothly. These are mostly small things that require little modification in the software. The bigger items, for example developing support for clinical reasoning as I mentioned earlier, require more effort and input from the hospitals themselves. Usually, three hospitals will work together to create a plan, then we'll make a proposal. We then discuss these within the user group and with ChipSoft consultants to refine the solution further and remove any confusions. Collaborating with the software consultants is very pleasant and effective. The user group functions very smoothly thanks to the support of the chairpersons.
Do you have any idea how long do you think you'll remain at the bedside?
That's difficult to say at the moment. I'll remain at bedside while we're still scaling up the crisis organisation for example with more IC beds etcetera. However, when the crisis has been brought under control, we will want to restart the regular patient flow. Regular patients also require attention. As an organisation, we need to think carefully about how we are going to approach this process. We must be careful with our nurses and employees. Sustainable employability is the magic word here. We often say that it's not a sprint, but a marathon. COVID-19 is quickly becoming the new normal and we need to ask ourselves how are we going to integrate this into our daily business operations? This also calls for a recalibration of processes with or without digital support.
