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Ward 7b is predominately acutely unwell renal patients who require 2-4 hourly observations. The team ranges from Healthcare Assistants (HCAs) to Consultants but predominantly staff taking observations are HCAS and Registered Nurses. Observations are currently being taken and documented on paper before being transferred over to EPR (transcription), increasing the time between an observation having been completed and this information being available for review and escalation despite this not being the Trust policy. A basic literature search was conducted to aid our project.

We found multiple contributory factors for this issue:

- Availability of PCs/Laptops and ability to easily log in!

- Multiple pieces of equipment to take to patient but limited space in patient’s bed space

- Disconnection from WIFI

- Machines not working

- Staff behaviour – EPR is relatively new concept/difficult to change practice

- Knowledge and understanding of the system

including the “2 person technique” whereby 1 member of staff did the observations whilst the other directly inputted the observations at the bedside.

Data was also collated to see if the “Tap system” using the smartcard helped.


To improve the ease and timeliness of NEWS information entry onto EPR within 12 months


- Wrote and sent questionnaires to all staff on 7b regarding their thoughts on inputting observations onto EPR.

- Observed staff on how they took and uploaded observations. Discussed how they felt this could be improved.

- Asked staff to try the Tap system and the “2-person technique” through a defined period of time

- Gathered data from Business Intelligence, including before any changes were made, when we implemented the changes to the ward, and a time period afterwards (over 2 months)

- Discussions with Medical divisional leads, Matrons, Chief of Nursing and the Deteriorating Patient Committee.


Initially a positive result as reflected by the graph when the Tap system and 2 -person technique were encouraged and used on ward 7b. However, the results dip again when there was a notable amount of sickness/lack of staff on the ward.

There is currently minimal improvement on ward 7b. However, we have collated over a 12-month time frame from across the Trust. This shows the wards who are better staffed and use the 2-person technique have better results in inputting their observations over this time period.

Lessons Learnt

- Not straightforward!

- Changing staffing mindset and culture is difficult.

- Staffing challenges

- Lack of equipment and space is a key factor as to why observations are still transcribed.

- Scale up projects can include the Oxford SEND

Next steps

Introduction and Implementation of an electronic point of access device to improve accuracy and timeliness of inputting patients’ observations onto EPR reducing risk and improving patient safety.