Starting in April 2015 and following a three phase implementation, Guardian and Athena have been in use at Peterborough City Hospital since July 2016. When the hospital merged with Hinchingbrooke Trust in April 2017, the North West Anglia Foundation Trust (NWAFT) was formed. At the time, Hinchingbrooke Hospital was mostly relying on paper-based notes with basic datasets entered into HICSS, a far cry from the end-to-end electronic maternity IT system at Peterborough City Hospital.
This gap was filled in July 2020 when Hinchingbrooke Hospital implemented Guardian and Athena. While there is still a period of transition as women booked on paper see out their antenatal care on paper, all women admitted in labour and delivery are now cared for on K2. We spoke to digital midwife Danielle Harper from NWAFT to hear her thoughts on how the system has impacted care across the two sites and how she and her fellow digital midwives are helping staff to overcome the hurdles of the digital transition.
What improvements to care have you seen since the implementation of Athena?
We’re now paper light and all information is stored in one place, to a point. We document on Athena and Guardian at the point of care, but there is still some paper in use. This includes drug charts, consent forms or to record baby observations. Other than that, there isn’t a lot else we use paper for. At the Peterborough site, all paper notes are scanned to a PDF viewer system, so when a doctor wants to review a patient, they can instantly look at all of their medical history and previous births at the hospital, electronically. This isn’t the same at Hinchingbrooke site yet, but we hope it will catch up with Peterborough in time and will really facilitate information sharing between hospitals.
It’s improved care in the sense that more information is in one place and it’s safer because it’s on a computer rather than being in paper format. It’s also legible so there’s no more contending with bad handwriting!
Has the quality of documentation improved?
To be totally honest, the data quality did initially suffer when the system was implemented at PCH as it was such a massive cognitive shift for staff in the way that they document care. This is a lesson learnt which we took with us to help staff adapt at Hinchingbrooke. At the end of the day, data quality or the level of documentation is down to the actual clinician and their own practice. As with any system, Athena and Guardian are only as good as the information that’s put in there. But reporting in K2 is really powerful and very quick. Long gone are the days of paper note audits!
How has the system helped to improve clinical oversight?
We’ve had various instances, for example, a situation when a staff member needed to review a case at Hinchingbrooke and she was at Peterborough at the time, and she was just able to log on to the system, review all patient’s history and give an opinion. She could see all the notes live.
Community midwives can now see all women’s notes, so if she calls the helpline or is admitted, the community midwife can see this information whereas before this wasn’t always accessible to her. There was one occasion when a community midwife was out visiting a woman who was having breastfeeding difficulties. She called the breastfeeding consultant who was able to look live at the record about the woman’s delivery and all the care she’d had up to that point. The community midwife had her on loudspeaker so the consultant could give a live plan there and then in the woman’s home. So that stopped the woman having to come in and also enabled learning for the community midwife who could hear what happened in that given situation and would then know what to do in the future in that situation with other women.
How has the system helped you to save time?
The ability to access K2 from anywhere speeds up access to notes, so if you want to get a second opinion from a consultant at one hospital to another, they don’t need to send a lengthy email. They can just look at the notes in real time. It’s a really good way of working.
It has definitely saved time in that we no longer have to retrospectively enter the delivery details into a system for the handwritten notes. This used to take in the region of 60 minutes post-delivery for the midwife to record the necessary information as well as complete her clinical notes. With Athena, it’s all captured contemporaneously. If the midwife is up to date with her notes in Guardian, during the labour, once the baby’s born, she’s probably only got another 15-20 minutes of documentation to finish. Once you’re familiar with the system, you can probably do it quicker. And the beauty of it is that all the information is there, you haven’t got to remember the information, it all gets transferred across.
What were the biggest challenges faced from introducing the system and how did you overcome them?
Traditionally, midwives stay in the profession for a really long time. So there are a lot of midwives who are nearing retirement and they don’t have good IT literacy, and they’ve never needed it either. So embracing it was very daunting for them. They deal with a lot of complicated safeguarding and quite complicated reporting for all that. So to change their way of working was hard for them. I think we get big wins with them eventually but it does take time. Now we’ve got some of the midwives who were initially resistant who would be really against it if we went back to paper! Once they get confident with it and see the benefits of the system, it’s a no-brainer, you can’t go back from there.