Ease of Use
• Easy to use, visual and self-explanatory
• Template and concerns checklist can be easily adjusted
• Flexible and secure – patients can complete independently or with nurse supervision
• Time efficient – quicker to complete than paper version
• More convenient to use across sites
• More precise measurement of concerns
• HNA data immediately saved into InfoFlex Cancer System on submission
• All information stored in one place
• Information easily accessible for reference at different stages during pathway
• More patient data can be captured
‘The patients couldn’t fill in the paper copies so well themselves. On the paper copy it’s more that we’re judging how they feel and how much of a concern it is for that patient.’
There was a range of disadvantages with the existing HNA process. Before the eHNA was introduced the Clinical Nurse Specialist carried out the HNA on paper, with patients being required to fill in two pages of information, each with three carbon copies. The process was time consuming as it required patients to handwrite their responses, then the Clinical Nurse Specialist to handwrite a care plan and then these documents to be filed with the patient’s notes. These previously recorded patient concerns and care plans were not necessarily easily available for subsequent nurse-patient dialogues. Also, impractical paper copies were not convenient for the Clinical Nurse Specialist to take to other sites so potentially fewer HNAs were carried out.
There were also issues with the design of the previous HNA. Some patients found the paper HNA difficult to complete and were quite likely to need nurse assistance with its completion. Furthermore, the paper version did not facilitate precise communication of a patient’s perceived degree of concern. Gynaecology Clinical Nurse Specialist at Leicester’s Hospitals, Nafisa Patel, said: “The patients couldn’t fill in the paper copies so well themselves” and “on the paper copy it’s more that we’re judging how they feel and how much of a concern it is for that patient.”
Design and Implementation
|‘Once we were sure and practised a few times, we could do it. From our point of view it’s been very easy to use.’|
The InfoFlex Cancer System was installed across the Trust in April 2014. The eHNA, installed in 2016, is fully integrated into the InfoFlex Cancer System at Leicester’s Hospitals via the Clinical Portal.
CIMS (Chameleon Information Management Services Ltd) worked in partnership with the Cancer Pathway Project Lead to design the template for the eHNA, using InfoFlex. The initial trial version was easily switched to the more familiar Macmillan model which staff were keener to use. Some bespoke revisions of the paper HNA were made, such as the removal of the ‘distress thermometer’, which was not felt to be essential and sometimes confused patients.
The eHNA was piloted by Clinical Nurse Specialists in the Gynaecology, Lung and Hepatobiliary specialties. During this phase the main problem experienced was poor WiFi connection but this has subsequently been greatly improved because of the need to meet the increasing use of handheld devices across the UHL. Another glitch, the timing out of the HNA form because of the unpredictable length of time some discussions might take, was easily remedied by CIMS during the testing period via a ‘save’ button.
During the trial, Gynaecology Clinical Nurse Specialists at Leicester’s Hospitals found the eHNA quick to get used to. Clinical Nurse Specialist Louise Boulter said: “Once we were sure and practised a few times, we could do it. From our point of view it’s been very easy to use.”
Training was given in-house and after a 3 month trial period the eHNA was rolled out to all tumour site specific Clinical Nurse Specialists for use with patients on iPads.
The Improved HNA Process
|‘It’s just really simple; they’ve just got to press. It’s really visual and self-explanatory.’|
A Clinical Nurse Specialist is likely to carry out an HNA several times during a patient’s pathway. It is now conducted on an iPad, one to one. Nafisa Patel explained: “We can either go through it with them if that’s what they want or they can go through it on their own, it’s entirely up to them. It’s really easy to use.”
The Clinical Nurse Specialist logs on to the InfoFlex Clinical Portal and selects the patient’s ID in order to reach the patient’s Dashboard which provides background information such as referral, diagnosis, Multi-Disciplinary Team decisions regarding treatment and so on. The HNA ‘launch page’ requires discussion of the process and the patient’s consent to continue, after which it is described as “really self-explanatory and visual.”
The process requires the patients to click on issues of concern, such as physical or emotional worries, and each concern can be rated precisely on a one to ten scale. It goes on to ask the patient about specific help or information they might want, followed by the handing back of the iPad to the nurse. Discussion can then take place before the form is electronically submitted. At this point the nurse can create a tailored Care Plan in free text boxes, save it into the patient’s notes and print a copy for the patient as necessary.
The Gynaecology Clinical Nurse Specialists who were interviewed concurred that the eHNA is patient–friendly. Louise Boulter said: “We get different age groups of patients and even the older ones have not had any problems. It’s just really simple, they’ve just got to press. Sometimes if the older person can’t see we can make it bigger or we can do it for them.”
Furthermore, they highlighted the advantage of the InfoFlex system that allows them to have a permanent electronic record of all the dealings they’ve had with patients, “from beginning to end.”
Nafisa Patel also commented: “I think it’s become much more flexible because of our iPads, we can take them wherever. If we want to go and do HNAs with patients at Leicester Royal we can take them there. I think the flexibility is definitely there. And we can capture more patients than we would have.”
The InfoFlex eHNA has provided an improved, easier method of conducting, recording and acting upon discussions about cancer patients’ concerns across the Trust.