Information flow and consultation in home care – problems and solutions
A safe and reliable flow of information is indispensable for nursing. Its role is particularly emphasised in mobile care, such as home care. Inefficient information flow poses a threat to patient safety and continuity of care. What measures can be taken to support the flow of information?
Challenges to the information flow have long been identified in several healthcare organisations 1, 2, 3. Inefficient flow of information poses a threat to the continuity of the customer’s care and patient safety3. In the studies conducted for theses, the problems of the flow of information have been highlighted, for example, in the poor reachability of colleagues, missing or incorrect information or information received too late 2, 3.
Information is often passed through an intermediary
In Pasanen’s thesis, more than half of the respondents experienced difficulties related to communication within the team. In particular, reaching a co-worker during the shift was perceived to be difficult, as nurses could not call each other directly and home care work planning had to act as a telephone switchboard between the nurses.2
In the past, the home care workers of Siun Sote in Northern Karelia, Finland, had difficulties in reaching the doctors. To consult a doctor, the nurse had to call the health centre, queue over the telephone and leave a call-back request. The doctor was informed of the need to consult through an intermediary, whichh often interrupted their work. And when the doctor called back, the call interrupted the nurse’s current tasks. Lots of interruptions, too many links in the chain.
Different solutions to improve the flow of information have been sought
When the home care of Varkaus in northern Savonia, Finland, focused on streamlining the flow of information in 2019, the most pressing wish was that there would be more time for communicating the information, reading it and participating in meetings. The intention was to organise the use of time by rationalising the work, for example by arranging the nurse’s visits in a way that the nurse would not have to drive back and forth unnecessarily.1
The use of large service providers’ communication solutions such as WhatsApp and Teams has also been trialled in several healthcare organisations for different purposes1, 5, 6. However, security concerns have led to a total ban on the use of these services by many healthcare organisations.
Despite this, the use of technology is seen as a key means of supporting both the users of the services and the employees, also in the quality recommendation of the Finnish Ministry of Social Affairs and Health concerning the services of the elderly. According to the recommendation, practices would be created in 2020–2023 on how to make technology part of the normal operation of preventive and regular services for the elderly.4 However, the solutions used should be designed for clinical use and, above all, they must be secure.
Communication between nurses before and now
Modern solutions to improve the flow of information are already available. The table illustrates two different processes of communication between home care nurses in a situation where the home care customer has fallen and the nurse needs urgent lifting assistance.
| Traditional process | Process using the instant messaging tool designed for clinical work |
| 1. Nurse 1 notices that the customer has fallen on the floor. The nurse calls the home care office and asks whom they can contact for immediate lifting assistance. | 1. Nurse 1 notices that the customer has fallen on the floor. The nurse sends a message to the Medanets message group of the home care team working in the area: „Selma Asikainen has fallen on the floor of the toilet in her home. I need immediate lifting assistance.“ |
| 2. The office informs Nurse 1 that Nurse 2 appears to be nearby and tells them which of the shared work phones nurse 2 has with them today. | 2. The nurses in the team receive a notification of an incoming message on their work phone. |
| 3. Nurse 2 responds to the call and reports that her customer is currently having a bath and, therefore, she is unable to come for help. | 3. Nurse 3 replies: “I’ll be right there, I’ll arrive in about 5 minutes.” |
| 4. Nurse 1 calls the office again to see who else she can call for help. | 4. After 10 minutes from the initial situation, Nurse 3 arrives and the customer is lifted up. Further investigations can also be started immediately using the Medanets app: for example, the customer’s pain level and vital signs/EWS can be documented and the customer’s risk of falling can be assessed using the FRAT method. This way, the information will be available to the doctor using Medanets even before the consultation. Consultation can also take place through the Medanets app. |
| 5. Nurse 1 calls Nurse 3, who promises to come as soon as possible. | |
| 6. After 30 minutes from the initial situation, Nurse 3 arrives, and the customer can be lifted up. After this, the nurses can start to assess injuries and evaluate the need for further treatment.. |
Table 1. Communication between nurses before and now (adapted from Pasanen’s 2 thesis).
Consultation in home care before and now
The table illustrates the home care doctor’s consultation in two different ways in a situation where the home care customer has fallen and the situation requires a doctor’s assessment.
| Traditional process | Process using the instant messaging tool designed for clinical work |
| 1. Nurse 1 is visiting the home care customer in the morning. The customer has fallen, and the nurse needs a doctor’s assessment of the situation. The nurse calls the health care unit and waits on the phone for five minutes until the call is answered. | 1. Nurse 1 sends a message to the responsible home care doctor using the Medanets app: “Selma Asikainen has fallen on the floor of the toilet in her home this morning. After the incident, I checked the EWS and logged the pain information, see the information in the Medanets app. No visible injuries or significant pain. I also did FRAT and I wonder if the dose of the antihypertensive should be changed. It was recently increased, and after that Selma complained of dizziness and now fell for the first time. |
| 2. Nurse 2, who answered the call, forwards the callback request received from Nurse 1 to the doctor. | 2. The doctor receives a notification of a message in the Medanets app. The doctor has time to answer the message between the morning appointments. “I checked Medanets for the information and medication you mentioned. Let’s reduce the dose of antihypertensive medication. I changed the medication in the patient information system.” |
| 3. The doctor has time to go over the callback requests in the afternoon. She calls the number indicated in the callback request. | 3. Nurse 1 receives a notification of the doctor’s response, and the medication information is updated immediately in the Medanets app. |
| 4. Nurse 1 has just finished their shift, so Nurse 2 answers the phone. Fortunately, Nurses 1 and 2 had time to discuss the customer who had fallen down during the shift changeover. Nurse 2 is not with the customer in question at the time of the call, but she reports that the customer did not suffer any visible injuries during the fall and was not experiencing significant pain. Nurse 1 had questioned whether the customer’s antihypertensive medication should be reviewed to prevent future falls. | |
| 5. The doctor says on the phone that she will change the customer’s antihypertensive medication and prescribe the new dosage. | |
| 6. The nurse records the call and the doctor’s instructions on the change of the antihypertensive medication at the end of their shift at the home care office. |
Table 2. Medical consultation of home care before and now (adapted from Pasanen’s 2 thesis and the current process of Siun Sote).
Ultimately, the use of a mobile solution for clinical work, such as Medanets, serves the flow of information. The crucial thing is that all users of the solution – doctors, nurses, caregivers, etc. – have access to the same information at the same time, without delay and without intermediaries. The status of customers can be discussed and evaluated using a common language; according to the study, multi-professional communication became more effective in Nordlandssykehuset when objective parameters such as EWS results were used in communication.
Although the Medanets app is intended for the use of healthcare professionals, it can also support the flow of information between the customer’s family and home care. If the customer’s family member provides the nurse with information that affects the care of the customer, the nurse who has discussed the information with the family member can easily and quickly forward the message to other nurses through the app.
Sources:
1. Super 29.8.2019. Varkauden kotihoidossa ryhdyttiin toimiin – hoitajien tavoitteena sujuvampi tiedonkulku. Referred to on 18.11.2022.
2. Pasanen (2017): Internal communication development at Home Care with digitalisation. Thesis, Maste’s Degree Programme in Wellbeing Technology.
3. Nieminen & Pessi (2021). Flow of information about home care clients between specialized medical care and home care Developing the operating model using Apotti in basket functionality. Thesis, Maste’s Degree Programme of Health Care (nurse).
4. Ministry of Social Affairs and Health (2020). Quality recommendation to guarantee a good quality of life and improved services for older persons 2020–2023 : The Aim is an Age-friendly Finland.
5. Lehtonen (2020): Well-Being through Communal Shift Planning. Experiences of Employees and Supervisors in Clinical Laboratories. Thesis, Master’s Degree Programme in Management of Health Care and Social Services.
6. ECHAlliance 11.4.2019. Clinician use of WhatsApp is a ticking time bomb. Referred to on 18.11.2022.
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