ipams - integrated Patient Acuity Monitoring
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- Juniper Atkins
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1 Introduction: ipams is a web-based solution that uses the criteria set out by the Shelford Groups Safer Nursing Care Tool ( to measure acuity and dependency at individual patient and overall ward level in real time. It allows nurses to record acuity and transfer information quickly and effectively at the bedside up to three times a day. ipams monitors the level of patient dependency to enable nursing staff to ensure safe staffing levels based on the volume and acuity of patients cared for. This document provides you with an overview of the functionality of the ipams data collection tool and resulting dashboard analysis. Index: 1. ipams Data feed Page 2 2. The ipams data capture screen explained Page 3 3. Select ward and shift Page 4 4. Input staffing by volume, type & shift Page 5 5. Select level of care by Patient/bed Page Alerts Page 6 7. Hand over notes Page 8 8. The big 4 Page Front end QlikView Dashboards Page Keeping up to date with the national agenda Page 15 1
2 ipams Data feed: ipams uses a live feed of ward stay data from the Trust's PAS system via HL7 messaging. HL7 messaging is a process that sends out data containing information about patient movements via text messaging. This ensures that ipams contains the correct patients on the correct wards at the correct time. 2
3 The ipams data capture screen explained: The ipams data capture screen is a web form which connects to a data repository containing the data as mentioned above. A nurse or ward clerk will log in to the ipams data capture screen and select their ward/s. They firstly populate the top two sections. Note: bed availability and establishment figures are pre-populated. 3
4 Select ward and shift: Day shift - includes early, long day and late Usually 8am to 7:30pm Night Shift - usually 7:30pm to 8am Shifts names and times can be configured to suit each Trusts requirements Admissions are the total number of patients admitted to the ward at the time of data capture Discharges are the total number of patients discharged from the ward at the time of data capture Transfers in are patients that have been transferred in from another ward or hospital/trust Transfers out are patients that have been transferred back to another ward or hospital/trust Ward attenders are patients who are not admitted but require nursing care. Examples include patients requiring dressings or bloods taken. Deaths are the total number of deaths that may have occurred on the ward at the time of data capture Escorts for Long periods are patients requiring an escort for 30 mins or more away from the ward such as visits to x-ray etc Establishment is a predetermined figure set by the admin based on the total number of funded whole time equivalent staff allocated to the ward. Bed availability is a figure set by the administrator and can be adjusted by the lead nurse and is the total number beds available on the selected ward. Note: It is possible to collect data as many times as you wish during a 24 hour period. On each occasion that the data is saved the system will create a date and time stamp. This facility allows you to monitor the trend of acuity over a 24 hour period. 4
5 Input staffing by volume, type & shift Day shift Night shift Staffing data capture is split by shift type, registered/unregistered and substantive and bank/agency staff UA stands for unplanned absence - staff who have not turned up for their shift Select level of care by Patient: This is where the nurse selects the relevant level of care required for each patient on the ward. If the user is unsure of the criteria of each level it is possible to click on the blue buttons above which will open up a dialogue box with the criteria/descriptions for each level of care. 5
6 Once the form is completed and saved, the front end dashboards will display the recommended establishment figure which is calculated by using the weightings in the safer nursing care tool multiplied by the totals of each level of care. The current weightings are as follows (Released July 13): Level 0 Level 1a Level 1b Level 2 Level WTE nurse per bed 1.39 WTE nurse per bed 1.72 WTE nurse per bed 1.97 WTE nurse per bed 5.96 WTE nurse per bed Using the totals above, the recommended establishment using the safer nursing care too should be 6 x 1a = x 1b = 5.16 = 13.5 WTE nurses are recommended to care for the 9 patients on the ward based on the acuity scores recorded. Alerts & Follow ups: There are four different Alert Types which can be configured for each individual ward: o Acuity alerts are triggered when the combined acuity score for a ward hits a preset % threshold figure over or under the funded Establishment. The example below shows that this ward wishes to trigger acuity alerts only when the ward is 5% or more under established and 10% or more over established. o Unplanned Absence Alerts are triggered when the unplanned absence figure exceeds a preset % threshold figure of the Funded Establishment. The example below shows that this ward wishes to trigger alerts only when the recorded unplanned absence figure hit 3% or more of the total funded establishment. o Planned versus actual staffing Alerts are triggered when the actual staffing figure is a preset % threshold figure lower than the planned staffing figure. o Qualified Nurse to Patient Ratio Alerts are triggered when the actual qualified nurse to patient ratio does not meet the predefined ratio which is configured by ward in the admin settings. The default will be 1:8. 6
7 Parameters can be set globally (default parameters), and can also be overridden at individual ward level for a specified date range. Only Administrators can change the parameters. Once an alert has been triggered an is automatically sent out to operational and management staff. An example of an alert can be seen below: 7
8 When you click on the link you are directed to the follow up screen in ipams where you can respond and document your actions providing an audit trail. Hand over notes: (Please note that your Trust may already have an e-noting system and may not wish to use this facility. It has been included should you require it.) At the end of each shift it is possible for a nurse to complete detailed handover notes to pass on to colleagues taking over the next shift 8
9 Handover notes screen: It is possible to export all of the data contained in ipams by clicking the "print" button which will export the data in to Excel which can then be printed or distributed in that format. 9
10 The Big 4 The big 4 could be be used by lead nurses/matrons to convey 4 key safety messages to all members of staff on a ward. However, your Trust may wish to use this facility to convey any other type of key messages. Examples could be: There have been instances of incorrect medication being administered to same name patients - Please pay closer attention when checking patient medications There has been an increase in falls within the unit/ward - Please ensure that vulnerable patients are monitored more closely 10
11 ipams Dashboards - Note: These examples are to be viewed as generic templates which can be enhanced based on an individual customers requirements Please ignore the dummy data contained within these sample reports. 11
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16 Keeping up to date with the national agenda: It is essential that we remain reactionary to all updated mandatory national guidance and agendas, therefore we ensure that the software is updated and enhanced within weeks of any updates being released. Future enhancements due imminently as of May/June 14 include: 1. The ability to capture planned staffing figures alongside actual figures. 2. We will be adding the facility to allow users to set a qualified nurse to patient ratio figure by ward and shift. 3. We will be adding two new alerts: a) Qualified nurse to patient ratio breached alert which will take in to account the info in point 2 b)there will be a new alert which will be deployed when the actual staffing figures are lower than the planned staffing figures. As with the existing alerts you can set up an agreed % threshold allowance. 4. We will be including a weekly workforce review data capture form which will allow for the capture of relevant HR/Staffing detail for each ward. It will contain the following information: 16
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