Equipment

Cerner have minimum requirements for what can be connected to their product and therefore it is important to make sure that the hardware and infrastructure is compatible with FetaLink.

Importantly, FetaLink requires:

The ‘Cerner connectivity engine’, which coupled with the ‘Cerner device adaptor’ USB dongle, translates data from CTG devices and feeds it into connectivity engine, which sends it to a Cerner server.
Philips FM30 CTGs, which were already standardised and in use at ICHT.

Understanding the state of devices in use prior to implementation

To prepare for implementation, surveys were carried out to gain an understanding of the devices that were currently used and find out whether they needed to be upgraded or replaced.

Planning how additional kit would fit in the rooms

ICHT had to examine the kit required for the new workflow and analyse how it would fit in the rooms at both sites, taking into account that the layout would be different in different wards and in different rooms.

Purchasing additional CTG Machines

Maternity wanted one CTG device per bed to avoid having to move the device from room to room. Some of the existing CTG machines needed software upgrading before go-live and, in order to meet the one device per room requirement, ICHT had to purchase eight additional CTG machines (along with the associated equipment, such as mounts).

One ward now has a total of approximately 18 machines, while the other has approximately 10. Not all of the CTGs are in the delivery rooms: some are spare free-standing machines that can be used if needed, and others are in the triage department.

Other equipment – Screens, trolleys/wall-mounting, telemetry

In terms of equipment, it was important to make sure that the screens were not too big as this would skew the view of the CTG trace (which had been specified to display 1cm/hour). It was also important to adjust the equipment to the estates requirements at each site: one opted for trolleys, while the other decided to wall-mount everything due to a lack of space.

This also had implications for the attachment of the screens to the CTG machines, as screens can be wired to the CTG machines if mounted on trolleys, while wall-mounting requires telemetry (wireless connection).

‘Telemetry is for the mother’s sake, so they can move around more freely, and not be limited by the length of the cable that is attached to the CTG’
– Cerner Project Midwife

Key lessons

It is important to take into account the physical infrastructural needs: this will inform decisions about mounting (wall-mounting versus trolley).
Failure to take into account infrastructure might lead to an increase in cost; for example, initially the two screens were mounted next to each other on the trolleys, however this obstructed the midwives access to the emergency bell. Therefore, new trolleys needed to be procured in order to mount the screens one on top of the other.

Supporting evidence

Both the Health Foundation (2015) and the Nuffield Trust (2017) argue that a careful assessment of infrastructural requirements and of necessary changes/upgrades are key facilitators to innovation adoption within the NHS. However, it’s important to remember that these assessments are not always completely accurate (particularly in cases in which there are few lessons to draw on from previous implementation efforts). A robust communications strategy is also necessary (The Health Foundation, 2018) to avoid or attempt to limit resistance among clinical staff, who might feel uncomfortable if things don’t go to plan, and to reassure the project board that measures are being taken to ensure patient safety and avoid cost escalation.

References

Castle-Clarke, S., Edwards, N., and Buckingham, H. (2017) Falling short: Why the NHS is still struggling to make the most of new innovations. Briefing, Nuffield Trust. Available here. (accessed 21 March 2019)

The Health Foundation (2015). Using communication approaches to spread improvement. The Health Foundation: London. Available here.

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