The NHS CUI programme: patient safety needs – you!

Every year, “safety incidents” put patients at risk in NHS hospitals. The NHS Common User Interface programme is working to make patients safer by reducing avoidable medication and documentation errors. However, it needs people working on the frontline to help – and that means you. Sally Whittle reports.

Every year, thousands of patients in hospitals across England and Wales are put at risk through “safety incidents.” Sometimes there are unnecessary deaths. The problem also adds billions of pounds to hospital running costs, because of the extra care that people need.

After slips, trips and falls, the most common causes of safety incidents are medication errors, record documentation errors and failures in technology. However, a project is aiming to reduce these errors by as much as 50% by using better, more consistent technology.

Many systems can cause confusion

“As an NHS worker, the chances are that you use multiple computer applications every day - but none of them look the same,” says Richard Smith, a consultant obstetrician with the Norfolk and Norwich University Hospitals NHS Foundation Trust.

“If you’re a junior doctor, you might move from one department to another and be faced with a completely different prescribing system - that you’re still expected to be able to use safely.” 
 
This is why Smith welcomes the NHS Common User Interface (CUI) programme, which is working to make NHS IT easier to deploy and easier and safer to use. Run by Microsoft in partnership with the NHS, part of the programme is looking at how computer systems can present information consistently across different trusts, departments and wards.

“At the moment, there are absolutely no common user interface design standards within the NHS, and that’s a problem because staff using unfamiliar systems are more likely to make mistakes,” says Phillip Joe, a user experience architect with the NHS CUI programme.

Creating a more consistent look and feel

The NHS CUI programme is three years into a four year development of platform-independent guidelines for independent software vendors (ISVs) involved in creating new clinical and non-clinical applications for use within the health service.

“We create Design Guidance documents that ISVs can download from our website, where there are also demonstrations showing how software will be used, or typical patient journeys,” explains Joe. “This means technology developers can see how a common interface can improve productivity, communications and decision-making.”

A lot of the programme’s work is focused on very basic elements, such as how to display a patient’s name or date. Once these “building blocks” are in place, they can be included in many new applications. “So if you’re using a prescribing or an admissions application, the name and date of birth should be the same, and end users won’t need to re-learn those kinds of basic elements,” Joe says.

The NHS CUI programme is a major project and faces enormous challenges; not least trying to create standards for one of the largest single organisations in the world.

“It’s a large ship to turn in any direction,” says Joe. “Healthcare is also what I call a classic ‘wicked problem’ because you never know when you have solved it completely – you can only really ever endeavour to make it better.” 

Reaching out to the frontline

A second major challenge is reaching end-users – staff on the wards and in labs and NHS offices across the country. “Our whole research is predicated on a user centred design philosophy, but we have to balance working with end users against the even stronger principle of patient privacy,” says Joe. “It’s a constant challenge.”

One senior clinician who has been involved with the NHS CUI programme from its earliest stages is Ann Jacklin, chief of service for pharmacy and therapies with Imperial College Healthcare NHS Trust. She has taken a number of email questionnaires from the team about her work, and has also provided feedback on demonstration systems.

Jacklin believes it is vital for clinicians to provide feedback to the programme. “We understand the processes involved in healthcare,” she says. “We are also the people who are going to be using the output, so it’s important to be involved.”

Richard Smith has also attended a number of workshops with the CUI team, and believes that direct involvement of clinical staff can provide huge benefits. “If you take the example of prescribing systems, a small thing is what appears in drop-down menus and how that can be tailored to different departments,” he says.

For example, the doses of the painkiller pethidine that are used in a child health setting are completely different to those used on an adult ward - yet many computer applications list all doses for adults and children. “That sort of thing, to me, should be changed because you’re making it easier for people to select the wrong dose by mistake,” says Smith.

Positive about the benefits

Early results from the NHS CUI programme are very promising and Jacklin says her team has been universally positive about the demonstrations they have seen to date. “The work looks valuable in bringing together a common approach, irrespective of suppliers,” she says. “It’s very user focused and it’s coming up with sensible, practitioner-based recommendations.”

The ultimate goal is to improve patient safety. “We hope this will reduce the number of avoidable patient safety incidents that occur in the NHS, and will make clinicians’ work easier,” says Joe.