Industry Voice: How collaboration across 7 trusts is reducing the burden of nurses documentation, and laying foundations for the single patient record

Hayley Grafton, Chief Nursing Information Officer at University Hospitals Leicester NHS Trust and Chair of the CNIO Network, discusses a collaborative initiative between the East Midlands Acute Provider community. The seven trusts,plus affiliated organisations, successfully rolled out a digital project to improve documentation workflow for nurses as part of their EPR programmes, initially focusing on core nursing assessments.

We are currently doing some exciting work across a group of trusts in the East Midlands region with the goal of driving meaningful digital change for nurses and care providers. The East Midlands Acute Providers Network, EMAP, has been an established provider collaborative for some time. As this collaboration evolved beyond executive alignment, it created the space to bring operational and digital leaders together to turn shared ambition into practical action.

In 2022 we formed a Digital Design Collaborative (DDC) as part of this initiative. Starting out as willing volunteers primarily from the digital nursing teams sharing information, we realised that we all shared similar goals for our Nervecentre EPR programmes. Although some were more advanced on their journey, we saw this as an opportunity to work collaboratively on a more formal basis, sharing resources and insights to help each other move forward at a quicker pace.

An opportunity for collaboration

Creating a working group and finding a way of pooling funding to create a shared team has helped us to bring things together and accelerate our progress. Each trust contributes financially with a membership fee that goes towards funding joint projects.

At the moment, the most advanced project across the seven trusts is realising the ambition for digital documentation to be streamlined and standardised, starting with nursing. We recognised that our nursing documentation could be improved and the DDC has enabled us to employ a joint project manager, business analyst, and a clinical lead to drive the delivery of this work.

A measured approach to documentation workflows

We have followed a clear project path, setting out our baseline and current state, reviewing research, evidence, and standards to outline what best practice looks like and then prototype a set of standardised documentation.

The first tranche for this project has focused on high-impact areas for patients.

When you look at the injuries that happen to patients in hospitals, they tend to be caused by falls, pressure sores and catheter-related infections, and so these are the high-risk areas where we have focused to improve the nursing assessment documentation, to also increase effectiveness. We are now at the stage where we have an agreed several prototypes which we will start to deploy from April 2026.

Maintaining focus through the challenges

There is no doubt that it has been challenging to get consensus among the different trusts. There are varied approaches – some trusts are working to NHS England standards, some to European. It has been a real eye-opener to see how differently one hospital works compared to another.

Ideally, we would like to see the same care for a patient whether they are in Northampton, Nottingham or any location, but currently it does vary based on legacy systems and procedures. However, what can be standardised is the assessment process and there is plenty of guidance and evidence to support our recommendations.

The trusts are also at different stages of digital maturity. Some will need to update existing EPR documentation processes to align with the new standards, while others can implement them from the outset.

Benefitting hospitals on a local level

A key driver to this work has been to reduce the burden of documentation for nurses. By standardising processes, the aim is to reduce the monotony and repetitiveness of unnecessary documentation and save time when conductingpatient risk assessments, and this will be a key indicator of our success through the evaluation stage.

A patient centric approach to healthcare

This will mean that a risk assessment is only carried out if it is valid for the patient. In our research, for example, we found that one trust was carrying out 13 different assessments on every patient, while another was doing only 5. Both trusts were providing exceptional care, but why was there such a difference in approach?

We identified in the first trust that every patient that walked through the door would get a falls assessment. However, since most people are not at risk of falls, it is not necessary to carry out unless there is a trigger. Discussing these issues amongst the project team has helped us create a patient-centric approach that also retains the nurse’s autonomy to perform the assessments they consider pertinent for their patient.

Sharing resource and effort

So far, the evidence has helped us to standardise a best practice assessment approach that can be applied across the seven trusts, and possibly beyond. It’s a case of build once, share across many. This is also creating an ecosystem for the future. If we have a digital footprint for patients that is done consistently, then we can share documentation across services and between trusts more easily.

Maintaining a single patient record

The work is helping us to lay the foundations for a single patient record, from which we will be able to use the data to benchmark performance and possible improvements. It is also helping patients to receive better care in hospital and come to less harm.

Security and governance best practices

All data collection should also ensure the information is protected and shared safely. When we're looking at how we create documentation practices for staff, it needs to be specific to their role.

This means looking at workflows and the secure access management needs required based on each organisation’s technology. Is the member of staff using mobile devices or kiosks in the ward? How often and which systems do they need access to? These are the sort of discussions about role-based access that we can have with our trusted vendors (like Imprivata) when designing solutions.

Proof of concept demonstrates success

Once successful as a proof of concept, we can look to roll it out across all nursing documentation as well as medical and healthcare practitioner records. This could extend across each hospital’s EPR, such that we have role-based, model ways of capturing information and working.

For example, outlining what an exemplar ward would look like - what systems might be required on a nursing station, and/or what mobile device should be used, as well as workflows and security processes. Having such a ready to use model makes life easier for nurses, saves time and improves security governance.

Comparison across trusts

We also hope that the uniform data collected will be cohesive enough that the chief nurses can look across the region, compare their performance to other trusts, and see which initiatives are working well that they might adopt.

We might even have regional-wide dashboards to reimagine what service delivery could look like, or perhaps highlight where a focus is required in a particular area or where there is an issue with capacity management.

Overcoming blockers to change

Often resources and money are the blockers for change. Working together and sharing ideas and knowledge can only go so far when relying on goodwill and motivation. What has been a catalyst for us is being able to put rigour and governance into our plans by jointly funding positions and recruiting people to drive projects forward.

By working together we are already maximising these resources. We feel confident that we will be able to deliver concrete changes to ensure best practice across our organisations and ultimately deliver more effective, better care.