Table 4 Summary of themes arising from the data

Device

Type of device

Portable device allows staff to access care plans and record assessments at point of care.

Desktop device may be preferable for writing longer documents.

Portable device should be discrete and have a mute function.

Number of devices

Staff involved in assessment, care planning, and care provision should ideally have access to their own device so that important information can be immediately accessed or recorded before and after care delivery.

Software functionality

Drop-down menus

Incorporation of drop-down menus that can be customised by the nursing home may save time during assessment and care planning and act as prompts.

Space for free data entry may still be required.

Customisable

terminology

Nursing home should be able to customise terminology used in assessment and care plan templates that is appropriate for staff level.

Alerts about changes in a resident’s condition

EPR should alert staff on entering the programme to any significant changes in a resident’s condition, such as admission to hospital.

Alerts to update care plans

EPR should alert staff when care plan requires updating.

Nursing home should be able to choose whether old care plan is automatically deleted or not.

Interoperability

Interoperable system would mean less time is spent entering information from hospital discharge forms into the EPR and clarifying unclear information.

Interoperable system would allow nursing home staff to remain up to date about a resident’s condition whilst in hospital and plan for their return.

Structure & content

Assessments for dementia

EPR should include assessment scales relevant to dementia care, for instance:

-QUALID Scale

-Mini-mental State Examination

-Barthel Index

EPR may need to incorporate assessment templates based on observations of individuals for those at advanced stages of dementia.

Various assessment templates should be incorporated for all relevant staff, including assessment of social needs.

Assessments should be customisable for client group and not force staff to enter irrelevant information.

Care planning for dementia

EPR should alert staff to any specific changes in physical health that could impact on a resident’s behaviour, such as:

-Changes in eating or drinking habits.

-Changes in bowel habits.

-Changes in body temperature.

Care plan template should be customisable, but may need to prompt staff to include the following:

-Type of dementia.

-Key contact person such as family member or friend.

-Life history of resident.

-Information about routines.

-Information about hobbies,

-Past profession and whether this was enjoyed by the individual or not.

Improvements in structure

Staff require a table in the EPR where they can record all observations (e.g. blood pressure, temperature, oxygen saturation, heart rate) in the same place.

EPR should allow staff to easily access assessments and care plans of other staff, for instance, by incorporating tabs according to each profession (e.g. physiotherapist, occupational therapist) that appear on the screen.

EPR may need to include space to record how long each task of the care plan takes to complete.

Organisational support

Access

EPR may need to offer customisable access to assessments and care plans for staff according to their level of training. For instance, management may decide access to dementia diagnosis should be restricted.

Training

Training ‘on the job’ should be offered as an alternative to classroom-based teaching.

Training should be customised according to previous experience with technology.

Ongoing training should be offered at appropriate times.

System support

Ongoing communication with EPR developers is crucial for appropriate updates to be made to the programme.

A named person within the nursing home who maintains contact with the developer and to whom problems can be addressed may be appropriate.

Onsite support for immediate IT issues may also be important.