Using QR codes on plaster casts: empowering patients to self-manage

Abstract

An audit found that patients who had a plaster cast fitted were frequently contacting or visiting the fracture service with minor queries during their recovery. They were not using, or would lose, the information leaflets they were given to take home. At Bradford Teaching Hospitals NHS Foundation Trust we piloted and implemented an initiative using QR codes on casts to give patients direct access to a website with specific information about cast care and their recovery. This dramatically reduced the calls and visits, and was popular with patients. This initiative won the Nursing Times Technology and Data in Nursing Award in 2021.

Citation: Connor J (2022) Using QR codes on plaster casts: empowering patients to self-manage. Nursing Times [online]; 118: 3.

Author: Janine Connor is fragility fracture liaison sister, Bradford Teaching Hospitals NHS Foundation Trust.

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• To contact Janine Connor about this project, please email: janine.connor@bthft.nhs.uk

 

Introduction

At the time of having a plaster cast fitted, all patients are given guidance and information leaflets that answer many of the questions they may have. However, patients may be overwhelmed with this information or not be in the right frame of mind to absorb or remember what they have been told. At Bradford Teaching Hospitals NHS Foundation Trust, we were aware that, after having a cast fitted, patients would often call or visit the hospital without an appointment for minor issues because they were unsure how to look after their cast or what problems meant they had to be seen in the clinic.

When the Covid-19 pandemic hit, as well as there being concerns about capacity, there was also a push to stop patients attending hospitals unnecessarily. We carried out a baseline audit from January to April 2020 that showed the service received an average of 20 telephone calls per week, each one taking around five minutes to resolve. Most patients were returning for reasons that could have been managed without a hospital visit, but said they did not access the information they had been given, had not read it or had lost it.

We began to look at solutions to, not only make our service better for patients and staff, but also to empower patients to take responsibility for their own care by providing accessible information and education about plaster care management on discharge from the clinic. We also wanted to ensure optimal plaster care for patients at home by improving communication pathways between them and plaster room staff.

Use of QR codes

Our plaster technicians, Charlene Brown and Ben Gracey, had the idea of using a QR (quick response) code, which could be attached to the plaster cast to enable easy access to patient information on smartphones. This way there would be no website to remember or leaflet to lose. Through this technology, we could provide videos, photographs and text in different languages that was specific to the type of cast the patient had. On the videos, we added subtitles to be inclusive for any patients who were deaf or hard of hearing.

In January 2020, we assembled a key team to plan and deliver the project. This included those working in the fracture service and an informatics team that would be able to provide technical support.

In the first phase of the project, we created a website in collaboration with the University of Bradford, which helped us create the QR code technology we needed to link the patients to the right information. Initially, the information provided on the website was for a forearm cast so this could be piloted and built on.

We also had to design a robust tape to attach the QR code to the casts as sticking a QR code onto the cast would not work. Working with the trust’s medical illustration department, we sampled different tapes to decide on the best materials, as it had to be robust enough last several weeks and through patients’ daily activities.

Pilot

Once a website with the specific patient information had been developed, we piloted the scheme on 40 patients with forearm casts and 40 patients with below-knee casts. We explained the purpose of the QR code and obtained verbal consent from the patient and this was recorded in their notes. At the time of the cast application, we ensured the patient understood that the information detailed via the QR code featured the most important aspects of cast care. We also checked that the QR code worked on the patient’s telephone while they were in the clinic. Patients were then contacted two to three weeks later by telephone for their feedback.

Patients and relatives/carers reported how easy the information was for them to access at any time of day, and how reassuring and useful they found the information available via the QR codes.

“The judges were astounded by the creative solution to a common challenge. This solution could be adapted and adopted by all in the healthcare continuum” (Judges’ feedback)

Results

After the success of the pilot, we rolled out the application of QR codes to all types of plaster casts. The QR codes and website information were refined to be unique to each type of cast so patients were immediately directed to relevant and specific information. As well as information on caring for a cast and when to seek additional help, we introduced links to physiotherapy exercises to help patients recover from their fracture. For patients with split casts that they can remove themselves, there is information on how to safely remove the cast once the injury has healed.

We did another audit between September and November 2020; analysis showed that the use of QR plaster codes reduced telephone calls to the service from, on average, 20 per week to five per week. This freed up ≥75 minutes of staff time per week. The number of unscheduled follow-up appointments to clinic also fell from 35 to five, on average, per week, which was of particular importance during lockdown. This approach for giving patients easily accessible, relevant and targeted information specific to their cast has also generated cost savings of between £580.50 and £981 per week. This is based on 30 forearm cast changes, costing £19.35 per visit, and 30 below-knee cast changes at £32.70 per visit, considers the cost of replacing a cast and that of the technician but excludes the need for review by a doctor.

We also telephoned 80 patients to ask whether they could access the information via the QR code, found it useful and had any problems. They all said they found the information very easy to understand, were comfortable using the website on their own and could easily navigate it. Of those 80 patients, 76 (95%) said having access to the website stopped them needing to call or attend the plaster room with queries.

Ongoing work

The website is now complete and has been handed back to the clinical team so they can update content as needed in response to new practice or research. We have assessed the most effective way of translating the patient information on the website into different formats and languages, while making sure it remains accurate.

The QR code innovation can be easily transferred to other healthcare contexts and platforms to improve patient care, and this is already being done in Bradford. Our orthopaedic consultants have adapted our idea and are using QR codes to give patients access to physiotherapy regimes, and information about conditions and surgeries. The paediatric asthma clinic at the Bradford Royal Infirmary is also developing a QR code for children and families to educate them about using inhalers.

We hope to roll out the idea to other plaster rooms across the UK and globally, and have been contacted by teams wanting to use our technology and resources.

Conclusion

Our team was inspired to use its knowledge and expertise to make creative, innovative and positive changes to improve the service for both patients and staff. The goal was to improve patients’ timely access to relevant information and to make that information immediately accessible in different formats and languages.

The audit of the approach has shown that QR codes on plaster casts improves the accessibility of information and enables patients to be more confident in managing their care in terms of preventing problems, knowing the appropriate physiotherapy exercises, removing split casts, and being aware of general bone health. This has also helped us, as a team, to be more efficient and make better use of our time in the clinic by reducing the time spent with follow-up queries.

We believe that implementing QR codes on plaster casts is a real innovation, supported by demonstrable evidence of improvement and patient empowerment. The website can be updated when necessary and has proven to have a positive impact on the quality of patient care and outcomes.