Healthcare IT: A Nurse’s Revealing Perspective

Posted by Cyndi Coyne, RN on Nov 19, 2014 @ 02:54 PM

Hey! IT departments, CIOs, CNIOs! Did you know that your nurses are NOT happy!?! The results of a survey by Black Book Market Research were just released and it isn’t good. More than 13,000 nurses were surveyed for Black Book’s EHR Loyalty Poll and, I’ll warn you, what they had to say may be very tough to hear.

Nurses’ dissatisfaction with their electronic health record system is at an all-time high with 92% saying they were unhappy with the EMR system in their healthcare facility. That’s a shockingly high number!

Why are they so unhappy? The survey sheds some light on that. 98% of RNs said they “have never been included in hospital technology decisions or design”. 98%!! Nurses complete 80% of documentation in the patient’s record and are the largest group of end-users. Why would any organization not include them in the selection, building, and implementation of one of the largest investments they will ever make? Maybe they were willing to help but were not given time away from their normal work duties to make it possible. Maybe they were asked, but just didn’t step up and participate. Or perhaps they were never asked.

Doug Brown, Managing Partner of Black Book Market Research, said “Technology can help nurses do their jobs more effectively or it can be a highly intrusive burden on the hospital nurse delivering patient care. Many compounding nurse productivity problems can be sourced to the failure of those selecting and implementing an EHR to involve direct care nurses in the process.”

Ideally, the clinician should be able to do all necessary documentation in the most efficient manner possible. In other words, the best documentation systems are designed so we can get in, do what we have to do, and get out and back to our primary focus—the patient.

Undoubtedly, documentation is important but it should be balanced with patient care. The survey revealed that 84-97% of nursing administrators felt “the impact on nurses’ workloads including the efficient flow of direct patient care duties were not considered highly enough in their administrator’s final EHR selection decision”. Documenting our care should fit in to the natural flow of our work, not create speed bumps that slow us down diverting our attention from caring for patients.

Another startling finding: when nurses were asked to describe their IT departments, 69% said they were “incompetent” in their level of knowledge and expertise regarding the EHR software. Whoa! As a nurse who also worked in IT, that hurts! And it should make all IT professionals cringe.

If I may be so bold, I would like to offer some advice to my fellow IT professionals:

  • When embarking on the daunting task of choosing and building a new EHR, ask yourself who is going to use and interact with the system every day? Who is your end user? Who is your customer? What is the ultimate goal/purpose? You may spend months building out the documentation, but it will be the end users, primarily nurses, but also respiratory therapists, patient care techs, physicians, and other hospital staff, who must live, work, and interact with it every day—hundreds of times throughout their shift. So, please, PLEASE, include them in the planning and building of the system!
  • Bring together and meet with end users regularly throughout the build process. Ask them what they’d like to see and show them what you’re building to get their opinion on how it will work for them. They have the real world experience. They know the workflow of each of their units. They are the experts! And it’s far easier to make changes during the build phase than it will be after go-live. To find the best candidates, ask the leaders in all the different areas. They know who of their staff will be best for the project. Also ask the nursing leaders to allow these people time away from their typical duties to fully participate.
  • Don’t forget your “customers” after go-live! Keep in touch and meet with them periodically to continue to ask for their feedback. What’s working well? What could be improved? Are there new elements or additional items they need to document?
  • Rounding—Don’t be afraid to get away from your desk and walk through the units you help support and talk to the nurses! You’ll find out about issues they find aggravating but might not be important enough to take the time to call into the IT help desk. Many times a little tweak can fix it. This is a BIG staff satisfier! They will quickly recognize you really care about what they have to say and it will elevate their opinion of the IT or IS department.
  • If you do receive a problem call, do your best to take the least amount of time necessary with the nurse to get the information you need to start to solve the problem. Remember, they are VERY busy! Their main focus is taking care of their patients! They don’t have time to take away from patient care to stay on the phone with you as you try to troubleshoot the problem. If you think it will take an extended period of time to gather the information you need, ask if they have time. If it’s a bad time, find out if there is a better time to call back. I’ve even given out my personal phone number so they could call me back when it was a better time for them. Please understand, if they have a patient who is going downhill, it is NOT a good time!
  • Device integration is also a great way to help streamline the documentation by clinicians as well as provide more accurate and timely data capture. Has your organization implemented device integration? If so, do you have all of the devices capable of “talking” integrated? If not, please consider doing so. Auto-gathering of data from physiological monitors is a great start but how about ventilators? Dialysis machines? Balloon pumps? All of these devices output a huge amount of data that takes precious time to document. Again, this is a BIG staff satisfier and allows them to take the time used to manually key in this data and reinvest it into doing what they do best, caring for patients.

Okay, I’ve said my piece and will step off my soapbox for now. I know it can be difficult for those in IT to comprehend how much their role contributes to quality patient care. In the best healthcare organizations, IT and clinical staff are partners in achieving the best care possible for the patient, leading to happy nurses and, ultimately, happy patients.

Here’s a link to the survey results if you’d like to see the rest of the findings:

http://blackbookmarketresearch.com/hospital-nurses-forced-to-develop-creative-workarounds-to-deal-with-ehr/

Does your organization invite nurses to participate in technology decisions?

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Tags: Patient Care, Patient Safety, Nurses, Workflow, Health IT, Healthcare Technology, Nursing Stories, Clinical, Healthcare IT Departments

Wish List

Posted by Halley Cooksey, RN on Nov 13, 2014 @ 10:18 AM

The holiday season seems to have officially kicked off this past weekend. It seems to happen earlier each year. Gone are all the witches, bats, and ghoul decorations. In their place are festive trees strung with lights, with only the occasional Thanksgiving turkey to break things up. Soon we’ll face the barrage of commercials advertising the countless ways we can spend our holiday budgets. Many of us will spend hours listening to our children and grandchildren describe in very finite detail all the things they have placed on their wish list and how they promise to behave so they’ll get as many of the coveted gifts as possible.

Like our children, as adults we also have wish lists for our toys and that can extend into our professional lives. As nurses we have wish lists for things that will make our work life not only easier, but also allow us to truly practice our profession – caring for patients. Do you have a wish list? What sort of things do you wish for to help you in your daily practice? Do you wish for the kind of technology that can enhance your nursing practice and not hinder or slow it down? We know that no amount of technology will ever be able to replace our assessment skills, our ability to connect with a patient or their family members. There isn’t any form of technology that can console them during a very trying time; nor can technology wipe away a tear or put a band-aid over an injection site. However, we also know that technology can help free up the time for us to give our patients the kind of attention they need and that we want to provide.

If you could create a wish list of the things technology could do for you as nurse, what would you put on it and why? Would you wish for tools that could decrease the amount of time you spend documenting in a patient’s record? Or, perhaps a technology that could help you see the subtle changes in your patients and could alert you that they are beginning to decline and are in need further intervention? We want to hear your thoughts!

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Tags: Medical Device Connectivity, Medical Device Integration, Nurses, Health IT, Healthcare Technology, Nursing Stories, Medical Device Information System, MDIS, Clinical, Clinical Documentation

Applying Technology in Nursing: Lessons to be Learned From Other Industries

Posted by Karen Lund, RN BSN on Nov 04, 2014 @ 10:17 AM

Technology will not replace nurses at the bedside, but applied appropriately can enable nurses to work smarter rather than harder, and help alleviate some of our complex practice issues. Yes, we need better staffing ratios, work environments and benefits for when our aging baby boomer population requires more care.  But we also need to provide nurses with the right technology tools and support to enable them to deliver the best care possible.  In fact, if we can make nursing “cool” from a technology perspective, then perhaps more young people would be attracted to the profession and help alleviate some of our nursing shortage. 

Just as nursing theory has drawn from professions like psychology, sociology, physiology, anthropology and other disciplines to create better nursing practices, we should also draw from cutting edge technologies to help us provide better and more efficient care at the bedside.  For example, just as manufacturing applied Toyota’s “lean” strategy, nursing has started applying it to health care by giving nurses the power to change their environment to support their ability to deliver better patient care.  But there are still many, many ideas we can borrow from other industries. Waiters in restaurants, for example, can order food from the kitchen using a handheld device while customers are giving their food order.

As nurses, we should be able to order and/or charge supplies, chart medications, take and post pictures and chart all from one device. Nurses should be able to monitor patient vital signs, and automatically record changes to the Electronic Medical Record (EMR) and receive notification of trending changes. 

The technology solutions to achieve these simple, yet time and resource consuming tasks is available today, but have sadly been slow to adopt. I challenge you to ask you hospital why not? Why aren’t they using the technology that would help nurse to give better, more efficient, safer care to patients?
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Tags: Medical Device Connectivity, Medical Device Integration, Healthcare Technology, Medical Device Information System, Medical Device Data

Slow Down To Achieve Expected Results with Medical Device Integration in Med-Surg

Posted by Ken Choquette on Oct 15, 2014 @ 03:00 PM

ID-100269987“Slow Down” may not be words people use when talking about device integration.  Not all device integration initiatives are created equal.  Achieving results within med-surg units requires a bit more clinical involvement than it does in a higher acuity unit. 

Frequently, organizations want to move too fast, which undermines the value of integrating devices in these units, frustrates the implementation team, and worse, destroys end user adoption.  Neglecting the clinicians’ workflow or not conducting a network assessment in the med-surg area could render the system as unusable.  Usually, this is the result of not involving the implementation team in the device integration roll-out and hence, they’re not understanding the issue(s) you are trying to solve.

The decision for device integration in med-surg is the “starting gun” to set goals and to set the finish line.  Start by finding a baseline. 

  • What are you trying to solve with device integration in med-surg? 
  • Who currently collects the data?  How is it collected? 
  • How is data entered into the patient record?  
  • How much clinical time does documentation take away from nursing? 

We know that these are not always the easiest answers to obtain prior to integration, but knowing the current state from start to finish will help an organization set the right expectations for how device integration can improve the efficiency and safety of the existing workflows – and better yet, quantify it.

By taking a little time in beginning of the project – by SLOWING down at the start – your implementation will stay on track and result in FAST adoption and a success story for all to share.

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Tags: Medical Device Connectivity, Medical Device Integration, implementation, Medical Device Infrastructure

Patient-centered Care

Posted by Cyndi Coyne, RN on Oct 10, 2014 @ 05:00 PM

Patient-centered Care … it’s a phrase I’ve heard from the beginning of my nursing career.  But do our actions back up our words?  Is the patient truly the center of our care?  It is certainly what nurses strive to do, what we all want for our patients, and what we expect when it is a loved one who is the patient. But with all of the distractions during any given shift—some necessary, some not—it’s difficult to keep the focus on our patients.

Complicated workflows, redundant, time-consuming documentation, inefficient hospital unit design, unproductive processes can all pull the clinician’s attention away from direct patient care and create unnecessary steps to complete tasks.  There are so many tasks that must be performed during any given shift that it can be difficult, if not impossible, to get it all done. It can be overwhelming. 

With so many responsibilities, there is a risk that nurses may resort to prioritizing the many tasks required and possibly leaving some undone, known as “missed nursing care”, in order to just make it through their shift.  Activities such as ambulation, turning, patient education, and discharge planning are very important duties that, if missed, can cause complications such as blood clots or pressure ulcers, or worse, lead to increased length of stay and a greater chance of re-admission.

As we move from a fee-for-service to a value-based care model (where hospitals are paid a fixed fee according to diagnosis), it is increasingly important to provide the absolute best care possible.  We can’t afford to have anything missed.  Payers will not cover complications, extended inpatient days, and readmissions.

Fortunately, technology is available that can help by reducing obstacles and assimilating seamlessly into clinicians’ natural workflow.  Wearable communication devices aid in locating staff, asking for assistance, and can even alert staff to alarms or call lights.  Rapid sign-on devices can speed up the process of logging in to a computer workstation.  Automating the capture and documentation of the vast amount of data emitted by the medical devices used to monitor and treat patients is very effective in assisting clinicians.  I can speak from experience.  I worked in critical care prior to device integration and it is very time consuming to manually key in all that information.  I can tell you there is a world of difference after the deployment of device integration. 

Capsule has solutions to accomplish device integration.  SmartLinx Vitals Stream can acquire all the continuous data from the devices used in critical care, OR, endoscopy…wherever these type of devices are used.  Even med-surg can benefit from integrating mobile vital signs monitors with Capsule’s SmartLinx Chart Xpress.  And with the addition of the Early Warning Scoring System, the clinician can be alerted to a patient who is at risk of serious decline early so interventions can be set in place to help prevent a serious event.  The outcome of medical device integration is accurate data sent directly to the patient record nearly simultaneously with its collection and greatly reducing the number of necessary steps to complete the process.  This results in the recovery of time that can be redirected to patient care, enhancing the ability of nurses and the rest of the care team to perform the duties essential to helping patients recover.  Time also helps them stay tuned in to the patient’s condition so they can recognize changes that can lead to the development of serious complications.    

Keeping the patient in the center of what we do is what contributes to the overall patient experience and leads to better patient outcomes, as well as higher nurse and staff satisfaction. Most important, though, it’s how we want all patients treated.

Does your hospital promote patient-centered care?
What initiatives have been instituted to ensure the focus is kept on the patient?
What obstacles have you seen that hinder this effort?
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Tags: Patient Care, Medical Device Integration, Nurses

You can change the face of Sepsis. (Yes you!)

Posted by Karen Lund, RN BSN on Sep 30, 2014 @ 05:41 PM

SAMlogo2014According to the U.S. Department of Health and Human Services, care for persons with sepsis is one of the most costly health conditions with a total healthcare expense of over $20 billion every year.  Why put this burden on hospitals and families?

Early detection, early treatment, lower costs, decreased mortality and better long term outcomes all are dependent on the prompt and correct diagnosis of sepsis. And it’s easy to do if your hospital recognizes their data is a critical asset in fighting sepsis. By compiling all data elements from various systems and utilizing that data to its fullest is an indication your hospital sees the value of its data. 

Why would you only use the four data points of Systemic Inflammatory Response Syndrome (SIRS) to detect sepsis when you could be analyzing and evaluating over 120 different data points from the entire EMR for more accurate early detection and communication? Who wouldn’t want to decrease mortality and the number of catastrophic long-term multi-system organ effects of post-sepsis syndrome? 

Does your hospital see their data as an asset? Look to optimize the use of your data to combat sepsis with Clinical Vigilance for Sepsis software from Capsule.

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Tags: sepsis

The Pecking Order of Device Integration

Posted by Halley Cooksey, RN on Sep 26, 2014 @ 03:16 PM

When I first became a nurse, one of my favorite questions to be asked was “What kind of nurse are you?” The fine print of this question, of course, is “where in the hospital do you work?” I would swell with pride and proudly state that I was an “ER” nurse.

As far as I was concerned (at that time) an ER nurse was the best kind of nurse anyone could be. Sure, working in the critical care area must have its challenges, but how hard is it to take care of an intubated patient who I had so kindly stabilized for you? As for the nurses on the floor, I mean, really? These patients were of the walkie-talkie population. Hang a few bags of IVs, push a little Lasix and remind your nurse tech to measure their output. Obviously nothing compares to the ER.

Fast forward many years to today and I have to tell you what an awakening I have had. After leaving the ER for a myriad of reasons, I crossed over to the dark-side of nursing … also affectionately known as “HIT”. It was during my years working as a clinical systems analyst that everything I thought I knew about med-surg floors made me realize that I had no concept of what it was to walk in their shoes and understand what their workflow was all about.

The nurses who worked on the med-surg unit were taking care of a complex, diverse group of patients with varying degrees of acuity; more times than not, without the assistance or extra set of helping hands of a patient care tech, because the patient care tech was in a room with a confused geriatric patient who couldn’t be left alone. I watched these nurses document on napkins, scrubs and sometimes bed sheets all while taking phone calls from different doctors and receiving orders. Additionally, they were working with social services, the hospice nurse and every other visitor who decided to stop them in the hall and ask about their loved ones. I remember thinking, who signs up for this gig? To say the least, I was humbled by their dedication.

The big picture of this is that “floor” nurses are the ones in need of technology to complement their workflow and not impede it. Technology should not be seen as “big brother” watching over their shoulders, but as an extra set of eyes to help them do what they do best: take care of patients.

Interestingly enough, though, med-surg units are typically that last areas to be thought of for medical device integration. Walk into any critical care area and you’ll likely see monitors feeding to a central station that, in turn, feeds directly to an EMR. Ventilators are cutting edge and their data is flowing to the EMR, as well. Conversely, walk onto a med-surg unit and you’ll likely observe nurses with tattoos of vital signs up and down their arms, or on scraps of paper that they will later transcribe. Their patients’ data is just as important as the patients sitting in the critical care unit or ER, right?

So, here’s an interesting thought to ponder: Typically, there are more med-surg beds in a facility than ER beds and critical care beds combined; therefore, there are more med-surg nurses working at any given time than there are in all the other areas put together. The med-surg areas are the backbone of the hospital. As a general cultural oddity, why is it that these areas are the last to get connected? Why are they not seen as mission critical like other areas of the hospital?

I’d like to hear your opinion as to why this is the case and how we can change this thought process.

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Tags: Medical Device Connectivity, Nurses, Nursing Stories, Clinical, Med-Surg

Oh, how times have changed… or have they?

Posted by Michelle Grate, RN MSN CPHIMS on Sep 19, 2014 @ 09:00 AM

chart_ring_binder_cart_rack_carstens_first_healthcareI stumbled upon an interesting statement recently, "The immediate availability of a patient's chart record means greater convenience to the nurse, the attending physician, the intern and the hospital administrator. Not only is there a marked saving in time, but greater accuracy is secured in clinical records when the chart and chart holder are easily accessible." Sounds like many of the conversations we hear today about electronic documentation. But the source of this statement may surprise you: it is from a series of articles in The Modern Hospital, circa October, 19221! Looks like the theme of immediate availability of a patient's record has been around for a long time and for the same reasons.

This has put me in a bit of a nostalgic mood. Recently I was doing some work at a hospital and I glanced fondly at the good ol' chart rack. It has always been an integral piece in our arsenal of nursing tools. Although they may be a little different from one hospital to another – some are square, some are round, some have wheels, and some sit on a desk – they are all basically the same. Even today with all the electronic documentation and EHRs, they can still be seen doing their humble job on the nursing units, albeit a little thinner than they used to be. I have many memories of pulling up the chart rack to my spot at the nursing desk and doing my documentation for the day, hour, shift or whenever I got the chance.

But I digress, so back to the subject of immediate availability. If you have been a reader of our blog posts, you are already aware that we are advocates of immediate availability of patient's vital signs in the electronic record. Our goal is to help make that possible for any med/surg environment.   We can help you collect vitals directly from most spot check monitors and transmit them along with additional documentation to the electronic record in near real time. This isn't future availability, it is available now. And apparently it still helps with the age old theme of "immediate availability of a patient's chart record".

Does your facility still have chart racks?
What is in them?
Do you think they will ever go completely away?

 

[1] The Modern Hospital (Vol. XIX, p. Adv. 105). (1922). Chicago: The Modern Hospital Publishing.

 

Image credits: Franklin Mills Co.

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Tags: Nurses, Clinical Documentation, ThrowBack

The Documentation Paradox in Med-Surg

Posted by Susan Niemeier, RN BSN MHA on Sep 17, 2014 @ 11:44 AM

The med-surg unit is an operationally intense care environment with typically two out of three hospitalized patients residing in this area. The acuity of patients in this setting is escalating, along with rising co-morbidities and patient age. In parallel, the hospital's patient population is shifting more toward outpatient care, increasing the number of short-stay patients. Short-stay patients are those who stay in the hospital for approximately 23 hours or less and are then discharged to go home. Often, these patients are placed in med-surg units and require a heightened level of observation to assess for subtle changes in their condition. As acuity increases, so do the number of devices at the bedside, along with the requirements for entering data into a patient's record.

Despite these conditions the nurse-to-patient ratio in med-surg units has not changed. This results in more work and immeasurable stress. Add to that the regulatory, legal and hospital compliance efforts for higher degrees of documentation, as well as pressure to discharge patients as soon as possible, and you can see that there is a "perfect storm" of increased workflow requirements that could lead to errors putting patients at risk.  

The environment wherein med-surg nurses work has become incredibly complex and demanding. The result is that they must provide increased effort, energy, and attention just to perform their normal, daily activities. Many are close to the breaking point; they simply cannot take on any more work or responsibility without significantly impacting patient care.

One responsibility that steals substantial time from patient care is documentation. The increasing complexity of patients seen in the med-surg unit means that nurses are constantly moving (between one and five miles during a typical 10-hour shift), making decisions on the fly, and multitasking, all of which takes a high toll on performance and work processes.1 Given all this, nurses view documentation as a lower priority item on their list, choosing to document in batch mode when they have a few minutes rather than in the real time.

In fact, studies find that it takes between two to twelve hours after collecting data from patients' monitors before nurses enter it into medical record. The manual entry of data leads to error rates as high as 17%.2 Yet documentation is taking up an increasing amount of nursing time, with studies finding that 35% of a nurse's time is spent on documentation (147 minutes in a 10-hour shift), while less than 20% is spent on patient care and education, and just 7% on assessment and surveillance.3

The focus on quality in today's healthcare environment means the EMR must be fully integrated into clinical care and decision making. Among the benefits when used properly, for instance, are better decisions and better coordinated care. With physician order entry, physicians need an ‘information rich' record with real-time data. Ancillary departments such as respiratory, physical, occupational and speech therapy also require access to an up-to-date medical record so they may immediately know a patient's state. Such information is equally important for pharmacy, infection control and discharge planning.

However, while EMRs can bring numerous benefits to the hospital environment and improve patient care, they are impractical and even dangerous if the data is not accurate, timely, and complete. So, therein lies the paradox: much of the data entered into an EMR is on the shoulders of med-surg nurses. Yet med-surg nurses are forced to place this task towards the bottom of their list because of their patient care priorities.

The current system relies on the nurse to function as a "human bridge" between medical devices and the EMR. The med-surg unit is no exception. Med-surg nurses capture patient data throughout the day from a number of devices, manually writing the data on a clipboard, sticky pads, paper towels or even alcohol wipes. At a later time during the shift, they key the data into each of their patients' electronic record. The danger of this approach is the increased likelihood of errors and potential for omissions. Moreover, valuable time slips by - time during which critical decisions are made based on data that could be hours old. Just as important, all of this activity of capturing data from various bedside devices and manually keying it into a record takes the clinicians away from direct patient care and surveillance, which can affect outcomes. Very simply, under the current system, clinicians doing both clinical documentation and patient assessment simultaneously is ... well ... incompatible, to put it lightly.  

There are solutions to this "human bridge" problem that can remove the nurse as the "middleman". There is increased focus on the automation of clinical documentation, that is:  the electronic transfer of data from a medical device to the EMR, and other clinical systems. The integration of data in med-surg is even more critical as the patient acuity rises along with the number of number of bedside devices to assist in monitoring. Due to the fundamental nature of vital signs, devices that take these measurements are typically among the first to be targeted for automation. Integration, however, is not limited to devices measuring vital signs. Other types of devices that can be integrated in med-surg include (but not limited to) scales, smart beds, infusion pumps, etc. By not having to record and transcribe information into the EMR, a considerable amount of time can be saved. And, automating the collection of data ensures that all desired information is accurately collected. This eliminates the possibility of accidentally omitting essential data during documentation. Recording patient data at a higher frequency allows for catching subtle changes in a patient status much sooner. 

In an environment where information is recorded automatically into the patient's record, there is no need for a physician and the interdisciplinary team to wait on the med-surg nurse to complete rounds and transcribe the data.

In the end, bringing a flexible, documentation automation system into med-surg can help reinvest nursing time to direct patient-care activities, improve nursing productivity and satisfaction, enhance the completeness of the medical record, and ultimately, improve the delivery of safe, high quality care.

My question to you is, why do hospitals choose not to automate device documentation in med-surg when the evidence is clear?

 

References

1) Potter P, Boxerman S, Wolf L, et al. Mapping the nursing process. J Nurs Adm. 2004; 34(2):101-109

2) Wager KA, et al. Comparison of the Quality and Timeliness of Vital Signs Data During a Multi-Phase EHR Implementation Computers in Nursing. CIN: Computers, Informatics, Nursing. 2010; 38(4):205-212

3) Hendrich A, Chow M, Skierczynski B, Zhenqiang L. A 36 hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal. 2008;12(3):25-34

 

Originally posted on ADVANCE Healthcare POV Blog.

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Tags: Medical Device Connectivity, Patient Care, Medical Device Integration, Nurses, Clinical Documentation, Med-Surg, Low Acuity

Time. It’s What Med-Surg Nurses Need Most to Care for Patients

Posted by Cyndi Coyne, RN on Aug 27, 2014 @ 11:01 AM

Join-MDI-in-MedSurg-webinarI read an article a few weeks ago that truly blew me away. It first caught my attention in Becker’s Hospital Review, but I have since seen it appear in other publications, such as the Wall Street Journal. It was about bringing nurses back to the bedside. You may be thinking “Isn’t that where they are already?” But here’s the big surprise. The article was about Novant Health in North Carolina and their initiative to free-up nurses so they can spend more time doing what they do best: taking care of patients.

It all began when hospital leaders wanted to know how much time nurses actually spent in patient rooms during a 12 hour shift. What they found was shocking to me, at first. It was only 2 ½-3 hours! They weren’t alone; other healthcare organizations had similar findings. Still, that really floored me! But then I recalled when I was a bedside nurse and I have to admit, considering the nurse/patient ratios and all the activities involved in caring for the average med-surg patient, 2 ½-3 hours sounds about right. I often commented that although it may have taken me five minutes to complete a task, it took more than twice as long to gather the supplies … sometimes having to call or even go to another department … then round up a co-worker to provide an extra set of hands, and afterwards, of course, document it all. With shorter patient stays, quicker patient turnover, and older, sicker patients, med-surg nurses are really squeezed.

Novant decided to do something about it and set an ambitious goal—70% of nurses’ time (or 8.5 hours of a 12 hour shift) spent in patient rooms. To develop a plan to accomplish this, they gathered a group of 40 nurses from across their healthcare system. Wisely, they engaged their own experienced nurses to brainstorm solutions instead of hiring an outside consulting group to swoop in, do a big study, and then dictate a plan of action. The nurses studied process flow and discovered the top activities that pulled them away from the bedside: hunting for supplies, tracking down medications, filling out paperwork, and looking for test results.

The battle plan they developed involved implementing a care team approach that called for LPNs, CNAs, pharmacy techs, and other support staff, to rally around the RN to ensure all of a patient’s needs would be addressed. This included some adjustments in each person’s role so that each team member functions to the full extent of their training and licensing.

In addition, they relocated supplies either in or closer to patient rooms; brought medications to the point-of-care; and implemented an EMR with physician order entry, along with a computer workstation in each patient room. This was all aimed at reducing the required steps in caring for the patient along with documenting that care. Bringing everything the patient needs to the point of care—what a revolutionary idea!

Integral to this strategy was automating the capture of medical device data, which freed-up the clinician from the manual process of entering data into the patient record; not to mention increasing the accuracy of the data, as well. It’s an essential tool that allows nurses more time to focus on the most important part of their job—the patient.

Research proves the more time nurses spend at the bedside, the fewer patient falls, the fewer medication errors, the higher the patient satisfaction rates, and the lower the infection rates. Furthermore, nursing satisfaction also increases, leading to lower nurse turnover. Med-surg units are the backbone of any hospital. Easing the workload of this vital group can only lead to good things.

Oh, and by the way, Novant reached their goal. Nurses are now spending 72% of their time in patients’ rooms allowing them to not only care for their patients, but also keep patients and their families better informed regarding post-hospital care, ways to improve their health, and the prevention of subsequent hospitalizations. Very impressive Novant! Bravo!

How much time do you think nurses at your hospital are engaged in direct patient care?
What measures have been instituted in your organization to increase nurses’ time at the bedside?

We're Discussing MDI in Med-Surg Today at 2:00pm EDT!

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Tags: Medical Device Connectivity, Medical Device Integration, Nurses, Medical Device Information System, Med-Surg

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