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Medical Device Integration Blog

Are your care decisions based on comprehensive and accurate data?

Posted by Monica Demers on May 12, 2015 @ 05:00 AM

Blog Series: Medical device integration addresses multiple health technology hazards

To err is human--and we are all human after all.  So errors in transcription of medical device data do happen.  Too often, clinicians busy caring for patients scribble down information on slips of paper that may be illegible or are lost by the end of a shift.  Mistakes also happen as data is keyed into an EHR. 

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Tags: Medical Device Integration, Patient Data, Health IT, Clinical Documentation, Vital Signs

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, Clinical, Clinical Documentation

Oh, how times have changed… or have they?

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


I 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.

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Tags: Nurses, Clinical Documentation, ThrowBack

The Documentation Paradox in Med-Surg

Posted by Susan Niemeier, MHA, BSN, RN 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

Multitasking Nightmares? Tame Them with A MDIS

Posted by Karen Lund, RN BSN on Jul 10, 2014 @ 12:00 PM


Rising patient acuity and dramatically shortened hospital stays are threatening nurses’ ability to meet the needs of their patients. We are constantly on the move, switching from activity to activity, too often finding it difficult to spend enough time with our patients.

How many times have you had to tap your super-power multitasking abilities? Daily? Take, for example, the following all too common scenario. Patient #1 is coming back from surgery. The blood bank calls to say the packed red blood cells are ready for patient #2. You’re waiting for labs in order to give medications to patient #3. Your nurse aide has just informed you that your confused patient #4 has just fallen out of bed and requires immediate help. And patient #5 is waiting for you to complete brand new procedures for discharge paperwork so he can leave the hospital. Sound eerily familiar?

Nurses have adapted to the endless demands for our attention in order to meet both patient needs and their facility’s goals. Distractions may come in many forms on top of patient care, such as new equipment, increased education for new procedures, documentation requirements, and orienting new staff. Krichbaum (2007) reported 40% or more of a nurse’s workday is outside of direct patient care. So what happens when nurses feel like they’re no longer helping the patient and that they’re overwhelmed with non-value tasks? Burn out?

A Medical Device Information System (MDIS) can help nurses gain back more time by helping improve the efficiency of patient documentation. It automatically integrates your medical device data into your hospital’s information system(s), which can save documentation time, increase communication, all while improving accuracy and timeliness. Moreover, in addition to providing connectivity with the EMR, an MDIS delivers monitoring, management and analysis of real-time patient data, enabling nurses to recognize signs of a patient’s physiological deterioration.

Why is this important? An MDIS is one of the few IT solutions that can take some of the pressure off those who give care to our loved ones, while offering real enhancements to the quality of care we are so committed to deliver.

If your facility has already deployed medical device integration capabilities, what kind of impact has it had on your daily activities? And if you haven’t, what’s holding you back?

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Tags: Patient Care, Workflow, Medical Device Information System, Clinical, Clinical Documentation

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