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From the August 2001 Issue Nursing System Makes a Difference |
Nursing System Makes Northwest IDS reaps the benefits of using automated tools to support nursing.
It is no secret that there is a crisis in nursing today. According to a survey of 7,000 nurses by the American Nurses Association (ANA), most respondents said that care quality had been compromised by the shortage of qualified staff and increased demands on nurses’ time. As their dissatisfaction grows, up to one in five nurses is expected to leave the profession within five years. Labor- and paper-intensive documentation is a prime cause of dissatisfaction. Despite the proliferation and availability of automated information technology tools in other fields, many nurses still spend excessive amounts of time on paperwork. While clinical system vendors offer nursing tools, most organizations have yet to successfully adopt them. A key obstacle has been providing automated tools that truly support the way nurses work, rather than add to their already overwhelming workload. PeaceHealth, an integrated delivery system (IDS) located in the Northwest, believes that information technology can make nurses’ lives easier. PeaceHealth provides comprehensive regional services through its facilities in Alaska, Washington and Oregon. For the last five years, they have invested in information technology to support both the day-to-day work of nurses and their nursing department’s commitment to continuously improve nursing practice. Tools Streamline Nursing Activities
Reviewing clinical information. PeaceHealth has implemented their clinical system as a cross-continuum patient record to make information available to all caregivers, regardless of location. Nurses and other clinicians do not waste time looking for charts or tracking down missing information. “Before we installed our system, the History & Physical (H&P) was often missing from the chart when the patient was admitted to surgery,” explains Debra Taylor, R.N., nurse manager. “Now as soon as it’s dictated, the H&P is available.” “Because we document electronically, nurses view information in ways that are impossible with a paper chart,” explains Kim Williams, R.N., director of special projects. “Views of information are tailored to different disciplines and care settings, and clinicians can view results and findings in a spreadsheet or graphical format, so abnormal findings pop out for quick analysis.” Assessing patients. Using automated tools to guide and document assessments helps nurses work quickly, efficiently and thoroughly. They can use a previous assessment as a template for the current admission, so different caregivers no longer ask patients for the same information, such as allergies or medical history, but simply confirm and update information as appropriate. Charting. The system supports PeaceHealth’s approach to charting by exception. Because “normal” definitions are available via online help, expert users can work efficiently while novices can easily get the guidance they need. Nurses and other clinicians make extensive use of work lists to track and chart activities that are due for their patients over the course of their shift. The system automatically signs, dates and time stamps all entries, which saves time and provides a clear record of care activities. Medication administration. PeaceHealth’s system eliminates many inefficiencies—and potential errors—associated with medication administration. Because patient records and the current medication list are available across the care continuum, caregivers don’t need to rely on patients to provide crucial information about current medications, whether they are in the clinic, in the hospital or in the Emergency Department. PeaceHealth’s inpatient medication administration process takes advantage of online charting. A medication box outside each patient’s room is stocked regularly with that patient’s medications. To administer medications, the nurse logs onto the system outside the room, checks the medication list, checks the doses, charts, logs off, and then gives the medications to the patient. “There is no question that this process reduces errors and saves nurses time,” says Williams. “When we first went live three years ago, we saw the average time for the first dose of antibiotic drop from two hours to less than 30 minutes.” Shift report. PeaceHealth has used the system to automate shift report. This eliminates tape-recorded reports and drastically reduces time spent in face-to-face reports, while it facilitates a smooth transition between shifts. The key is the system’s viewer function, which can display a summary of all activities that happened during a shift along with a summary note added by each member of the care team. The oncoming shift sees information in views that are tailored for each discipline, including the summary notes from all disciplines. “The automated report is faster and cuts down on overtime costs, plus a recent survey of our nursing staff indicates that most prefer it to face-to-face report,” says Williams. Facilitates standards of care. PeaceHealth has applied its automated tools and multidisciplinary approach to disease management. They have implemented a complete, multidisciplinary standard of care for diabetic patients across all five regions. When a diabetic comes in for a clinic visit, the standard assessment reminds the nurse when to check the patient’s feet, eyes, etc. “Compliance on the parts of clinicians has increased dramatically,” says Williams. “We can show a patient a graph of his blood glucose levels or weight over time, which helps motivate him to stick to a treatment regimen.” Supports outcomes analysis and improvement. PeaceHealth’s system provides valuable, long-term data necessary for outcomes improvement. The organization is currently working to decrease the time nurses spend on documentation—especially information that is documented but never used. They are working to eliminate documentation that doesn’t meet regulatory, reimbursement or legal requirements. Also, they plan to take an in-depth look at nursing activities to determine which activities have a positive impact on patient outcomes and which activities do not. “We are putting the concept of patient-centered care at the heart of our efforts,” says Williams, “and often the best thing for patients is to leave them alone so they can focus on recovery.” For example, a multidisciplinary team analyzed documentation processes in intensive care and discovered that both nurses and respiratory therapists document breath sounds. Now that this information is available online, PeaceHealth is beginning a process to eliminate assessment and care processes that are duplicative—when they provide no additional value to patients. The goal is to disturb the patient as little as possible while reducing redundant effort—without compromising care quality. This will help PeaceHealth make the best use of scarce nursing resources. Improves patient satisfaction. It is clear to nurses that the electronic medical record has improved patient satisfaction. Instead of waiting days for paper reports to make their way through the system, patients can have test results within hours. Also, prescription refills are faster and more convenient. “Our patients definitely appreciate the online record,” says Taylor. “We have many patients with chronic conditions, such as renal failure. They know that all of their information is in the computer and appreciate that we don’t ask them the same questions over and over again.” Lessons Learned PeaceHealth has learned two critical lessons about how to make their clinical system work for nurses. The first lesson: simplify. “Our clinical system has literally thousands of data elements,” says Williams. “It also provides tremendous flexibility to tailor screens to the needs of different users. We learned early on the importance of removing extraneous information from the screens. Caregivers can drill down for whatever detail they need, but appreciate having their main screens include only the essential elements.” The second key lesson: Don’t simply automate the existing manual process. Williams continues, “We have worked very closely with our nursing and clinical staff to map out workflow processes that take advantage of our system’s features and capabilities.” The bottom line is we’re helping nurses get back to the bedside. “After five years of using our clinical information system, most of our nurses would have a hard time going back to the old way of doing things,” says Williams. “Although it is difficult to quantify, nurses tell us that the system saves them time—time that can be spent at the bedside. We are living proof that organizations can simplify documentation and streamline care processes, so nurses can spend more of their time doing what they enjoy: caring for patients.” © 2001 Nelson Publishing, Inc |
By Demi
Rewick, R.N., director of clinical applications for the Healthcare Improvement Division of
PeaceHealth; and Erica Gaffey, M.S., R.N., clinical informatics manager for 
PeaceHealth has progressively introduced tools that support nurses, therapists and other clinicians in providing
multidisciplinary care to patients across inpatient, ambulatory and home care settings. With automated tools in place to support assessments, charting, worklists and quality initiatives, nurses are more satisfied, and so are their patients. Here is a look at how PeaceHealth’s clinical information system, the LastWord® Enterprise Clinical System from IDX Systems Corporation, supports the patient care process.