Cost of electronic charting

[abooker]

All of my residents are dehydrated.

They're eating and drinking normally, their skin turgor feels good, and their urine looks straw-colored, but they're all dehydrated. I would never have known this if it weren't for our new electronic charting system.

Although we've only been using it for two or three weeks, I'm already seeing tremendous improvements in my delivery of care. How otherwise would I know to push fluids and hold furosemide?

If some of my residents start to cough and I hear crackles and wheezes in their lungs, I guess I'll be asking for chest x-rays? Maybe sending people out? I guess this will decrease medical errors by lowering the census and giving me more time per resident.

I don't see how our new system will help lower health care costs. Anybody have any insight into this?

[rninformatics, DNP, RN]

Healthcare costs are lowered when patients are treated in a more timely and cost effective manner. When quality care is delivered and patient outcomes improved studies have shown us that costs are decreased.

Research shows that medical errors,patient injury and often patient deaths can be decreased and avoided by the use of CPOE, electronic documentation, decision support systems, drug interaction alerts, eMARs and bar code medication administration systems.

When data is collected (from electronic documentation systems, results reporting systems, point of care diagnostic testing equipment, electronic vital sign monitors, etc) and synthesized into information and then that information is in turn utilized by clinicans as knowledge to diagnosis and treat patients -- that is how systems help to lower health care costs.

All of my residents are dehydrated.

I don’t see how our new system will help lower health care costs. Anybody have any insight into this?

[abooker]

Quality care seems to involve ignoring the information being compiled by the electronic chart. I don't know ... should I ask CNAs to avoid charting inputs and outputs, or should I continue to ignore the messages alerting me to dehydration, or ... ?

The only knowledge I seem to be deriving from the info provided by our new system is that I should question the information received. I'm not yet finding it useful as a clinical tool. Does this come with time, or is there something more proactive I could be doing? I'm in long term care. Looks like the system was designed with a hospital in mind, and maybe that's why I'm having problems?

[rninformatics, DNP, RN]

You first need to remember that information is only as good as the original data it was obtained from. GIGO - Garbage in, garbage out..........

IF the system is providing false alarms perhaps the indicators/alerts/alarms are set with incorrect parameters. Have you reported this to the appropriate people/depts at your organization? Instead of ignoring the message alerting you to what the system sees as a dehydrated pt have you proactively followed up with someone about this incorrect and false alarm? If my car beeps that my seat belt is not fastened or the "check engine" light keeps flashing even though I know my seat belt is fastened and I just had the car serviced. Its still my responsibility to report the problem to the dealer/mechanic.

Of course you should question the info received, you are still the human being - the system is only a tool to be used by you. The use of clinical systems does not eliminate the need for nursing judgement.

Good Luck!

Quality care seems to involve ignoring the information being compiled by the electronic chart. I don't know ... should I ask CNAs to avoid charting inputs and outputs, or should I continue to ignore the messages alerting me to dehydration, or ... ?

The only knowledge I seem to be deriving from the info provided by our new system is that I should question the information received. I'm not yet finding it useful as a clinical tool. Does this come with time, or is there something more proactive I could be doing? I'm in long term care. Looks like the system was designed with a hospital in mind, and maybe that's why I'm having problems?

[Schatzi RN CEN]

Dear ABOOKER, I feel your pain.

Our small hospital does not yet use electronic charting, but I believe some of our problems may still be the same. Whether it's electronic or paper charting, if the people for whom the information is meant to be helpful and informative (Doctors, Medical Providers) do not care what the (computer or paper) chart says, it does not benefit our residents or patients, no matter how diligent the nurses are in their charting.

I believe that our duty as nurses is to make sure that the issues

that are found using data collection and quality improvement processes are actually heard by the medical practitioners.

You state that the software your institution is using seems to be designed for a hospital. There may be a way to get together with the software company to customize the application to work better for a long term care environment.

I also work part time in a large hospital that uses computer charting, and it took me a while, but as I got more comfortable navigating the program, it became a great tool to make clinical decisions. So give the technology a chance, you might change your mind yet.

[justme1972]

I will give a "high five" to whoever came up with computerized Charting. The hopsitals around here have recently implemented them across all departments and the nurses love it.

What they like the most is two things:

1. Virtually every conceivable choice for an assessment is listed.

2. If it's not, a space where you can write an explanation.

Now...if we could just have computerized prescriptions and do away with the little pads forever....

[Mijourney]

I work with charting outside of the institution. Even though there are still kinks in the use of the EMR by individual providers, it is great progress from written notes. Now if individual providers bothered to hire people trained in the EMR and everything associated with it, our overall health care system would greatly improve.