eICU...is it for you?

OrthoNutter · Apr 19, 2003

How does that work??

I'm starting to feel very technologically deprived here in Australia. We don't even have Pyxis! lol

OzNurse69 · Apr 19, 2003

We are in the process of the whole hospital going electronic - currently in CCU & A&E....

All the monitors are connected to the laptops wirelessly (is that a word??!!) so NO MORE WRITING DOWN OBS!! Yaaaaay!! Also the pharmacy is linked, so when a Dr orders a new drug, you don't have to order it, it just comes up automatically, as do repeats etc.

There have been a few teething problems, mainly related to operator error - can be a drama if agency staff are working, but now they just pool staff from other areas & use the agency on the wards & ICU - not sure what they will do when the whole hospital goes electronic.

Jaded, just curious as to what the issues with Pt privacy are? We log on using our own passwords when we are at the screen, then log off whenever we leave - takes a few seconds each time to re-enter the password, so it's not a major drama....

mattsmom81 · Apr 19, 2003

We are going back to computerized charting and will implement the Meditech barcode scan for meds soon as well.

One thing I dislike is the typing of critical vital signs q 15 minutes...our monitors are old and even if we hook it direct, the values will need to be constantly edited. It is very time consuming. Plus our director wants a head to toe q 2 h which is extensive in the computer... makes for lots of computer time for us ...we can't document by exception/ 'stable.'

Our docs are livid as they are on record as hating this system in ICU...they prefer the old paper flowsheet (as we do) and the nurses available to them and not 'with their noses in the computer' in their words.

But time marches on and TPTB want electronic records throughout....

jadednurse · Apr 20, 2003

The eICU is very different from computerized charting. I'm sure I'll do a horrible job explaining it, but...we've basically been calling it the "eye in the sky."

I think Advocate Healthcare is the first to be implementig it here in the midwest(?). There are 2 camera's installed in each patient's room. One is directed at the patient and the other at the monitor (I think). Mind you I don't work there anymore, so forgive me if this is a crude explanation. There is a centralized office (in Oakbrook I believe) that will be manned 24/7 w/ physicians/nurses etc. They will have the capability to have realtime access to all patient data (everything is already computer based documentation there) as well as a video stream so that they can observe the patient whenever necessary. Some important points that were brought up when this was presented to the ICU staff:

1. There will be an audible notification (some sort of chime or bell mechanism) when the eICU staff is observing via their cameras. This presumably is to address the issue of privacy.

2. Not every patient has to be subjected to, oops, I mean managed by the eICU team. Allegedly if the patient or attending does not want the patient to be covered by the eICU they have that option.

The objective here is to provide the best possible care for the patient (my thoughts on this in another thread...) allowing the healthcare team to monitor your loved one theoretically every minute as needed...essentially providing the best possible care.

My thoughts: sounds fantastic in theory, but some things to consider...

This is being marketed as yet another "cost-effective" way to provide quality healthcare and is not intended to replace hands-on care by the bedside nurse but rather "enhance" it. Enhance? How about replace? Right now nurses on this Level I trauma unit care for 1 or 2 patients depending on acuity and the unit is staffed accordingly. Are the nurses going to become so adept at efficiently providing care that management will say "hey, you're handling it so well, there's no reason you can't handle just one more patient!" So instead of 10 nurses taking care of 14 SICU/trauma patients we're so efficient it only takes 7 nurses now!

Or, as if there aren't already enough chefs in the kitchen, let's add another team of experts to consult on this patient with a complicated diagnosis/injury. Those of you who work trauma/SICU know what I'm talking about here. An attending "team" , the surgical "team", the ortho "team", the cardiologist, the cardiac surgeon, the pulmonologist, the intensivist, the residents, social services, environmental services, the butcher, the baker, the candelstickmaker!!! There's already enough politics involved for the night shift nurse faced with the daunting task of whom to call when her/his patient "goes bad" at 3 a.m.

And I can't imagine any patient wanting to be on a live video feed when there are 2 or 3 nurses and techs cleaning them up after they've had an explosive BM! Would that video come with sound bytes like "whoa, that's gonna leave a mark!"

I guess what frustrates me most, is that it seems like, from a lowly bedside nurse's perspective, they were asking for our input after the fact. For crying out loud, it's like going to a restaurant and the only thing on the menu is chicken and then having the waiter politely ask what you'll be having that evening:confused: !

P_RN, ADN, RN · Apr 20, 2003

Big Brother watching you?

liberalrn · Apr 20, 2003

P_RN--my thoughts exactly! I work in the Advocate system and this is being touted. Can't find a way to get a job interview though. Also, not sure I want a camera watching my every move w/ pt. Can you imagine the evaluations?" See, Nurse Nelly, on 2/11/03 you were suppoosed to be turning Mrs. X, as you can see from this tape, you actually were watching Oprah for 3 minutes prior to turning her. this in unprofessional--you're fired."

PLease don't hijack the thread to whether TV watching is unprof. or not--not my point! I dislike being watched and no, I have nothing to hide, just don't like being watched while I work. I know the RN's performance will be judged--how could it not? Dislike it for the pt, too. We already rob them of dignity (even the best of us...the gowns are humiliating enough) and now any privacy....not sure about the chime thingy--who turns that on and off? Not hands on nurse, I bet!

jadednurse · Apr 21, 2003

Originally posted by liberalrn
I work in the Advocate system...

Sorry to hear that, liberalrn:chuckle Oops, there's my jaded side showing through again...

debi87021 · Apr 21, 2003

Ok, let me get this straight, a doc and nurse constantly "watch" a pt, or just "check-in" every so often. Well,....who is doing the actual nursing care. I can however where this could be handy in a observation unit for seizure patients, but not in icu. I mean, what are "they" going to do, call you to tell you that your patient coded, hell you knew that 2 minutes before they called!...anyway i may have misunderstood the whole concept.

Geeze...my facility has never even heard of electronic charting, much less talk about it.:chuckle

jadednurse · Apr 22, 2003

The bedside nurse still provides all the hands-on care, she just has yet another doctor to deal with! The concept is geared toward getting more immediate attention for a patient who is going down the tubes. So, instead of paging a resident or physician, who may or may not know the patient very well, and having delays in responses, you'd have this "nifty" system at your disposal.

I could see it being useful at a facility where there isn't 24 hour in-house coverage, say a remote rural institution or something, but in a large Level I trauma center and teaching hsopital. I'd be curious to know what the residents think of this. On the one hand it could be a great resource for them (god knows they already work a trillion hours...and there are those that are about as useful as teats on a bull!) but I'm not sold.

RyanRN · Apr 22, 2003

So technically we become a cross between a NA and a Tech with continuous monitoring, distant assessments and second guessing. What about our experince, will it count? I mean if you have some off campus people just sitting there ready to act on any minute change in status without first hand input won't it lead to overkill?

For example, if I have a guy with uncontrolled hypertension, assess that, use my judgment and PRN treatment(IF I feel it necessary, only I know if he's upset, anxious, excited, in pain etc.) I'm gonna keep a close eye, not jump in too fast, wait for a nice mean and a 'feel'. Are these guys gonna be calling me every 5 minutes or let me make the judgment call?

I hate to poo poo everything new, but I don't have a handle on whether this will turn out like they think. You do though. Keep us posted.

ceecel.dee, MSN, RN · Apr 22, 2003

Sounds like a "reality" TV show.

In our hospital, there already is continuous monitoring of the patients in ICU...by the best people we have...they are called nurses.