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New hosptial computer systems pull nurses away from patient care

Hi all,

Just want to know if any of you have been involved in a new computer roll out in your hospital where bedside paper charting is being eliminated and all done in the computer----eclypsis, cerner, etc. have systems

How was it handled. How many hours of computer instruction? The whole place going "live" or only selected units??? How many "super users" on all shifts. How long did it take to learn the system? What were your nurse/pt ratios? Did you feel you denied care to your patients while trying to learn this system???

You can learn the system in less than four hours. After using partial computer charting and going back to everything by hand, and in triplicate, I would kill for a computerized system. You will find that it won't be taking away from your time but actually giving you more time to get things done for your patients. The first few days may be a little scary, but you will find it so much better. I worked on a few units that had trial programs when the computer charting was first starting, and that was well over 12 years ago, and have never stopped loving it. The programs have actually improved immensely since then, and I love them. Especially when you can get a computerized system that uses a laptop built into a movable cart, then you can get your work done at anyplace around the unit.

gwenith, BSN, RN

Specializes in ICU.

I worked with the system in ICU and it might have just been that hospital but I resented nursing being reduced to a "tick and flick" response - mouth/eye care - 2nd hourly - tick appropriate boxes.

But could have just been them:(

DutchgirlRN, ASN, RN

Specializes in OB, M/S, HH, Medical Imaging RN. Has 33 years experience.

Once you go computer for charting and especially for meds you'll never want to go back. It actually allows me more patient time. The patient ratio and patient accuity are the factors that cut down on my patient time.

caroladybelle, BSN, RN

Specializes in Oncology/Haemetology/HIV.

Once you go computer for charting and especially for meds you'll never want to go back. It actually allows me more patient time.

I agree with this. Done right, computerized charting decreases the fight over who has the chart/info and allows things to get much quicker and more efficiently. If MDs use order entry, it decreases errors.

That said, it only works if there are enough working terminals, and all use it, including the MDs to input their own orders. However, too many facilities do not have enough terminals or let the MDs skate on (have a secretary put their orders in, look things up) not learning to use the system. And that defeats the system.

Having online immediate access is great....after it gets going and all the kinks get worked out.It will make patient care better, safer etc.Its just the getting the kinks worked out part.Superusers....we had about 2 per shift per unit.But there needs to be a quick reference card posted beside each computer so you will be able to emergently place orders or at least allow a way to override the system/bypass it when it is an emergency until the "bugs" are worked out.

So, I see most of you liked it once the kinks were worked out. What systems did you use?? What was pt/nurse ratios during computer rollout??

Did you go completely live or just piece by piece? What if your unit was unstable---not enough regular staff, hi acuity patients, too many travelers/agency??

Pros apparently come down the line but cons seem to be at the beginning if things are not organzied right???

So far it seems that 12 hours instruction are not enough at my facility, not enough super users, too hi acuity patients, massive OT, nurses not able to get out on time, etc. All at the Holiday season when people just want to go home. System too complicated. Have not even started MD order entry or pharmacy yet. Docs not trained, asking nurses to help them too often and they cannot get their own charting done.

We really like it now, but when we got our new system there wasn't nearly enough training. We did get a lighter patient load for the first two days of training, but after that they thought we should be able to handle it and bumped us back up. We all demanded more training time though, and ended up getting it.

DutchgirlRN, ASN, RN

Specializes in OB, M/S, HH, Medical Imaging RN. Has 33 years experience.

That said, it only works if there are enough working terminals, and all use it, including the MDs to input their own orders. However, too many facilities do not have enough terminals or let the MDs skate on (have a secretary put their orders in, look things up) not learning to use the system. And that defeats the system.

We have plenty of terminals + we each have our own portable while we're working. I consider us very lucky indeed.

SmilingBluEyes

Has 20 years experience.

it depends on the technology. Some systems actually make the job harder, like where I work. I would go back to all paper charting tomorrow, if I could. It's that bad, and yes, that slow. It's dos-based and needs to go away.

Hospitals that try to computerize "on the cheap" are doing a dis-service to patients and staff alike. Ancient software, minimal terminals and understaffed IT departments are a recipe for disaster. If a hospital is not ready to commit huge amounts of money and time to institute one of the proven systems, it should not bother at all.

The nurse/pt ratio did not change...but we did have safety features to bypass during computer downtime.It is great once it gets going.Past admit hx..at the click of a mouse.Lab values at the click of a mouse,surgical notes same too.H&P's....anything you want to know about that patient....is right there available in seconds.So...be patient, ask for reference sheets to be given to all the employees ...so that you can quickly get any orders in and processed that you need.Good luck!!!

i'm curious as to which hospitals have such computerized systems. Especially in the New York metropolitan area.......

Thanks,

Bryan

So far only 1 person has told me that their staff/nurse ratios were lowered but only for 2 days. Any others???? For how long???

What type of systems?? Anyone using Eclypsis???

Did your charge nurse have patients?? Did you HN have patients?? Where they the superusers??

mdfog10

Specializes in Med-Surg. Has 20 years experience.

:angryfire I agree with SmilingBlueEyes. Our system is horrible. We were given extra staff for two weeks (besides the time that the supervisor pulled our extra RNs -"I don't care you are new to the computers"). We went from charting by exception to charting by inclusion. Right there that doubles your time. Our patient acuities are high, not enough RNs or assistants, and now time with patients is diverted to the computer.I refuse to lower my pt care standards and thus find it hard to chart as I go. Two of our travelors have told us this is a time consuming program. I have never felt more disconnected from my patients. When busy, it is hard to get into the computer to see their previous vital signs or follow their current I and Os. Plus I feel that management can "audit" my charting so much easier. It is getting so hard to deliver the care that I am used to and that patients deserve. No wonder Nurses leave hospitals.

I LOVE our new system. I was counting down the days until it rolled out, and I was probably one of the few that had a HUGE smile on my face on GO LIVE day.

We went live in June and piloted the system on several units for a 6 week period first. My unit was a pilot unit. When we went live, we had at least 2 RN superusers on each unit, and we nearly doubled the number of nurses with patient loads on the unit in the first 3 days. By day 3, most of us were bored silly because we only had 2 patients and the computer issues were getting ironed out. The "roll-out period" was supposed to last for 2 weeks, but didn't need to be that long, IMHO. The number of superusers kept getting weaned down, until eventually there was only a handful of "roving" superusers that you could page to the unit if you had troubles.

Yes, there are kinks, but it's a whole lot better than pen and paper. I used to DREAD doing a discharge because of the horrific discharge summary that had to be written out longhand - always took me at least 15 minutes. Now, I have a number of "canned" summaries that I can copy/paste and only need to be tweaked with patient specifics - this takes me about 2 minutes max. That in itself is a HUGE improvement. Fortunately, TPTB are willing to make upgrades/updates intermittently to incorporate process improvements. In our recent JCAHO survey, when it was discovered that certain issues were not being addressed properly, it was easy to incorporate these changes into the new charting system which ensured that all nurses housewide were addressing these issues within days of the discovery. Another great PLUS to computer charting!

Admittedly, even now, 6 months later, there are certain nurses that still struggle with the system. Of course, they had limited computer literacy to begin with. Practice IS improving their skills and time management, however. We have made one major overhaul to the admission process, which has resolved a lot of the original gripes. Now, the charting portion of a direct admission takes about 15 minutes tops, and a transfer from ED can be accomplished in about 5 minutes, including documentation of assessment. LOVE IT!!!

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching. Has 40 years experience.

so, i see most of you liked it once the kinks were worked out. what systems did you use?? what was pt/nurse ratios during computer rollout??

did you go completely live or just piece by piece? what if your unit was unstable---not enough regular staff, hi acuity patients, too many travelers/agency??

pros apparently come down the line but cons seem to be at the beginning if things are not organzied right???

so far it seems that 12 hours instruction are not enough at my facility, not enough super users, too hi acuity patients, massive ot, nurses not able to get out on time, etc. all at the holiday season when people just want to go home. system too complicated. have not even started md order entry or pharmacy yet. docs not trained, asking nurses to help them too often and they cannot get their own charting done.

at my old hospital, we used eclipsys. when we "went live," we did so 2 or 3 units at a time, and there were plenty of extra staff around. we had two or three super-users, the informatics staff and every patient was staffed 1:1 (in cticu) for three days. all of the staff had had four hours of classroom orientation to the system prior to going live. there were a few bugs to be worked out, but in my opinion, it wasn't too awful. the patients were cared for and the charting got done. some of us had to work some ot to get our charting done the first few weeks, but all in all, it wasn't that bad.

we offered training to the docs, and impressed upon them that the nurses weren't there to help them with the computers. the biggest problem we had was docs not remembering their logins and passwords and wanting nurses to sign on to the system for them so that they could review their patient's chart. and then they sat at the bedside computers and surfed over all of their patients on several nursing units under that nurse's id. we were all warned not to do that, but some did any way, and if you wouldn't sign a doc on, they were less helpful to you. same if you signed them on, then asked them not to look at other patients under your id. and the other problem: terminals at the bedside for nurses to use, terminals in the hall for mds. the mds walk into the patient room and demand that the nurse get off her computer (they didn't pull that with my husband as much as with me!) so that they could use that one. i always replied "i'm using this one. there's one out in the hall you can use." it took a long time before docs stopped trying to kick nurse off whatever terminal they were using. in my new hospital, that's still a problem!

hope that helps,

ruby

tntrn, ASN, RN

Specializes in L & D; Postpartum. Has 34 years experience.

I agree with my "neighbor" SmilingBluEyes, and our other West Coast friend from California. Computer charting bites. What I hate the most about is this: many of our nurses do the admission from the prenatal. Not at the bedside, but at the nurses' station. How does this get the overall picture? I actually print off a blank copy of it, sit down and do a face-to-face interview, just like the old days, and then go to the nurses' station and input that information on the computer forms. I do not like the idea of paying attention to the computer screen and keyboard and not paying attention to any kind of non-verbal information or clues or red-flags that might occur when I do not eye-to -eye contact with my patient. Yes that takes me more time, but I feel like I do a much better admission interview that way.

Some nurses get to the screen about familial and genetic histories and will ask "Do have a history of genetic problems?" The patient says no, but if you actually read off the list, which I do, often the answer will be yes, because the patient and family may not know that Uncle Bill's whatever was a genetic problem. But when they hear the name of the problem, they recognize that.

lee1, thanks for starting this thread as the responses are helpful to me. We have not gone live yet so I can only tell you what is planned. We are upgrading from an old DOS-based system to Eclipsys.

Eight to 12 hours of instruction depending on unit - those who currently chart nurses' notes on paper (critical care) only have 8 hours as they will continue to use paper notes initially. The training system can be accessed from just about any computer in the hospital for practice and there are exercises and weekly drop-in clinics to get everyone up to speed before go-live.

The whole hospital is going live at the same time - Md order entry, Pharmacy, Lab - everything, and the old system will only be available for retrieval of data, so there will be no "back-up".

At least 2 super users per unit per shift have been recruited and trained. They will NOT have patient assignments or be in charge - they will be super-users ONLY - for 7 days.

We are in CA, so we already have nurse/pt ratios but we are planning to staff more generously for the first week (7 days) and floating will be avoided if at all possible. In our unit we are praying for low census/acuity.

I will have to thank our steering committee for having the sense to avoid go-live during the holidays - the original date (which we couldn't make) was specifically chosen to be well before the holidays and though it is disappointing to have to postpone it so long (and also causes a problem with meeting new rules that go into effect Jan. 1), the new date is well after the holidays.

What kind of prep did your facility make? What system are you using?

Nell

At 3 of the Florida hospitals where i've done medical surgical (1 south and 2 gulfcoast area) the computer saved us so much in charting time that we were given more patients. Of course, then there's more charting. As well, the more patients the better you better be at balancing your patient bedside demands. We are expected to chart within one hour (and preferably immediately) of when something is done/assessed as the computer logs our real time. Were computers at bedside, perhaps this would be more reasonable. Some of the nurses where I work actually admit to sacrificing bedside care in order to 'technically' look good. I do recognize the definate possible advantages to computer charting but feel that some employers are using it as a tool to better push the envelope.

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