Impact of computers on pt care and workflow

  1. Hello everyone,
    I'm a health informatics grad student looking at the impact of computers on nursing units. We are in the midst of implementing an electronic patient records that will be shared among a group of hospitals in Canada and are trying to identify the concerns/benefits of placing computers in different areas on nursing units.

    What is your experience having computers in a patient's room for charting?
    - how does this affect patient care and your interaction with the patient?
    - what measures/procedures have you instituted to make sure the use of computers doesn't violate infection control standards?

    If anyone works with Psych patients, how have you dealt with the possibility computer equipment can be used as a weapon or endanger patients whether it is in the room or placed in a hallway or a computer on wheels?

    Where are the best places to install computers or store computers on wheels (COWs) on your unit? How does this enhance/inhibit your workflow?

    Thank you in advance for your input- it is greatly appreciated. If interested, I also have another post in the Nursing Informatics board.

    Cheers!
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    13 Comments

  3. by   Bonny40
    See CTV.ca News Staff-a report from Dr Gary Noskin & Dr Alison McGreer. Bugs such as MRSA can live on the keyboard for 24-36hrs but people often don't think of cleaning them or are worried too in case of damage. You need a wipe clean cover over keyboards or a sealed unit keyboard that can be sterilised & also rolled up and put away in a drawer for example. See www.inpace.com
  4. by   barefootlady
    I am a better typist than I even expected to be. Keyboards are dirty. After using one and before touching a patient, hands should be washed. Think how many people had access to those stations in a 24 hour period! I can pull up lab results on patients, get email from the boss, send email to the boss, catch up on facility news, but the computer does not help when a patient has real pain and no orders, needs turned and there is no one to assist with this 300 lbs mass, needs a new IV site, and needs ambulated or a dressing change. Of course, I need to document all of this, sometimes the documenting gets in the way of the actual doing or vice versa. Just give me a pen and paper and I can give you a detailed nurses not in half of the time.
  5. by   RNinSoCal
    The hospital I work for switched to Cerner Millenium last year. We now have 8 computers in the nursing station, 3 in the med room and 6 laptops on rolling carts. The rolling carts are great for charting vitals and ADLs at the bedside or for filling out admission information forms. The CNAs are using the rolling carts more than any one else.
    The RNs do not use the rolling carts very often because they are impractical. You can not fit a paper chart on the cart to review orders or fit your "brain" paper on the cart to take notes. Our MAR is on the computer so the written orders are entered by the pharmacist and verified by the RN. We have to be able to have the paper chart, the computer, and our notes in front of us in order to review orders. It is also a HIPAA violation to have the paper chart or electric chart in areas where non staff members can look over your shoulder and read information.
    Another problem is that RNs are always on the phone. There are no phones in the hallway and it would be another HIPAA violation if there were. You can't read lab/radiology results off of the computer over the phone while standing in the hallway.
    My last problem with the carts is the amount of clutter in pt rooms. Trying to push one more thing into a room full of IV pumps, chairs, Feeding pumps, Continuous pulse oximeters, BiPAP machines, wheelchairs, walkers, etc is almost impossible. I personally don't like to take the cart into the room because the patient and family always talk about how "busy" I look when I do. I think they see me a doing a job instead of caring for them when the computer is in front of me.
    We have had psych and detox patients try to steal the lap tops. None have been successful yet.
    There are wipes for the keyboards that are effective against our lovely MRSA/C-diff/VRE etc. isolation bugs, but it is hard to get staff to use them after leaving each room.
    I forgot to mention that I do like computer charting. I don't miss the paper MAR or paper cardexes at all. I thought I should mention that fact since this post is beginning to sound like a rant. BUT...The computerized system only works if you have a computer for each RN and several for the physicians in the nurses station away from prying eyes.
  6. by   Dixielee
    I posted on the Nursing Infomatics forum about a disasterous system we have. Nurses and patients are leaving over this. One night last week we had 38 patients sign into triage and left either before triage or before treatment because this computer system has everything so backed up. I decided not to renew my contract because of the system and so did most of the travelers. At least 6 RN's have resigned in the past few months because of it. NOPE, not a good idea in my book. I know there must be good systems out there, but we sure had a lemon.
  7. by   nancynurse3182
    My hospital just implemented computer charting in our ICU about 3 weeks ago, and I can truthfully say that it has done nothing but bring down the morale in our unit... we are so intent on getting all of our "stuff" in before it either (a) goes down, (b) we have a code which would really make us behind in our charting, or (c) it's time to go home! I know the first week was mayhem, and our pts really suffered... now we're getting better at finding time for patient care and charting.God forbid we have a real emergency... I've seen more nurses cry in the last few weeks out of frustration, than in my entire 30 year career! We feel that true nursing care has gone right down the drain... will it get better? It wouldn't be so bad if we could have overtime, but our hospital really frowns on it ( it's non-profit).Any input would be welcome...sigh...
  8. by   music
    Quote from nancynurse3182
    My hospital just implemented computer charting in our ICU about 3 weeks ago, and I can truthfully say that it has done nothing but bring down the morale in our unit... we are so intent on getting all of our "stuff" in before it either (a) goes down, (b) we have a code which would really make us behind in our charting, or (c) it's time to go home! I know the first week was mayhem, and our pts really suffered... now we're getting better at finding time for patient care and charting.God forbid we have a real emergency... I've seen more nurses cry in the last few weeks out of frustration, than in my entire 30 year career! We feel that true nursing care has gone right down the drain... will it get better? It wouldn't be so bad if we could have overtime, but our hospital really frowns on it ( it's non-profit).Any input would be welcome...sigh...
    Nancynurse,

    We started using computer charting years ago and I felt the same as you when we first started. It was frustrating for all of us and so many new things to learn. Now, we all love it and have added many things to assist us in our charting over the years through group input. My typing is really fast now. I actually have more time for my patients and I've gotten good at putting in info as I go from patient to patient. It will get better.

    We have gotten so used to it now when we have down time for one reason or another, we all go crazy because we have to use PAPER again.........so you see, it's all in getting used to it. We have given a lot of input into what we need and we now have a lot of drop down items that we can click on to save typing time......for example under symptoms there are many listings. We just click on the right one. Under breath sounds there are several things to pick from such as clear, clear Rt., Clear Left, wheezes, rales, absent, etc, There are drop down lists for many subjects................This saves time and then you type a brief narrative to go with it..............Over time, we have added many pre-written drop downs to choose from rather than having to type them out each time. .....Maybe you already have that. Just examples of what works for us...........Of course, you always need to type out the narrative that clearly describes each individual patient but the many drop down lists that we have now helps to decrease time charting and gives prompts that help many new nurses to cover all the bases. Hope this helps.

    Change is always difficult at first but I think this one is good. It gives you a very readable picture of what goes on with your patient. It is the wave of the future so make the best of it and be patient with yourself at first. It took me awhile but I picked up my speed as I did it more. Before long you will find that you really like it and your time is better spent.

    We all love it now. Everyone contributes to it and it is all legible............!

    Hang in there. It really will get better.
  9. by   Gompers
    Quote from music
    Change is always difficult at first but I think this one is good. It gives you a very readable picture of what goes on with your patient. It is the wave of the future so make the best of it and be patient with yourself at first. It took me awhile but I picked up my speed as I did it more. Before long you will find that you really like it and your time is better spent.

    We all love it now. Everyone contributes to it and it is all legible............!

    Hang in there. It really will get better.

    Excellent post - you're right, change is difficult at first (especially for nurses!) but sometimes it is for the better. We've had our medications on the computer for years, which I love because it's so easy to look up dosage ranges and things like that. But now we have a new program and everything is on there - MAR, physician orders, lab and radiology results, nurse-written info like patient history and family phone numbers, etc. Next year we are going to ALL computer charting, including our flowsheets and physician progress notes. That's going to be great, because then everything will be legible and accessable from any hospital computer - no more trying to figure out the chicken scrawls the doctors call notes and no tug-of-war with the residents over the flowsheets. We have an open neonatal unit, and there are computers at every other bedside, probably about 30 computers in the whole unit and we usually work with about 18 nurses and 4 respiratory therapists per shift, so more than enough machines for everyone.
  10. by   Spidey's mom
    So far all we have is a computer pharmacy system - which we all hate and we've been using it for 2 years. It is a cumbersome and time consuming mess. We miss paper.

    Now they are talking about putting our MARS on computer :angryfire

    We don't chart on the patients (yet) by computer.

    We are a small and rural hospital - at the most I have 5 patients. I can write an assessment faster on paper than computer.

    We have one computer to write in our meds/times .. . and two nurses. The ward clerk also uses the computer to print out labels for new admits.

    When a doc wants to see a trend for pain control med use . .. it takes forever and a day to get that info on the computer. We used to have 5 days worth of med administration on one letter-sized paper and you could see the trend in an instant.

    Pharmtrak is a terrible terrible program.

    And we have had time to get used to it . . .. . it never gets faster.

    steph
  11. by   tntrn
    I hate computer charting. I can type faster than any computer our place can provide, so that's not even in the equation for me. Getting better at typing may be the end result for some, but not for me.

    I don't care for it for a number of reasons, some of which have been mentioned here: some nurses pay far more attention (by necessity of preference) when doing a history to the computer than to the patient. I will print off a copy of the admission forms, sit down and have a face to face interview with me patient (like the good old days) and then go later to a computer and input the answers. Makes me feel like I've given my patient the impression I'm interested in her and not the machine.

    There's the ergonomics of it. Our Watchchild computers in patient rooms are all set at one height, no adjustments are possible. Now if all nurses came in one height that was perfect for the computer table that would be good, but that's not how it is. As a result, the tall nurses are stooping sometimes to see or work, and the rest of us are constantly craining our necks to use them.

    They can be very slow. And I mean slow. Just getting our program or mainframe or whatever to recognize my log in and password takes enough time at times that I could have had a set of vitals and assessment hand-charted before the computer has blessed me.

    Infection! Well, as far as I know we haven't even addressed that one where I work. And of course, we should. Just one more thing for nurses to do. Add more housekeeping duties to our nursing care. And then what's to keep the grimy fingers of visitors off the keyboards when we're not there?

    Privacy: I do not like to chart any kind of progress notes while in the room because visitors or family members who do not need that information can be standing nearby and see it all. It doesn't stay on the screen but there is nothing to prevent them from seeing it as it's being typed in.

    Charting in general: When I chart, I like to have the chart, all of it, in front of me. It makes it so easy to just take the med sheet, the progress notes, the orders, flow sheet and whatever else you are going to need, OUT of the hardback and go to work. No flipping from section to section for it. On the computer, this is totally not possible. I do not, even at home, like to use a number of windows scattered all over my computer screen. I want one screen, one topic, one task.

    I think it gets in the way of good patient care. At least the kind we were taught 30 years ago, when hands-on meant hands-on the patient, not a bunch of machines.

    I can see something things being on computer as better: doctor's orders and med sheets for example, but I do not, EVER, want to be completely paperless. I will still print out a copy of anything I think I need instant access to ( and that means without a computer, without a password) in order to clarily something.

    Hadn't considered the use of a computer as a weapon, but sadly, I guess we must consider even things such as this. We have none on rolling carts, and we don't have one for each nurse (which can be another problem). I'm glad I'm an old-time and short-timer too, because although technology can be great (we have the latest and greatest in our home) there are sometimes when it is cold and incompassionate. Perfect avenue for administrations to think it's saving you time which guess what? means they give you more to do.
  12. by   jetsetter
    we do all computer charting, and I have to say I truly love it, BUT. they just announced they're going to take away all the computers in the nurse's station, they have installed computers in every room, and they expect us to ALL of the charting at the bedside. Administration has gone totally insane. We are a tele unit, how on earth are we supposed to watch the monitor from inside a room. Oops, I forgot , we are all telepathic and just "know" what's going on somewhere else.
    I think the idea of computers in the rooms is good, really. It would be very handy for post op pt's, when you stuck in the room for an hour anyway. It would be good for I&O's, scanning meds at the bedside, lots of things. But I spend all day on the computer, getting lab and test results, admissions, discharges, Kardex,problem lists, ordering tests and labs. all interdept memo is by email. How unprofessional am I going to look to pt family as I stand in the room 'checking my email' Heaven forbid some joke pops up. It's completely impractible. So far we fussed and groaned and comlained to the "proper" people but it has done no good.

    I'm turning gray by the minute just thinking about it.
  13. by   webbiedebbie
    I absolutely hate computer charting! Every facility I have worked in has a different system. Working on a unit with 2 nurses and no unit secretary or CNA can mean many interruptions. I spend more time going back to see what what last charted in the computer than if I had the hard chart right in front of me.

    We don't have computers in patient's room and it is sometimes difficult to maneuver the rolling cart into the patient's room filled with an IV pole, cots for dad's to sleep on, chairs for the many visitors, wastepaper baskets, tables, infant cribs at bedside....

    Plus, I hate the fact that when things are really hectic, I may not get a chance to chart until a couple of hours later, and the computer records "knows" when I made my entry!

    I love my home personal computer. It opens up the world to me. But in my workplace, I wish they would have thought things out.
  14. by   elthia
    I could not survive without computer charting and bar code med administration. the chart, labs, MAR, everything is linked together.You can go back as far as you need to in the patient's record. If the patient has a violent hx it's flagged first thing when you open the record.
    When the computers are down, I'm lost.

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