Point of Care Technology Group F

[kputman]

How has Point of care technology changed the way we care patient in and out of the hospital?

[kstrohm]

I have found point of care technology to be a great asset to my nursing care. I think that it provides better patient care in regards to efficiency and better documentation. Since we rotate at different locations, we are able to see the different ways each unit implements this technology. During this semester alone, we have seen the implementation of arm band scanning for medications. This has been trying for some of the nurses on our unit to become acclimated to, but I found it to be a very safe and effective way to administer medication. We also rotate on a unit that has computer terminals in between every 2 rooms, allowing nurses to chart immediately after leaving the patient's room, but also allowing the nurse to visibly see patient and stay within in range in case of an emergency. There is also a unit with computers in each room to allow for direct bedside charting; however, there are some barriers to this type of technology. Location of the computer in each room can cause nurses to turn their backs on patients while charting and having to ask visitors to step out of the room due to privacy laws. The computers can be unreliable and slow and patients have complained about the light from the computer interrupting their sleep (Stowoski, 2013). I, personally have used my tablet at the bedside to answer patient questions regarding medications and disease processes. This allowed for me to give a quick answer without needing to come in and out of the patient's room.

The only experience I have had outside of the hospital with point of care technology has been personal. My doctors office uses laptops to directly chart in the patient's room. I understand the need for this, but me as the patient felt it took away from the care that was provided. So, I guess I would pose the question to Group F as to how we can implement point of care technology without sacrificing quality nursing care to our patients?

Stowoski, L. A. (2013). Electronic nursing documentation:charting in new territory. Medscape, Retrieved from http://www.medscape.com/viewarticle/810573_7

[jperedo1]

To expand on the first comment, point of care technology in nursing has both advantages and disadvantages. Advantages include obtaining information much quicker and having access to information from almost anywhere. For example, we can see new orders that physicians input into the system immediately, making care more efficient and safe. Also, we can access patient records from any computer within the hospital system, as we have seen throughout our rotations. Another benefit is one that has been mentioned in this discussion, which is our ability to access research and information that we can share with our patients immediately. Simpson (2012) argues that technology at the point of care is a major factor in pushing evidence-based practice in nursing, which is critical because we have all seen how often our profession changes best practices. A perfect example is our medication rights: our teachers have told us how it used to be four, then five, and now we are at six or seven, depending on what source you consult. Simpson (2012) strengthens his argument by discussing how point of care technology allows nurses to connect to the Internet and find numerous relevant studies and literature in order to access peer-reviewed evidence, leading nurses to current evidence-based practices. Therefore, there is no question that nursing has accomplished leaps and bounds because of point of care technology.

However, while I agree that it is efficient and promotes accuracy of documentation, I think that oftentimes it hinders patient care in ways that we may not have considered. For example, I have noticed in our clinical experiences that communication among the health care team is hindered by point of care technology. During morning report, I have noticed that nurses often say things like "you can just look at the [electronic] chart." It seems as if nurses are becoming too accustomed to the efficiency of technology and in a way it is making us lazy about communicating comprehensively. Another example that I have noticed is that electronic charting often leads us to copy the past charting. Not only can I see everything that the person charted before me, but it is also right next to what I am currently charting. I believe that this can tempt nurses to copy the previous person. For example, as a student I have noticed that I often doubt my nursing skills, and when I am charting I might think, "well, I thought I heard crackles at the lung bases, but the previous nurses have charted clear lung sounds...maybe I am wrong because after all I do not have much practice." In the past, I may have had to turn back pages of a chart in order to see previous nurses' notes and be influenced by their charting, but now I can see everything from the past two or three shifts right next to what I am currently inputing into the system. I think that this can be a dangerous disadvantage to point of care technology.

In conclusion, there are countless benefits to point of care technology, but I think we must be cognizant of the pitfalls as well.

Reference: Simpson, R. L. (2012). Technology enables value-based nursing care. Nursing Administration Quarterly. Retrieved from http://0-ovidsp.tx.ovid.com.opac.uthsc.edu

[kstrohm]

I agree that I too have second guessed my assessment based on the previous nurses charting. I also think that point of care technology can have many disadvantages. One that comes to mind is not using the seven right of medication administration. Bar code scanning is safe and efficient, but it too is a machine and as we all know, machines can malfunction. I do not think that point of care technology should make health care professionals jobs easier, but make information and care of the patient better.

[lbosi]

I agree with you Julia and Khristina, I have second guess what I am charting several times. I remember one in particular time, I was charting that this patients eyes were pinpoint in the left eye and the right eye was round. This previous charts stated that both eye were PERRL and that was not the case when I assessed the patient. So, I decided to talk to my clinical preceptor to make sure that this was the correct assessment and she agreed. I felt as though if I would have charted just based on the previous nurse that I would be hindering the patient’s true assessment. After looking at previous weeks from charting, the baseline was pinpoint in the left eye and round in the right eye. I have learned that chart what you see on the patient because it could save a life.

[lbosi]

The point of care has changed the way nurses and other medical professionals interact with patients. I believe that technology has helped the medical professionals by having the past medical history and current information on the patient. This is ensuring that all people interacting with the patient are receiving all the information about the patient. The patient safety should be the number priority in all medical professions. Technology is assisting with safety by having computers at beside or laptops the staff can carry around. Bolton (2008) states “Nurses believe it is essential to have smart, portable, point-of-care solutions for capturing and transmitting data, as well as routine communication.” I would have to agree with this because having computers at bedside or laptops portable allow nurses to ensure that medication each patient is receiving is safe and correct. If nurses did not have computers at beside or laptops they could roll around, they could get distracted and get the medications mixed up with someone else’s and give the wrong medication to the wrong patient.

Bolton, L. (2008). Smart technology, enduring solutions. Healthcare Information and Management Systems Society, 22(4), Retrieved from http://www.aannet.org/assets/docs/fall_jhim.pdf

[Amber Shanice]

The original point of care system seemed to be just a writing utensil and paper, if even that. Documenting and reporting to others the condition of a patient allowed for communication in the care of the patient. Like in all relationships, the more efficient the level of communication, the more efficient the relationship. So it is not surprising that when point of care technology advances so does patient outcomes. Mobile point of care devices allows documentation to happen at the bedside as care is being given. I would think this would eliminate a large percentage of documentation errors due to lapse in memory: "I got busy with my other patients and now can't remember what I needed to chart." The implementation of id scanners at the point of care is to help eliminate errors dealing with the Six Rights: The system will alert you if you have the wrong patient, medication, dosage, etc. With today's technology, in some systems, a provider doesn't even have to be at the hospital to access certain patient files and information. This allows providers to get much needed rest and relaxation at home while still being able to input information and study patients' health. Studies have shown that adequate rest improves a person's ability to function effectively. This makes for a safer environment for the patient and healthcare workers. And then there is the fact that advancements in technology not only allows us to document and share with involved parties, but it allows us to retain a health history on a patient. The allows for a long-standing medical record which is so crucial to accurate diagnosis and quality healthcare. With new technology comes new issues but I believe using advancing point of care systems in health care positively effects how we care for patients in and out of the hospital.

[Amber Shanice]

Reference for the above post :

[COLOR=#0066cc] Specialized Electronic Healthcare Information Systems. Informatics and nursing: opportunities and challenges (4th ed., pp. 350-351).

Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

[kstrohm]

This is a unique perspective that I did not think about. Rest is very important especially for those who provide direct care to patients. Data available to health care professionals outside of the hospital is a new and different idea that could potentially become a norm in years to come. There is however, the risk of violating HIPAA or having your network compromised by some kind of virus or hacker. Basically, there will always be pros and cons with new technology, but do the risks outweigh the benefits? That is the question that will need to be answered after each new implementation.

[Amber Shanice]

Khristina, that is a great question and I have shared in similar experiences as both a SN and a patient. In the physical I had before beginning nursing school my long-time doctor was charting simultaneously on a laptop while talking to me. I thought he was having a friendly conversation with me but I later realized he was assessing me. During the visit I often caught myself wondering, "What is he typing in there?" It is a very delicate balance we teeter between to monitor the patient instead of monitoring the monitor. Because not all patients are familiar with our point of care systems, I believe it is best that we be open and honest about what we are doing (again, communication!). "I am going to use this computer to document that you took your medicine today," as an example. This seems to allow patients to feel more comfortable and understand that our care is still patient-centered.

[jperedo1]

Shanice, I think you bring up some interesting points. I never considered how beneficial having access to these systems at home would be for physicians. I know that policies have changed regarding how many hours physicians, especially residents, are allowed to work in a week - to promote adequate rest - but I never considered home access to charts being a factor. I agree with Khristina about the dangers of technology with hackers and potential HIPAA violations, but I would also like to point out something that Shanice may not have considered: I wonder if home access to charts is almost like a loophole to the work hours cap that many hospitals have implemented. Physicians may be at home, but if they are studying charts and putting in orders, they are still working those hours and not using the time to rest and sleep.

[zoranpavic1]

Great post, and great research question.I do agree with you Julia that the technology, especially information technology is giving us so many advantages. The most prominent advantage is that everything about the patient treatment in the hospital and outpatient is available across databases. We can make available a chest X -ray from December 4 2010 to compare to the patient who has difficulty breathing and compare these two X-rays and this will help us determine the diagnosis. As for your research question I think it is to early for me to give you an idea maybe when I am in leadership course and when I am more familiar with entire process I can give you more thorough answer, as for today I can tell that this is possible.

Zoran Pavicevic