• Abstract and Figures
• Public Full-text

FOCUS QUALITY OUTCOMES AND PATIENT SAFETY Vital Time Savings Evaluating the Use of an Automated Vital Signs Documentation System on a Medical/Surgical Unit By Meg Meccariello; Dave Perkins; Loretta G. Quigley, RN, MS; Angie Rock, MBA, CCRP; and Jiejing Qiu, MS t Anywhere Hospital it is 7:30 a.m. and the KEYWords day shift is just beginning. Sue, a nurse’s Vital signs, vital sign, automated download, safety, nursing A aide, begins to collect patients’ vital sign documentation, documentation errors, time studies, work assessments. She starts with room 5106 and moves flow studies, computer transfer, computer charting. through her assignment. She gathers the results Abstract and writes them on her assignment sheet to be doc- Vital signs documentation was the focus of this study, umented in the electronic medical record (EMR) because multiplication errors, transcription errors, illegible after she completes each of her five patients. Mr. results, late data entry, misidentification of the patient, Couldbeu is in room 5108 by the window. Sue notes undocumented readings and missed readings can lead to faulty data, as well as unnecessary and potentially dangerous that some of Mr. Couldbeu’s readings are above his interventions or withholding of treatments. Technology is now baseline, however the patient looks fine. She will available to medical/surgical units that automate the vital mention it to the charge nurse when she sees her. signs documentation process. Sue moves on to her next patient, but she is inter- This study compared the accuracy and time efficiency of manual-entry vital signs documentation with workflows rupted by Joan, a nurse taking care of patients on that use a data management system to automatically the other side of the unit. Sue is asked to help move transfer vital signs assessments from a bedside vital signs a patient on the other side of the unit to a chair. device into the electronic medical record. The study found At 7:39 a.m. Mr. Couldbeu pushes his call button. that the automated vital signs documentation system was more accurate than manual documentation and errors were He has chest pain. The RN who answers his call reduced by 75 percent. The wireless automated vital signs takes his vital signs, administers his medication documentation system saved time compared to manual and checks the EMR to compare his current status documentation: and combined vital-signs acquisition/ to his morning assessments. They have not been documentation times were reduced on average by 96 seconds per reading. charted and she cannot find Sue. Vital signs (blood pressure, pulse, respiration, oxygen satura- tion and temperature) are indicators of body system health. They provide information on how patients are adapting to the changes brought on by illness and disease.1 Treatment decisions are rou- tinely made subsequent to the assessment of vital signs, one of the hallmarks of nursing care. 46 JHIM n FALL 2010 n VOLUME 24 / NUMBER 4 www.himss.org 2510_JHIM_Fall_COLOR.indd 46 9/23/10 12:38:32 PM QUALITY OUTCOMES AND PATIENT SAFETY In addition, “Vital signs are a tool used to communicate study of an emergency department, found that inadequate docu- patient deterioration to healthcare providers”.2 (p478) Endacott, mentation was one of the main reasons clinicians failed to respond Kidd, Chaboyer, and Edington found that both nurses and doc- to patients with abnormal vital signs.6 McGain et al., when look- tors relied on vital signs when identifying patient deterioration.3 ing at vital signs documentation during the first seven days after Assuring accurate and timely vital signs documentation may lead surgery, found significant levels of incomplete documentation.7 to improved patient care. Multiplication errors, transcription errors, illegible results, late data Vital signs documentation accuracy and clinician time efficien- entry, misidentification of the patient, undocumented readings and cy were the focus of this study because technology is now available missed readings can lead to faulty data, as well as unnecessary and to medical/surgical units that automates vital signs documenta- potentially dangerous interventions or withholding of treatments. tion, transferring results from the automated bedside vital sign Chen et al., evaluating the Merit Study investigators, found in machine to the electronic medical record. Experience has shown that many hospitals REVIEW OF LITERATURE undertake the move to new technology without fully Hospitals have applied medical technol- ogy to reduce errors, but until recently have understanding the impact on workload, patient focused on the most critical care areas. Expe- rience has shown that many hospitals under- safety and data accuracy. take the move to new technology without fully understanding the their randomized multi-site study “even in the hospitals that knew impact on workload, patient safety and data accuracy. Healthcare they were a part of clinical trials monitoring, documentation, providers are often told that a new piece of equipment will be safer responses to changes in vital signs were not adequate.”8 (p2096) for patients and a time saver for staff, only to find out that the sys- The authors further evaluated the Merit Study data and found tem has a steep learning curve or takes more time than the “old that 77 percent of the patients’ studied were missing one vital sign way.” This often results in frustration for frontline staff and a waste measurement prior to an adverse clinical event. The use of tech- of scarce resources. nology may help decrease these errors. In an era of spiraling costs, competition and the advent of evi- Technology has been applied to prevent errors in other areas dence-based practice, healthcare practitioners expect research of nursing care. Bar-coding is now being used to decrease the studies to aid them in their clinical practice decisions. Evans, Hodg- human error factor at the point of care, preventing misidentifi- kinson, and Berry4 found little evidence of study in the area of use cation of patients. Foote and Coleman found that, when used for of advanced technology in vital signs measurement and noted that medication administration, bar code technology reduced errors these technologies have the potential to change current practice. by 80 percent.9 Adding the use of bar code technology to vital Lockwood, Conroy-Hiller and Page5 (p208) also noted the need to signs documentation could assure correct patient identification, research “the role of new technology in patient monitoring.” making certain results are charted in the correct electronic medi- cal record. ACCURACY IN DOCUMENTATION The advent of the electronic medical record system has helped While the vital signs acquisitions and documentation process is the accuracy of patient documentation. Gearing et al., evaluated taught in the early weeks of most nursing programs, the documen- the use of the electronic record in vital signs documentation.10 tation of vital signs can be fraught with problems. Patient identi- They found that out of 613 sets of vital signs taken on a medical/ fication is completed by asking the patient his or her name, and surgical unit and manually documented using paper records, 25.6 comparing one of two long series of numbers (potential patient mis- percent of the medical records had at least one error related to identification). Results are gathered in 15- or 30-second timeframes transcription or result omission. As for a cardiac step-down unit and are documented as per-minute results (potential multiplication that utilized an electronic medical record system, 14.9 percent of error). Clinicians memorize vital sign results (potential for forget- the 623 records had one or more errors related to transcription ting result or remembering incorrectly), then, after the measure- or result omission. Smith et al. completed a post implementa- ments are complete, write them down on scrap paper or paper tion study to using the Gearing results to determine the accuracy towel (potential illegible result), later transferring them to paper of an automated system that sends the vital sign measurements forms or manually entering them into the electronic medical record from the vital sign monitor to a PDA and then uploads them in the (potential transcription errors and transposition of results). medical record.11 They found that the error rate decreased to less When documenting a full set of vital signs (blood pressure than 1 percent. (systolic/diastolic), pulse, respiration, oxygen saturation and tem- perature), there are six potential areas or errors. Further, what CLINICIAN TIME is often double documentation, first documenting on paper then Clinician time is one of the most valued and costly resources in in the electronic medical record, creates even more chances for healthcare. “Because vital sign measurement in hospitalized patients human error. is a frequently performed procedure, investigating the potential The most precise vital signs assessment may not lead to an of cost containment in this practice is clearly warranted.”12 (p244) A accurate response if it is not documented correctly and in a timely recent time and motion study showed that nurses spent 35.3 percent manner. Cioffi, Salter, Wilkes, Vonu-Boriceanu and Scott, in their of their working time completing all types of documentation.13 www.himss.org VOLUME 24 / NUMBER 4 n FALL 2010 n JHIM 47 2510_JHIM_Fall_COLOR.indd 47 9/23/10 12:38:33 PM Storfjell, Omoike, and Ohlson looked at the costs of nurses com- 2008. The time and motion study was completed during two time pleting patient care activities in 14 medical/surgical units in three periods—7 a.m. to 8:30 a.m., and 10 a.m. to 12 p.m.—four days a hospitals.14 They identified activities that did not benefit patient week for four weeks. The hospital’s institutional review board care and their associated costs. They found clinical record man- approved the study prior to enrolling any subjects.

Load more

  6

Copy Link