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Tilting the Odds

December 2, 2008
by aguerra
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CIOs looking to stack the deck in their favor must bring nursing to the table.

Last year, when a ruptured aortic aneurysm landed my father in a Las Vegas ICU with little chance for recovery, I learned more about the world of acute-care medicine than I ever wanted. Like many with modest hospital exposure, I always conceived of acute care as similar to ambulatory — physician based. But it was evident during my month in the desert that, in the hospital, nurses run the show.

During August 2007, I spent about eight to nine hours each day bedside, talking with nurses, alerting them when I thought something was wrong and, occasionally, getting three minutes a day with his physicians as they zipped in and out of the room. The nurses, working their 12-hour shifts, were the constant caregivers, always available to him, and me. And while physician orders came through maybe once a day, nursing documentation occurred around the clock. I can remember them well:

  • There was Stanley from Kenya, working the night shift. Stanley was one of the nicest people I have ever met. He constantly encouraged me to keep my chin up, telling me my father was going to get better, get off the ventilator. When my father was put back on it, I was the one who buoyed Stanley, as he seemed more frustrated than me. Stanley often made me laugh, spending extra time in the room when he didn't have to.
  • There was Sheri, a nurse who had received a religious vision in her dream to start up a children's book publishing house. Sheri had gone after the funding and was well on her way to renting a building for its operation. She showed me her company's Web site with pride and gave my father excellent care.
  • There was Rita from the Philippines. After Rita came to America, her mother was diagnosed with cancer. Rita worked extra shifts for over a year to pay for her mother's care. Rita had recently gone through a divorce and was then trying to raise her two children in Las Vegas, not exactly a town without temptation.
  • And there was Alice from Oklahoma. Alice had grown up on a farm, and showed me her formidable hands as proof of days spent in the field. Alice was warm and comforting, everything you'd look for in a caregiver.

What do I know about his doctors, you ask? What were their hopes and dreams? Where did they come from and where were they going? Well, I really don't know, as I never got to spend the kind of time with them that I did the nurses. Don't get me wrong, I know this is the way most hospitals work, with doctors doing rounds to direct care and nurses carrying out their orders. The fact that my father recovered — beating the 1 percent chance of survival he was given on admission — is a testament to the skill of his physicians.

What I am saying is that CPOE (computerized physician order entry) should not be the initial goal of your electronic strategy, as it leaves the largest part of documentation off the table. Perhaps the biggest piece of the puzzle in creating the electronic patient record is nursing documentation. In fact, going with a nursing documentation-first strategy will make your nurses that much stronger when it's time for CPOE. And though no one wants nurses to actually put orders in for the docs, rolling out nursing documentation first ensures they will be ready to teach.

Nurses are the key constituency to finding success with any IT rollout in the hospital. With this in mind, it's critical to appreciate just how important it is to involve nursing in any product selections, rollouts and follow-up evaluations. A nurse's voice is sometimes the sweetest sound a patient or family member can hear, and CIOs who seek it out dramatically increase their chances of success.

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Comments

Anthony, I am so impressed that after all this time you still remember their names. but I'm not surprised.

thanks. I even found the Web site for Sheri's publishing company, but thought it might be odd to add it to the edit memo. But what the heck, here it is: http://www.gloryboundbooksltd.com/

Anthony,

Nurses!

They are often amazing people. Your observations about nursing documentation are right on both for the reasons you shared, and several others beyond the scope of your post.

I'm glad your shared Sheri Hauser's story and the link to GloryBound Publishing.
Sheri: 

During my daughter's hospitalization at a prominent Children's hospital in Wilmington, DE last year, she too had an amazing nurse. (To Daphne's point on names, that's obviously a tribute to your journalistic brain and passions. For me, it was helpful that the hospital policy was that the nurses name and other team members' names were on a white board, in every patient's room, and up-to-date. As it should be.)

So with that said, our nurse, 16 months ago was Liz.  Although I don't come from the journalistic tradition, I do share your passion for important details, I have hundreds of digital photos from important days in my family's life.  That said, here's the white board:

As a privacy issue, I've blinded  our readers to my family's names; but the hospital is obviously serious about including the family as part of the care team.

One of the amazing things about Liz was continuity.  She was in my daughters room (or on the floor nearby) from afternoon on the day of surgery till midnight.  She was back for another shift at 7 am.  She and the hospital value continuity of care.  She had a half hour drive home and another half hour back six hours later.  I, on the other hand had a three minute drive to the Ronald McDonald house.  (My wife stayed in my daughter's room, of course.)

I might have gotten a chance to see the nursing documentation, including plan-of-care, in their EMR.   Let's all deny that I said that.  It was a tribute to the hospital's IT build team; it was comprehensive yet succinct.  The documentation process was very fast; the update that I witnessed was under a minute.  Per the trend noted by Daphne, "Kids We're Getting a New EMR", this system will be replaced by another Enterprise EMR in the near future.  Our industry is maturing. 

To one of your high level insights,  Nurses and their documentation is central to high quality, coordinated, safe care.  It should be prioritized accordingly.

Thanks for sharing Joe. Here is the original memo I wrote on my father's illness. IT Can't Turn YouDespite the growing importance of IT, providing the proper care is still about staffing.

aguerra

Anthony Guerra is Editor-in-Chief of Healthcare Informatics. His blog contains story lineups for...