UCSF nurses test medical tablet PCs

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Great more lies

Patient safety is achieved by humans, not machines. Some reason why a new tech tool is not the answer.

I have found over the last 10 years that ALL the equipment/ software sales staff care is sales, not helping the nurse. Of course, the sales staff realize that the person who is going to be spending the millions, 1-3 million, does not have any idea about nursing care of the patient. The sales team knows this and that the chief executive thinks they know how to spend money wisely and do not need the input of the end users.

First rule in looking at any equipment purchase is get a very strong performance contract. The equipment performs or the sales staff gives you the money back. Nothing like spending a million dollars to add equipment to nurses and discovering that when all 1,000 RN are using those expensive PC, your sever system can not handle the load. Now you have to spend 2 million adding severs, upgrading the network from 10 MB to 1 GB, and spending months discovering which equipment blocks other equipment from working on the wireless network. Quess what: the sale staff promised and was able to show in the limited test program these problems would not happen and the hospital current network was up to the challenge.

2. The sales price requires the hardware / software vendors to be chained together for at least 30 days. Fine any vendors who claims the problem is the other company's fault.

3. I have spent days, yes days, tracking down why the system isn't reporting data correctly. My job is keeping the patient alive and improving to resume their life. It is never the nurse's job to troubleshoot system problems - Require the vendor to get their ass off the desk and do the troubleshooting. For example: my patient is in V-Tach and I have the CODE team at the bedside trying to keep the patient alive and IT IS NOT MY PROBLEM to fix the computer link that sends the ECG to the patient's MD, it is not my problem that the interface of any piece of equipment is not working.

3. It is one of the biggest lies that the new piece of medical equipment is going to "communicate" with any other piece of vital equipment on the hospital network. One hospital in Atlanta decided to modernize the Health Information System (HIS) and to reduce problems, this hospital went with one vendor for everything. For six months this hospital had to send bills out by hand because the chosen vendor had got their total HIS package together by buying other companys and spent the money buying small companies and not insuring their package actually did the job. The lab system was actually two seperate software packages, one for the lab testing and one for the blood bank. The lab techs had to signout of one system to get the other system to work. The X-RAY digital system could not communicate to this vendor's main software. So back to the past of printing the digital X-RAY for a wet read. The financial package was the true failure, it kept sending data to a black hole.

4. If the sales staff is selling the line that their item "will improve patient safety". RUN, Run far away. Another hospital in Atlatna has "Patient Safty First and Always" as a motto and is on track to spend 10 to 20 million to buy computer systems to elimate human error. SO the computer will not release an ordered drug to the bedside RN until the computer has 3 humans check the order for errors. It used to take me less than 5 minutes to get a pain med for a patient. It now takes up to 3 hours before the computer releases the drug if it is a new order. One person types the order into the computer entry system which crosses an interface to the pharmacy computer system which automatically checks the order against the patient's datebase for drug allergies and drug interactions of interest and the first Pharmacist rechecks the computer. The order then crosses another interface to the dispensing robot which "picks" the drug from storage and prints a label. A Tech then checks the drug and label and puts both together. A 2nd Pharanist checks the drug against the label and places the drug into the delivery system. How can a dispensing error occur: [a] Nothing insures the right drug is entered; the drug database can have errors because a human typed in all that massive amount of data or the database gets currupted by power surge or other system failure; [c] the wrong drug is in the wrong storage bin because a human loaded it incorrectly; and [d] the drug is sent to the wrong patient.
The RN at the bedside has to scan their ID barcode, the drug's barcode, and then the patient's wrist band ID barcode. The main error is scanning the drug barcode. A lot of drug barcodes can not be scaned directly from the manufacor's label by the scanner, so a human gave the pharmacy robot the task of placing the drug in plastic bag that has the barcode printed on the bag. Yes, I still find errors from the human telling the robot it is loading the a drug that is not the correct drug. So the final safety check as always is the bedside nurse matching the dispensed drug againts the manufactors label. My point is inspite of spending a cool million plus on the computer controlling drug dispensing, the human safety checks remain the same All that money just added complexity and longer dispensing times.

5. Oh, do not get me started about the problems with the wireless system not working.

7. Last year, the hospital went to computor base charting. After several meetings, the hospital is having to spend extra overtime money because of system slowd owns and crashes. Even the VP of nursing and the Nursing Infomatics staff have all denied wanting this system which insures patient safety. The vendor, a very big national vendor, repeatly told the HIS staff how smart the hospital IS was as while they strugged for 3 weeks to get a "proven" product to even run. Attention: if the vendors tells you how smart you are because you got the vendor's product to run, the vendor is blowing smoke up yours.

7. Battery life is a critical reason most hospitals uses PDAs at the bedside.

8. Did you know the machine can not tell if the vitial signs are accurate? A moving patient effects the ECG monitor, the SpO2, oxgen saturation, monitor and the BP monitor A human is required to make sure the recording of vital signs is accurate. The more a machine comes between the Nurse and the patient, the more likely harm will come to the patient. Come to the meetings about requiring a human to aprrove the machine taken vital signs and join the fight about if the computer system should record only the human approved numbers or every recorded data with annotation about which data was human approved. A see a lawyer asking me on the stand about those not human approved numbers and why I did not take immediate actiom. Hint: the ICU monitor checks the patient's BP 2 times a second and raising the arm with the A-line (measures BP) above the patient's head will have the monitor display a much lower BP which does not truely reflect the patient's true BP.

9 Paper charting is acctually very graphic and I have found most software replacement a very text intense system. I can write down vital signs numbers as fast as i can speak those numbers. If I open the nursing chart out I have 4 pages of vitial signs, IV fluids charting that allows me to tell at a glance fluids and rate of infusions, a sheet for respiratory status to include vents change / blood gases, and a sheet for lab reults and space for a comment. . On paper I could write A&O X 4 to mean patient is alert and oriented to time, place, self, and events. The current crap charting software from a major national vendor requires logging in, mouse clicking to load nurse charting section, and forces me to mouse click until the wrists scream in pain as I click on the Neurological section, click on Patient LOC is alert, click to next box and slected Oriented to time, place, and self. There is no block for orientated to events (reflects on short term memory) which most ICU patients have a problem with (I know I'm in a hospital, but I do not know why) On paper I can be more exact about the degree of orientation. A patient able to fully state Year, month and date/day is doing better than a patient who can only tell the year and maybe the season. The national major vendor decided not to allow a comment block for adding remarks that better describe the patient Trying to document all the little details that truely communicate the changes in the patient who has had stroke is immpossible on the computer system. The major national vender claims the computer charting actually improves charting. The nurses are so unhappy with the computer charting system that meetings have been held with senior management about returning to paper base critical care charting just like the respitory department has already had to do because of this piece of crap. The vendor's repsonse
has been seending another sales tema to pitch a new software add-on which resulted in all the bedside critical care RNs telling our senior management and the sales team that they are not listening - the problem is the vendor's crap for software. The next meeting was held in a demo room in the hospital to better reflect the software in action. Again this major national vendor sent a sales team and no techs.

Repeat after me: Humans help other humans. The machine is just a tool to aid the process, the machine is not the cure no matter how sexy the technology

Posted by: mbenwade@...   Posted on: 02/20/07 You are currently: a Guest | Members login | Terms of Use

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