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Cedars-Sinai Medical Center nurse Weena Gorospe, RN, works at the nurses station where there are monitors for several different computer systems. Staff nurses meet with the system’s programmers every month to suggest any customization changes.

High-tech documentation and monitoring systems help reduce errors and free nurses to devote more time to direct patient care.

Dominique Anderson, RN, BSN, has worked in intensive care long enough to know that when one thing goes wrong, everything goes wrong. At those times, it seems as if an ICU nurse must be in many places at once.

“If your patient isn’t doing well, the last thing you’re thinking of is charting,” says Anderson, who works in the 20-bed ICU at the Mayo Clinic Hospital in Phoenix. “You’re thinking, ‘What can I do to get my patient through this crisis?’”

In a different ICU, Anderson would have to follow patient stabilization by poring over printouts of vital signs, comparing them, marking dots, and writing notes to graphically display the crisis. But because Mayo has a modern, electronic information system called Picis, she can instead tell the computer which vital signs to compare and generate an assessment in minutes.

High-tech solutions like ICU information systems can give nurses more time to spend on patient care. According to a study conducted by David Wong, MD, PharmD, chief of anesthesiology at the VA Long Beach (Calif.) Healthcare System, such systems can save a nurse an average of more than an hour per 12-hour shift in documentation time, freeing up more time for direct patient care and assessments.

Furthermore, the nurses studied did not have to interrupt other tasks to document care as often as their paperwork-bound counterparts.

National mandates to reduce human error in hospitals, as well as a move toward remote medicine, both herald a shift toward automated documentation, says Carol Bickford, RN, PhD, of the department of nursing practice and policy at the American Nurses Association. In remote medicine, critical care physicians might be able to treat their patients virtually from afar.

“We’re trying to streamline the data collection process,” Bickford says. “People like that.”

ICU information systems are nothing new, nor are the studies about them, Wong explains. But 20 years ago, when such systems first started, nurses had fewer requirements for recording information.

“As medicine and nursing care have advanced, we’ve developed new drugs and new treatments, which are usually additive,” Wong states. “That usually means more documentation. Fortunately, computer technology has advanced with the times, too.”

For Wong’s study, an observer watched nurses use the GE Marquette Quantitative Sentinel system and noted their tasks in real time.

“We actually recorded down to the second when a nurse stopped doing one thing and started doing something else,” Wong says.

In the newest systems, like that used at the Mayo Clinic Hospital, the computer is a relational database, which allows an ordinary user to retrieve and compare data like breathing rate, heart rate, blood pressure, or any combination of such vital signs. Previous incarnations required network administrators for data manipulation.

System buy-in

But Wong cautions that the system’s advantages are not automatic.

“Buying it and installing it are not even the half of it,” he says. Nurses, administrators, and information technology specialists who customize the program must all be enthusiastic about the system. “The more you can customize the system to match the ICU culture, the better,” Wong says.

Michael Roberts, RN, who has a master’s degree in organization management and is a service line manager of Cedars-Sinai Medical Center surgical ICU in Los Angeles, says customizations to their 10-year-old system come from nurses themselves. The staff nurses meet with the system’s programmers every month to suggest any changes.

“I think that’s what makes it so successful,” he says.

Roberts outlined a list of changes suggested by nurses: creating a nonverbal pain scale for comatose patients that correlates with the verbal scale, access to quality improvement data, and a medication safety alert.

Some elements of the system, like the medication safety alert, can protect against human error. Information from intravenous pumps feeds directly into the computer, which measures the medication rate every two minutes for high-risk medications, Roberts explains. If the rate goes over hospital policy, an alert is sounded. “We don’t just rely on the pump alarm,” he says. “We have something measuring actual rates.” Roberts estimates the system doesn’t save time as much as it increases accuracy.