Speed of Right
In the fast-paced world of nursing informatics, RN uses technology to help reduce medical errors, improve efficiency and enhance care

By Scott Mace
February 28, 2003

As a nurse, Robin Raiford has seen the health care challenge from the trenches. “I would do an eight-hour shift and finally had time to chart,” she said. “It’s incredibly common.”

In a world where computerized decision-support systems are supposed to help health care providers provide safer, faster care, an eight-hour lag in charting can mean that decisions are based on out-of-date information. The world of nursing yearns for a data-entry revolution.

Raiford may just help spark that revolution. As the health care business productivity enterprise adviser for Microsoft Corp., Raiford is conducting research and meeting customers whose information technology budgets can bring about faster, safer and more economical health care, and improve nursing productivity.

“The amazing benefit of grabbing knowledge—not just data—happens when you can start to query, sort, filter, analyze and reuse information,” Raiford said. “People generate data. If they can reuse it, it can become information. If that information can be applied to a trend, they can have knowledge. If they can bring that to the bedside, they bring wisdom to the point of care.”

A fresh angle

Raiford’s nursing career took a dramatic turn after she became head nurse at the Smithsonian Institution in Washington, D.C.

“I literally fell into informatics when I broke my leg in 1989,” Raiford said. “I just crushed my ankle and went into being a phone advice nurse at Kaiser Permanente.”

She missed the environment of ICU nursing a couple of years later and began doing home life-support nursing. It was then that she noticed that homebound patients on life-support equipment could have their health care home assistance benefit dropped after 30 days—leaving the family to care for the person on the ventilator 24 hours a day. This was before actor Christopher Reeve injured his spinal cord and the public became aware that people lived on ventilators for years in the home.

When President Clinton set out to reform health care, he asked the public to write the White House with reform issues. Out of a million responses, Raiford’s home life-support concerns rose to the top and she became one of 25 people selected to meet the president. “It was unforgettable to see the president of the United States have his eyes filled with tears as the horror stories were told about health care in the United States,” she said.

She became so fascinated about how her letter did not get lost that she went on to volunteer at the White House to help read letters from citizens and code them according to subject so they could be manually entered into a White House database. Every letter to the White House is entered into a database that can be queried by ZIP code by members of Congress so representatives know exactly what their constituency is writing the president about.

“At the time,” Raiford said, “I did not know about databases and was not about to touch a computer that belonged to the president of the United States.” She took Microsoft Office training during a 10-week course from ExecuTrain. “It absolutely changed my life, to know what a database could do,” she said.

From there, she moved on to become one of many consultants supporting the Department of Defense worldwide computerized patient record project. She also performed market survey analysis for an ambulatory care solution, looking to improve patient safety, clinical and financial outcomes, including enhancing return on investment, but always focused on improving the quality of life for patients and their families.

Technophobia

With the average age of U.S. nurses being 47, “there is a huge fear of change,” Raiford said. “There’s a huge tug-of-war going on. Vendors are challenged to build something that’s not fearful. We cannot afford to lose another senior seasoned nurse [from the profession] due to fear of automation.”

“So much of health care is still paper,” Raiford said. “If agencies such as hospitals don’t have a forms committee in place, individual departments start creating pieces of paper. If there’s no collaboration or strategy across departments, it’s not patient-centric.”

She gives the example of an expectant mother going into preterm labor, yet care providers do not have information copied forward about previous miscarriages and so that history must be gathered again. “It’s a crime to do that to people, to continually ask about a previous pregnancy loss,” Raiford said. “If you can automate that, there’s huge potential.”

At last summer’s American Academy of Nursing summit, these recommendations emerged: decrease patient errors, improve operational efficiency and improve workflow productivity. Part of her role at Microsoft, Raiford said, is to walk the halls in health care facilities to try to spot where these productivity gains can be achieved.

“In one client site, they gave us their forms, and you can see that they enter the same data five times, on a piece of paper that gets faxed to somebody, then gets entered again,” she said. “There’s huge productivity loss, and the potential for error can be huge.”

Productivity can be measured by looking at efficiency, cycle time and effectiveness. Once the steps to the process are defined, elimination of steps or ways to speed up the cycle time can be realized. Ultimately, this frees the nurse to spend more time at the bedside.

These problems are compounded when hospitals or other health care facilities merge. Nurses can easily become frustrated when they’re moving between two hospitals in what is now the same organization, perhaps to accommodate a change in their own work preferences, but each hospital still runs its own information silos, Raiford said. “You can’t ask these nurses to work any harder than they already are, you can only help them work smarter,” she said.

Rx accuracy

Getting a better handle on medication delivery is another challenge facing nursing. “It’s all about the patient’s five rights,” Raiford said. “The right medicine, at the right dose, for the right patient, at the right time, via the right route.” With today’s bewildering range of medicines, just making sure it’s the right medicine can be a challenge.

Raiford recounts her own horror of a medical error when she picked up a prescription on her way out of town. She was supposed to receive 4 mg of Avandia for insulin resistance to help her absorb the insulin her body had already made. But a pharmacy tech, by mistake, dispensed 4 mg of Amaryl, which drops the patient’s blood sugar. When she called the pharmacy, she was erroneously told Amaryl was what her insurance had approved. Thinking it was a generic substitute, she took the wrong medication.

“I was in a taxi out of town when it happened and almost ended up needing an ambulance when my blood sugar dropped to 40,” she said.

Raiford, of course, is part of a larger movement focused on bringing the best of informatics into nursing. Night and day, nurses also are using resources such as the e-mail discussion list of the Capital Area Roundtable of Informatics on Nursing [www.caringonline.org].

Recently, Raiford shared information with the group on progress being made on InfoPath, a new Microsoft software being used to quickly build electronic equivalents of paper forms.

As a nurse at one of the central places where innovation is happening fastest, “it’s almost too exciting to sleep at night,” Raiford said. “There is no more exciting place to be in nursing than in nursing informatics in the year 2003. No more time for whining that ‘we are too old to change.’

“People are dying from medical mistakes from nursing and health care professionals literally drowning in data. It is our responsibility to do something about that by turning data into wisdom at the point of care, and technology is the key driver to do that.”

Contact Scott Mace at scottmace@wiredmuse.com