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“The more you can customize the system to match the ICU culture, the better,” Wong explained.

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

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

Roberts ticked off 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 said. If the rate goes over hospital policy, he said, an alert is sounded.

“We don’t just rely on the pump alarm,” he said. “We have something measuring actual rates.”

Roberts estimated the system doesn’t save time as much as it increases accuracy.

“It works great in times of crisis: When the nurse is actually doing things for the patient, the computer is keeping track of the data so the nurse doesn’t have to remember or find the paper towel she wrote that information on,” he said.

Even when things go smoothly, the system gives a patient’s health care providers more detail, he said. Nurses’ notes alone run 44 pages long. Each patient has an interdisciplinary plan of care online, which is upgraded each shift.

“It’s really in-depth,” he said.

Nurses at the Mayo Clinic Hospital say electronic notes allow them to document more details more quickly, said Judy Whitman, RN, MSN, CCRN, clinical director of critical care and cardiac monitoring.

“I have not done any studies to determine if we save any money,” Whitman said. “However, I can tell you the nurses would not go back to paper.”

Furthermore, the entire Mayo Clinic Hospital uses paperless documentation and has since it opened in 1998. “It is easy to navigate the system if a nurse is floated into another unit,” Whitman said.

Techno time-saver

Fresno (Calif.) Heart Hospital has not yet installed an interface between the computer and the monitors — nurses still must type in a patient’s information — yet even this advance has administrators and nurses praising the system, said Pilar de la Cruz-Reyes, RN, MSN, the chief nurse executive.

“From an administrative viewpoint, it’s a wonderful tool when you have to review a chart and you don’t have to try to decipher things,” said de la Cruz-Reyes, a self-described “old- time nurse” who, like the 103 nurses in her employ, quickly adapted to the new system. “This is the wave of the future.”