Name of Group/Meeting: Nursing Informatics Advisory Committee (formerly HED Advisory Committee)
Date / Time / Location: June 6, 2013, 2-3pm, 5053/54, MCE, North Tower / Next Meeting: June 20, 2013, 2-3pm, 5053/54, MCE, North TowerChair: Vickie Thompson, Karen Hughart
Attending: Arlene Boudreaux, Elma Bunch, Kathleen Burns, Heather Campbell, Jennifer Campbell, Jennifer Erickson, Karen Hughart, Val Kibler, Abigail Luffman, Lillian McGehee, Maria Morrissey, Shelly Padgett, Connie Pollard, Nancy Rudge, Martha White,
Meeting Objectives:
1. Information sharing on new features & training and implementation plans if applicable
2. Decision making on new enhancements
3. Begin to identify significant enhancements needed (for future prioritization).
AGENDA
/ MINUTESWho/Time / Topic / Summary / Decision / Next Steps
Karen Wilson and Sub. Comm. , R0030266 & other requests , 5 min. / Present recommendations for Arterial Line documentation changes. (see below) / Changes approved as presented without change
10N, R0041964, 10 min. / Add an additional column for Bed Number to right side of Inpt. Whiteboard screensaver (in addition to the Bed Number that anchors the left side). (see below)
Need feedback from users about desire for change. / Suggestions to consider:
1. Decrease the space required for Attending MD column by listing just last name, first initial.
2. Decrease the space required for the Orders column by displaying “Orders” vertically instead of horizontally.
There was concern about adding a column for bed number on the right side because it would have the unintended consequence of compressing other columns and there were concerns about difficulty reading some of the content should this happen. Others felt the extra column would add safety so if we could create enough space to add this by making the changes suggested above, there was support for this change. / Once we determine if either or both suggested change is possible, we will bring this back to the group for final approval.
R0041981, Melinda Cherry, 8N, 15 min. / “…use a prompt to enter blood pressure measurements and heart rate prior to administration.” What would be useful --
· Option for HR for cardiotonic drugs?
· Option for BP for antihypertensives? Which BP results? Both?
· Neither?
· (see options attached below) / Clarifications:
· Only applicable HR/BP entered during the hour a med is being administered would display.
· The nurse giving the med could either choose the to save the hat value in connection with the med. administration, enter a new one, or leave it blank. The field is not required so practice standards should drive usage.
· These HR & BP fields are shared with Vitals/I&O Tab, Quick Assess, etc. so that results for these values entered on one of those other tabs would display on the AdminRx tab (if entered during the hour the med is administered) and results entered on AdminRx tab would display on the other tabs were these results can be documented.
Decision:
· Because all BP types of the longer list are used regularly, the group decided to make the longer list of HR & BP results available on the AdminRx tab in association with Cardiotonic & Antihypertensive meds. / Work will now be needed with Pharmacy to identify the cardiotonic and antihypertensives with which HR & BP entry fields will be associated.
Specific BP results to include:
BP (NIBP)
BP mean (NIBP)
ART BP
ART BP (mean)
ABP
ABP (mean)
Manual BP
Systolc BP
R0020338, R0042937 / Need an indicator for status of completion of Nursing Admission History
Review indicator logic that will soon be put in place--
Indicator will display as follows
1, Not started this admission - yellow
2. Started this admission but in draft state - yellow with "D"
3. Not started this admission or in draft state greater than 24 hours after admission - red
4. Adm hx form completed this admission - green / Additional information:
This is NOT the same indicator we used when StarForm Admit History was first put in place two years ago. That indicator looked at every single field and was triggered when required fields in any section were not completed. This indicator looks at whether an Admit Hx. Form is started or completed.
Additional Discussion:
The inidicator will help but will not solve all the problems. There is lack of accountability for completing a form started by someone else. The Immunization screen is not required while patients are in ICU level of care so almost all pts. coming from those units will have Admit History forms that are incomplete. The indicator will make it more visible when a form is not started or not completed but additional effort will be required to really solve these problems. / We anticipate the new indicator would be available within a month.
R0014780 / Placement of new Sensory section with Eye Assessment (see proposal below) / There is agreement to place this new Sensory Care Category between the current Special Neuro and Cardiac Categories on the left side bar of Assessments & Interventions tabs.
Real Time data entry – what are the barriers?
Examples: Vital signs needed for PEWS; % meal intake needed to correlate with blood glucose & insulin; etc. / In Aacute care:
– no computers in rooms
, have to pull a dinamap from room to room so cannot also pull a WOWmetimes and a WOW,
long time to log in
Decrease Care Partner , lack of extra care partners or nurses to help in patient care so data can be entered
In ICUs:
Decrease in Care Partner ratios
Balance between providing direct care and documenting often results in delay
Long time to log in; more pronounced for ICU pts. with long LOS due to large amount of data to be loaded with each sign on.
ICU – No time to retrieve data because of needing to provide patientt care essential to life, lack of help and care partners that are able to do simple tasks so the nurse can chart (sometimes only 2 CPs to an entire ICU floor of mostly total care patients, nurse often have to feed, perform ADLs, etc.), documenting on paper to then input data afterword =ward when RN has time, as new electronic obligations role out units are not staffed up fully to offset the burden of new obligations, sometimes it seems like primary nurse is really the “charting nurse” and that others become the true caretaker of the patient, ways of charting are ineffective and there should be more input from active group of nurse at the bedside or nurses that cross cover between the two group that can give honest and truthful insight in to how the electronic systems actually work (instead of the way the IT people think the will or should work), long LOS patients become time consuming and require one on one nursing at times. HED data can be partially archived to decrease login time in HED however this does not address the extended order confirmation times in CO. Changes we made earlier this year to reduce order confirmation times but some patients still require 1.5 minute per med (we can archive HED but nothing is being done about CO load times to confirm or unconfirmed medications, these often take over 1.5 minutes per med).
Smart Beds data download to HED –
What is relative priority for downloading available data?
[List of iBed attributes at bottom of minutes. .] / Clarification:
Only Stryker beds in CCT and a few other places are capable of capturing and sharing this data. Since we do not use some of the charting capabilities available on this bed for nurses to enter data, we think only the data that comes from the bed would be useful.
Group voiced concern that the cables never stay connected and that this is a known issue in the CCT. Trauma voiced concerns that they might not even have the wiring capabilities to be able to connect to a network. Great concerns about how the beds would connect to the network to input data. / Attributes that would be helpful if we could capture them from the bed:
HOB elevation
Bed position (eg. Trendelenberg, chair position)
Weight value
All
5 minutes / Updates and announcements & questions from participants. / Brief downtime Sun., June 9 from approximately 6:55 to 7:15am. E-mail communication has gone out all week. There will be overhead announcements 1 hr. and 15 min. before the start of the downtime.
Applications will not actually be down but due to maintenance on the “firewall” (a piece of security that will prevent external hackers from getting into our sensitive patient data), the connection between these applications and the users will be severed for a brief time. As soon as connectivity to the data center is restored, applications will be instantly available.
Approved -- Proposed Arterial Line Documentation:
Deferred for further analysis -- For discussion re: changes to screen saver for Inpt. Whiteboard:
A. Add 2nd Bed Number column on right side of screen.
B. Move Bed number column to center of screen.
Approved -- Proposed placement for new Sensory care category:
iBed Available Data InTouch and S3
Bed Information
· Identification (Bed ID)
· Options Available (Zoom, Scale, Bed Exit, Bed Exit Multi-Zone, Awareness)
· IP Address
· MAC Address
Bed Connection Information
· Bed Connection Status
· Room Location (Hospital Bed Bay Name)
· Last Known Room Location
· Room Location Module Connection Status
· Room Location Module Battery Voltage
· Room Location Module Low Battery Alert
Patient-Centric Information
· Current Weight
· Last Weight Logged
Bed-Centric Information
· Low Bed Height
· Brake (On, Brake Alarm Option On, Alarming)
· Bed Exit (Armed, Alarming, Zone)
· Siderails
o Patient Head Left Siderail Up
o Patient Head Right Siderail Up
o Patient Foot Left Siderail Up
o Patient Foot Right Siderail Up
· Fowler (Head Section) Angle
· Gatch (Foot Section) Angle
· Trend Angle
· Foot Angle
· Base Angle
· Foot End Height
· Locks
o Gatch Lock
o Foot Lock
o Bed Height Lock
o Patient Bed Motion Lock
o Patient Bed Height Lock
o Patient Fowler Lock
o Patient Gatch Lock
· Awareness
o Awareness Status (Armed, Alarming)
o Awareness Monitoring (Low Height, Bed Exit, Siderails, Brakes, Fowler 30 degree Lock)
o Awareness Monitoring (Bed Supine, Vascular Position) – InTouch only
o Awareness Alerting (Low Height, Bed Exit, Patient Head Left Siderail, Patient Head Right Siderail, Patient Foot Left Siderail, Patient Foot Right Siderail, Brakes, Fowler 30)
o Awareness Alerting (Bed Supine, Vascular Position) – InTouch only
Protocol Reminders (InTouch only)
· For all Protocol Reminders: Armed, Alarming, Expiration Time, Repeats
· Standard Group
o Medication
o Temperature
o Turn Patient
o Weight Patient
o Check Blood Sugar
o Rotation
o Percussion
o DVT
o Intake / Outtake
o Oral Care
o Hand Washing
· Pulmonary Group
o Head of Bed Elevation
o Sedation Assessment
o Daily Sedation Vacation
o DVT Prophylaxis
o Stress Ulcer
o Oral Care
o Rotation / Percussion
o Vibration Times
o Suction
· Skin Care Group
o Skin Assessment
o Turning
o Braden Score
· Restrain Group
o Release Restraints
o ROM
o Offering Food
o Fluids
o Oral Care
o Toileting
· Fall Prevention Group
o Fall Risk Score
o Check Bed Status
· GI Group
o Head of Bed Elevation
o Check Feeding Tube Placement
o Check Residual
· Neuro Group
o Skin Check
o Pupilary Reaction
o Orientation of Patient
o Motor Strength
o Pronator Drip
· Blood Glucose Group
o Blood Glucose
· Mobility Group
o Head of Bed Elevation
o Turn
o Out of Bed
o Walk
o Chair Position
· Patient Weight Group
o Auto-Store Weight
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