echnology on Patient Safety
When I got my post-masters and then my DNP, I built on the
research I had done for patient safety and CPOE systems. When
we went electronic, suddenly, you could actually read the chart.
I don’t think anyone has ever done any studies on that (because
I don’t know how you would do it), but just the fact that you can
actually read the physician’s writing unambiguously – it has to
have saved lives. It’s hard to capture it and say definitively what
the numbers might be, but I have no doubt that it has. Then there
are things you can build into the system that you could never do
with a pen and paper system – things like allergy alerts, duplicate
checking, or interactions with drugs. Even just these things have
been huge in patient safety.
Then there are things you can put into a system (like templates)
so important steps aren’t forgotten. It might be a template related
to how a patient who comes in and appears to be septic should
be treated. If you can build that into the system and have the
information right there, you know within three hours you need to
get a blood culture done, an antibiotic administered, and a lactate
drawn. All these things are based on evidence and can be put in
as queues and reminders.
We have a nurse-driven protocol for catheters that allows a
nurse to remove them when it’s appropriate, based on the Centers
for Disease Control and Prevention (CDC) guidelines. We built that
into the system so that when the provider orders the initial catheter,
there is a place that reminds him or her to follow the protocol. It
tells the nurse, “Should the nurse follow protocol? Yes.” If no, you
have to say why not. Then there is the criterion from the CDC that
says things like “Patient is on strict intake and output, not clinically
stable, just had a urinary procedure done,” and so on. When the
physician says to follow the protocol, which 95% of the time they
do, then the providers never see an alert. Then it’s up to the nurses,