Systems for use in critical care

VOL 4 NO 2 1991

While Australian critical care nurses are familiar with critical care computer applications such as physiologic monitoring (computers that acquire, process, store and display data and sound alarms when variables are life threatening) and computers that communicate data among multiple hospital locations and departments, there is limited knowledge concerning computerised patient data management systems and the concept of a "paperless" environment in critical care. This pre-conference workshop introduced a patient data management system CPDM) for critical care and discussed the process which was used to select a particular system, implement that system and evaluate the impact of the system in terms of staff satisfaction, financial costs and savings, recruitment and retention of staff and quality assurance aspects. Since there is limited exposure to true patient data management systems in Australia, it is important that people involved in the selection of future systems be adequately prepared for the task. A group of critical care nurses from Good Samaritan Hospital and Medical Center, Portland, Oregan (USA) presented sessions outlining the process that they used in selecting a computerised system for their critical care units. One aspect which was particularly interesting, was that the project was entirely driven by the critical care nursing staff, rather than by doctors or management information systems staffin hospitals. The system described was for the use of the clinical personnel at the bedside and the needs assessment phase of the selection process included input from the health care team (including physiotherapists, nutritionists, biomedical engineering, administration), brainstorming and focus groups, research into other systems and a literature review. Budget considerations included moneys allocated for the system,

allocations for future hardware and software upgrades and longterm support contracts and costs. Market analysis included nursing staff attending trade displays, visiting units that were using different systems and asking for recommendations from systems users. It was stressed that the planning process must take into account the future developments of the hospital or centre, as the system selected needs to be integrated, rather than interfaced, with the hospital information system to allow access to all patient-related data (laboratory, imaging, appointments) and to facilitate all on line ordering (order entry service) of services and goods such as pharmacy, stores, transport, and dietetics.

In the critical care unit the computerised patient data management system (also known as Clinical Information Systems - CIS) consists of bedside terminals and keyboards (or some other data entry mechanism) which can be linked to patient monitors for physiologic variable documentation as well as to other peripherals such as infusion pumps, ventilators and pulse oximeters. The systems are able to generate nursing care plans, 24 hour summaries, physical assessment and nutritional assessment reports, as well as providing facilities for rostering, performance appraisal and staff education. Manually entered data concerning the patients condition and treatment adds to the integrated nature of the patient record and all entries can be time sequenced and include the name of the person entering the data, thus legibility and accountability for documentation is implicit in these systems. There is also the benefit of a complete, legible medical record when the patient is discharged from the unit, or from the hospital if the system is integrated throughout the hospital. Facilities that have installed this type of system report a reduction in the

amount of nursing time spent on clerical work, increases in the quality of patient care and improved job satisfaction for nurses. With less time for manual charting, the nurses have more time for bedside care. Recruitment and retention of nurses in critical care units such as the one at the Good Samaritan Centre in Portland, Oregan has improved and they have been able to demonstrate a reduction in medication errors and incidents adversely affecting patients and staff. The Pre-conference workshop was sponsored by Marquette Electronics Inc. and they allowed a period of hands-on experience with the CliniComp System. This system offers the ability to customise screens to resemble reu charts and therefore the time taken to educate staff is reduced. The 24-hour graphics summary of all stored data includes arterial blood gases, vital signs, invasive and non-invasive pressures, intake and output. It is also possible to graphically and numerically track intravenous drug intake by dose/kilogram/minute at a selected time. Other screens include nursing notes, care plans, lab data, neurological flow sheets, treatment flow sheets and a reference library. Printed reports of any of these screens can be customised for different clinical environments. Computerised patient data systems represent a large financial investment in terms of purchases of hardware and software, staff education and the process of implementation and evaluation. Systems such as the ones described in this report, are used predominantly by nursing staff at the bedside and therefore the utility of such a system is dependent upon it meeting the needs of those clinicians. Nurses must be knowledgeable about the use of computerised information systems and the process of selecting and installing a system must be driven by the users - the critical care nursing staff and members of the critical care team. • 17