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Keeping Patients Safe: Transforming the Work Environment of Nurses
Asynchronous messaging—This technique allows team members to communicate with one another without each member having to be present at the same exact location at the same point in time. This prevents wasting large amounts of time trying to track down a busy physician during office hours or a nurse on the following shift. Things that should be communicated do not slip between the cracks. At Intermountain Health Care, 2,568 staff voluntarily chose to start using a message log in the first year after the message log application was made available. These users are primarily in the ambulatory arena; application to Intermountain Health Care acute care facilities is now under way. Other applications, such as personal radio transceivers, also facilitate instant messaging.
In general, an electronic information database aids patient care, quality assessment, and research. The hallmark of quality improvement is feedback to users on the results of their activities. With the ability, for example, to assess how often different nursing divisions use restraints for similar populations, one can begin to assess processes that lead to improved outcomes. The degree to which skin breakdowns occur in patients being cared for on different units can be assessed and the results fed back. Ultimately, much of patient safety derives from this process of analysis. Paper abstraction of handwritten charts is highly laborious and prevents large-scale analyses of nursing care. Automated record systems offer the potential to manage and assess the care provided to a much larger population on a routine basis.
As the discussion in earlier chapters on paperwork and documentation practices makes clear, automating patient records and clinical information also can reduce costs. Moreover, the nurse does not spend as much time in the find-and-fetch mode. Inventories are updated when supplies are used, so new supplies can be on hand when needed; charges are generated by the entry of point-of-care documentation rather than by the filling out of billing slips. Filing activities by ward clerks are reduced, allowing more time to help the nurse. Educational materials can be printed for the patient in multiple languages (Clayton, 2001).
Remaining alert to the limitations of and risks created by technology In searching for ways to improve patient safety, technology is often proposed as a strategy. Despite its potential, however, patient safety experts caution that technology by itself is not a panacea. While able to remedy some problems, technology may also generate new forms of error and failure (Battles and Keyes, 2002; Cook, 2002; Reason, 1990). Fundamental to the successful introduction of technology is a thorough understanding of the work flow and work processes involved in patient care (Cook, 2002; Goldberger and Kremsdorf, 2001). The expected benefits of a new technology may not occur if the technology is not designed appropriately (i.e.,