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    That moment a nurse never forgets

    May 5th, 2016

    Every nurse has at least one eye-opening experience that changes them forever. One of mine happened in a pediatric oncology unit almost 20 years ago.

    I was taking care of a seven-year-old boy, Jack*, who was recovering from a bone marrow transplant. Weakened by intense radiology and chemotherapy treatments, he had been unresponsive for several days.

    Despite his illness, Jack was an optimist. He was raising money to buy a bicycle so he could ride home from the hospital one day. Jack made and sold buttons for 50 cents each to help reach his goal.

    When I was doing rounds one night, I dropped two quarters in the jar next to his bed and took a button. I pinned it to my scrubs and gave the jar a shake to let Jack know he was one step closer to that bike, though he wasn’t conscious at the time.

    Kerry wore Jack's button as a patient safety reminder when administering medication.

    Kerry wore Jack’s button as a patient safety reminder when administering medication.

    The next night I was in Jack’s room, with a medication I had checked and was ready to give. The previous medication was still infusing, so I put the bag I was holding back in the fridge to administer later.

    When I came back to get it, I didn’t realize the pharmacy had delivered another bag and pushed Jack’s medication to the back.I grabbed the wrong bag.

    As I stood over Jack’s bed to begin administering the medication, he woke up – for the first time in a week. He looked at my pin and asked, “Hey, did you pay for that?”

    After I proved to him I had indeed paid, I looked up at the bag I was about to spike. It had another child’s name on it. I could have killed him.

    I’ll never forget that night, and how fortunate it was that Jack woke up at that exact moment. For the rest of my hospital career, I wore his button. It was my patient safety reminder – to double-check the “five rights” and beyond with every medication.

    Thankfully, safety nets have evolved since then. The technology we have to help with medication administration is one of the reasons I’m so passionate about what we do at Allscripts.

    Because of these experiences, every one of us is willing to do whatever it takes to improve patient safety. I’m so grateful for everything nurses do every day to care for patients.

    Nurses all have stories that have impacted their careers. I share mine to celebrate and encourage nurses during International Nurses Day (May 12) and Nurses Week (May 6 – 12) in the United States. Please consider sharing your own story, either about your own experience as a nurse or how a nurse may have helped you, in the comment section below.

    * Name changed to protect privacy

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    3 EHR improvements nurses most want to see

    May 7th, 2015

    HIMSS Analytics conducted a survey of nurses, uncovering what they like (and what they don’t like) about electronic health records (EHRs).

    One of the results shocked me: about 15% nurses wanted to go back to paper-based medical records, and another 15% said they weren’t sure if they’d go back or not.

    I flashed back to my experience as a pediatric oncology nurse on the night shift. For example, when a patient’s fluid intake and output didn’t match up, I had to figure out if it was a miscalculation. I could spend 90 minutes poring over a spreadsheet trying to find the math error.

    It got me thinking. Where are EHRs coming up short? What makes nurses want to return to paper? Based on the top three reasons indicated in survey results, I have a few theories:

    1) Easier to find information

    Nurse survey respondents who want to return to paper charts said it was easier to find information that way. Ironically, the majority of nurses who would not return to paper say that it is easier to find information in EHRs.

    It’s clear that nurses agree that access to information is vital for patient safety.

    My guess is that nurses who find paper easier to navigate than EHRs likely have a workflow design problem. If an EHR view does not exist where nurses can see their top five or six things, then nurses need to speak up and change it.

    2) More focus on the patients

    Nurses would much rather spend time with their patients, not on documentation. The second most common reason they gave in the survey for wanting paper records is that EHRs detract from focus on patients. Again, this could be a workflow issue.

    It could also be that people aren’t remembering the time-consuming aspects of paper-based records. For example, many of the pediatric units where I worked required us to keep patient charts at the nursing station. We spent lots of time going back and forth (taking time away from the patient). Hunting for missing charts also took time away from the patient.

    3) Faster data entry

    It might be easier to scribble a note in a paper chart rather than finding the right place to document in the EHR. But is paper documentation better for patients and the entire team of caregivers?

    Nurses who would not go back to paper cite “handwriting issues” and “allows for complete entry” as two significant reasons why they prefer EHRs. The EHR forces a clearer, more complete form of communication. Yes, it might take more time up front, but it can save time in the long run.

    Years ago, when paper dominated medical records, we managed new regulatory requirements by adding new forms. Need to do skin checks? Add a flow sheet. Need to start doing fall-risk assessments? Add another flow sheet. Given the increasing complexity and demands of today’s regulatory environment, I shudder to think about trying to manage it all with paper charts.

    Maybe some of these nurses have never worked in a paper-based environment. Maybe they have forgotten. Maybe their EHR isn’t working as well as it should. But I remember very clearly the limitations of paper. I agree with the majority of survey respondents that EHRs are helping to improve patient safety.

    To all my fellow nurses out there during Nurses Week, thanks for all you do. I’d love to hear your thoughts on this subject in the comments below.

    Want more detail about the HIMSS Analytics Nurses Survey? Download a free white paper or check out this infographic.

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    What nurses like most (and least) about today’s EHRs

    May 5th, 2015

    In honor of International Nurses Day (May 12) and Nurses Week in the U.S. this week, Allscripts is highlighting the results of a recent HIMSS Analytics survey. We wanted to know: What do nurses really think of electronic health records (EHRs)?

    I’m encouraged that the results were generally positive.

    HIMSS Analytics Nurses Survey 2015 Results

    Remembering how difficult it was to use paper records as a pediatric oncology nurse, I wholeheartedly agree. Some of the highlights include:

    Nurses are generally positive about EHRs, and most agree:

    • EHRs help improve patient safety and avoid medication errors (72%)
    • Nurses would not consider going back to paper-based medical records (71%)

    Mixed results on how EHRs affect collaboration:

    • EHRs help enable collaboration with other clinicians inside their organizations (73%)
    • Only about half of nurses agree that EHRs enable collaboration with clinicians outside their organizations (49%)

    Nurses are less likely to agree that EHRs help with efficiency:

    • Less than half of nurses agree that EHRs eliminate duplicate work (43%)
    • About one third of nurses agree that EHRs give them more time with patients (33%)
    NursesSurveyWhereEHRsCanImprove

    It’s important to note that through this survey we heard from nurses at all levels – from floor nurses to chief nursing officers – and they represent a variety of care settings and EHR vendors, too.

    Perhaps the survey is best summed up by one of the comments we received from a respondent:

    EHR has the potential to be an incredible tool to GREATLY improve patient care, data collection, ability to share information, etc. It has not reached its potential yet. Paper charting was so much easier to look over on a day to day basis, but compared to what EHR can be, paper charting is unsafe and marginally useful. Handwriting legibility, loss of documentation (coffee dumps at the desk were the worst), and inability to retrieve data without paper cuts make the thought of returning to paper charting horrifying. I just wish technology for healthcare providers – particularly nurses – would catch up to the rest of the world’s technology levels.

    Nurses shared a lot of great insights in this survey. Allscripts continues to learn from nurses in our efforts to deliver technology that helps clinicians provide the best possible care.

    To see more results from the survey, download a free white paper or check out this infographic.

    What do you think about these results? Nurses, do you agree or disagree with these findings?

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