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medpundit |
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Tuesday, March 08, 2005Nurses are required to record (chart) administration of medications contemporaneously. However, contemporaneous charting requires time when there is little time available. Computerized physician order entry systems compound this challenge considerably. To chart drug administrations, nurses must stop administering medications, find a terminal, log on, locate that patient’s record, and individually enter each medication’s administration time. If medications are not administered (eg, patient was out of the room), nurses must scroll through several additional screens to record the reason(s) for nonadministration. Nurses reported that up to 60% of their medications are not recorded contemporaneously but are charted at shift end or post hoc by the nurse manager via global computer commands. Many house staff, aware of recording inaccuracies, seek nurses to determine real administration times of time-sensitive drugs (eg, aminoglycosides). House staff reported that these additional steps are distracting and time-consuming. Interrupted ordering or medication reviews can increase error risks. Moreover, because of cumbersome charting, some medications, especially insulin, are recorded on parallel systems (ie, paper chart, separate paper sheets, or directly in CPOE). Multiple systems cause confusion, and off-system information is sometimes lost. Not all computer systems are created equally, and until you work with it, it's hard to tell how it will fit into any one style of practice or needs. UPDATE: D'Oh. Forgot to mention the second study which found a paucity of proof that computerized systems improve patient outcomes: Fifty-two trials assessed 1 or more patient outcomes, of which 7 trials (13%) reported improvements. posted by Sydney on 3/08/2005 10:10:00 PM 0 comments 0 Comments: |
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