Computer versus Paper Charting for Nurses - Essay Example

Computer versus Paper Charting for Nurses Professional nursing is an art and applied science. In 1859, Florence Nightingale the founder of modern nursing expressed her meaning of nursing as "the goal of nursing is to put the patient in the best condition for nature to act upon him primarily by altering the environment". However, with the increasing pressure due to several reasons, nurses in the past and present have not been able to achieve these goals with perfection. If we list the responsibilities of nurses it can be said that, they are responsible for performing patient assessments, administering medications, monitoring a multitude of patient parameters and recording it, managing hygiene and physical therapy activities, assisting the physicians during procedures, consulting with physicians, respiratory therapists, and other caregivers, keeping family members informed, and documenting each and every aspect of care. With so many responsibilities and so much information to assimilate, it becomes even more essential to take care of the documentation of information as this is the only method to reduce errors. Charting information regarding medication, observations, patients' history, etc. has been an age old practice and is the responsibility of nurses. The purpose of the medical chart is to serve as both a medical and legal record of patient clinical status, care, history, and caregiver involvement. The detailed information contained in the chart is intended to provide the patient's clinical condition by detailing diagnoses, treatments, tests and response to treatment, as well as any other factors that may affect the clinical state of the patient. Hence, it is beyond doubt that documentation is one of the most important activities that needs to be accurate. This essay compares computer and paper charting methods and also discusses in detail the history of charting technology; reveal medication errors in computerized and non-computerized charting, illegibility of orders and double charting, and accuracy. In the 21st century, nursing informatics has become a part of the professional activities. Informatics has advanced the field of nursing by bridging the gap from nursing as an art to nursing as a science. The term medical chart is a general description of a set of information on a patient. It is important that the information in the chart be clear and to the point, so that those utilizing the record can easily access accurate information. In some cases, the medical chart can also assist in clinical problem solving by tracking the past history of the patient. For instance, the baseline information or status on admission, orders and treatments provided in response to specific problems, and patient responses can be easily retrieved from the medical chart. Another reason for the standard of clear documentation is the possibility of the legal use of the record. For example, these records are frequently investigated for insurance clams and when medical care is being referred to or questioned by the legal system, the chart contents are frequently cited in court. In the earlier days, all the documentation was prepared on paper. But today, most of these are fed into the computers directly and is stored in it. The disadvantages with the paper charting are as follows: it is a tedious process to write and store the records and it takes away a lot of space. Since nurses work in shifts, different nurses handle each record as a result different handwritings appear in single report. A single nurse handles several patients as a result there are high chances of medication errors with serious consequences. These factors are even more of a problem for those nurses who are working in intensive care units (ICU). With the increase in stress due to shortage of nurses, the working staff will be handling more patients and many times it is possible that errors occur in medication. Nursing Informatics is a broad ranging field that combines nursing skills with computer expertise. Nursing informatics is the modern technology that aids with documenting and communicating the service of care provided. Today, in most of the hospitals the records have less information and most of it is stored in computers which is a total different situation from 80s and 90s. It is often seen that nurses are in the hospital with mobile computers in the patients' room. With the advancement in computers it has become easy for the storage of information. Most of the health care set ups are computerized and each and every information is fed into the computer. The electronic health record (EHR) is more and more being organized within health care organizations to improve the safety and quality of care (Committee on Data Standards for Patient Safety, 2004). The advantages of these systems are that it is easy to enter patientwise information and store it for years. Information such as patient's clinical condition by detailing diagnoses, treatments, tests and response to treatment, as well as any other factors are easily available with just a few clicks. Additionally, because this information is entered and reviewed by different persons such as the lab technicians, physicians, pharmacists and nurses regularly, there are very little chances of medication errors by the nursing staff. Maximization of the technical characteristics supporting the system such as speed and value-added functionalities such as order entry systems or automated reports have been documented with higher rates of EHR use (Ammenwerth et al. 2001; Bates et al. 2003). Ultimately there is no wastage of papers. There are several studies conducted by the researchers on this aspect. Human error especially in the ICU is not uncommon, and it is indeed more prevalent than equipment error. Shulman and coworkers (1987) recorded 180 errors in three months in a six-bed ICU. Among these 180 errors, 41 percent of errors were in drug charting or administration, and 31 percent were in non-drug-related charting or relay of information between shifts. They also reported that 22 of these 180 human errors directly led to clinical deterioration of the patient. Girotti et al. (1987) recorded 102 medication errors in 16 days in a 15-bed ICU, a frequency rate of 2.2 percent. 31 percent of these errors were omitted doses, although it is not clear whether the doses were omitted, or given but not charted. These types of documentation errors have significant clinical implications. Studies indicate that clinical observation of the patient is used by the physician to make treatment decisions only one fifth of the time. On the other hand laboratory data, drug and fluid balance data and monitored data are frequently used in an ICU for treatment decision making (Brimm, 1987). Therefore, the accuracy of these data is most essential which is easily possible with computerized recording but though not impossible is difficult in paper based charting system. The patient chart must be considered a medico-legal document which will be used by the insurance agencies, hence a computerized charting can be more legible. If data are not charted, it may result in the assumption that those medications or procedures were not done, which may further imply that the clinical team was deficient in patient care (Gravenstein, 1989). The advantage of computerized clinical information systems (CIS) over the paper based charting can be seen in its improvement of documentation practices, enhanced accuracy, and decrease in clerical nursing function. In other words, more and better documentation is accomplished in less time and which can be accessed any time by the hospital authorities. A study conducted by Hammond, et al. (1991) documented that errors occur in no less than once in 25 percent of handwritten flowsheet records for each 12-hour nursing shift. These errors include mainly the arithmetic errors, data omission, and legibility errors. These kinds of errors can be reduced with the use of a computerized CIS, which has medico-legal implications. In yet another study it was noted that adverse drug events (ADEs) are expected to injure or kill more than 7,70,000 people in hospitals each year (Lesar, et al. 1997). These errors are common in prescribing and are the most serious problems (Kohn, et al. 2000). Studies suggest that computerized physician order entry systems are also widely viewed as crucial for reducing prescribing errors and saving hundreds of billions in annual costs. Computerized physician order entry system advocates include researchers, clinicians, hospital administrators, pharmacists, business councils, the Institute of Medicine, state legislatures, health care agencies, and the lay public (Kohn, et al. 2000).These systems make the handling of information more easy with minimized errors especially by the nursing staff. As technology is playing a major role in all emerging fields, nursing is also growing in terms of technology. Hence, it becomes even more important to educate them in the field of computers. It is quite evident that the use of computer and information technologies in the health care increase at a faster rate and this is in turn going to improve the nursing practice and patient education. These technologies have also entered the teaching practices of Nursing. Modern teaching approaches with new technology-based teaching and learning assignments will increase student attainment, including retention, motivation, and class participation; improve learning and significant thinking, provide instructional reliability, and augment clinical education. Moreover, it will create nursing curricula which links people and information resources into a web of learners' community, communication, and group association as the nursing student engages in their journey from a student to a trainee practitioner. It is estimated that medication administration and charting may take up to 33% of nursing time in the hospital setting (Pepper, 1995). Advantage with the computerized medication and charting aspect of nursing practice has been greatly influenced by advances in medicine and technology. New drugs, new devices for administration, and computerized systems for documenting the medication administration process give the real advantage for nurses. Besides, it also improves patient safety through the use of information technology (Bates and Gawande, 2003). Studies suggest that this aspect of information technology has proven to be effective in reducing medication errors (Pepper, 1995). Though information technology has become an important factor in the improvement of medication administration and patient safety, there is still a great deal to be educated about these technologies and methodologies. One of the primary role of the nurse as a health care provider has been one of patient educator. Hence, nurse professionals and nurse educators require to look at how the nursing profession can use the potential of the Internet to revamp patient education and transform nursing practice. Knowledge management is the unambiguous and systematic organization of fundamental knowledge and its related processes. It necessitates turning personal knowledge into knowledge for learners-at-large through the organization of information across guidelines. The requirements for Registered Nurses are increasing regularly at a faster rate. Understanding technological applications in support of classroom and clinical education can make the best use of limited faculty, financial, and clinical placement resources. It is understood that any such strategies can be accomplished while upholding high standards for nursing education. Technological advances in simulation and virtual technology now present excellent attachments to "live" clinical education. Hence reducing the obstructions associated with limited experiences, clinical sites, and clinical faculty resources. Technology provides competent and effective choices to expand clinical teaching opportunities. By making suitable use of these technologies, and through teamwork across programs, can be increased the number Registered Nurses meet health care needs (Krautscheid and Burton, 2003). In conclusion, it can be said that paper based charting systems are tedious and time consuming when compared to computerized charting system. It is essential that nurses are educated intensively to use these new technologies and spend more time in patient care. It is important to integrate computer education into the nursing course and for the already employed nurses to have special training of computerized charting. It is important for the health care units to realize that these time-saving methods of charting can help to reduce the stress among the nurses and also there by decrease the medication errors that are a major concern in the medical industry. References Ammenwerth E, Kutscha U, Kutscha A, Mahler C, Eichstadter R, and Haux R. (2001) Nursing process documentation systems in clinical routine-prerequisites and experiences. Int J Med Inf;64:187-200. Bates, D.W., Kuperman, G,J., Wang, S., Gandhi, T., Kittler, A., Volk L., et al. (2003) Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc;10:523-530. Bates, D.W. and Gawande, M.D. Improving safety with information technology. N Engl J Med. 348:2526-2534. Brimm, J.E. (1987) Computers in critical care. Crit Care Q; 9:53-63 Committee on Data Standards for Patient Safety (2004), Board on Health Services, Institute of Medicine of the National Academies. 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