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Quality Care and Mobility

· Kim Tucker,

The Case of the New/Changed/DC Orders

During a recent conversation with a colleague who is a pediatric nurse educator in an acute care community hospital, the conversation turned to how the EHR has impacted workflow around New/Changed/DC Orders.  In the pre-EHR days, providers had to either come to the nursing unit to write orders or call them in by phone but either way, it was relatively easy to know when you needed to review a patient’s orders.

But today, many of those visual cues no longer exist.  No chart racks with a turned up order sheets, no raised plastic flags…in fact, not even a provider on the floor since orders can be entered in EHR from anywhere!

Some EHRs have a status screen that tells you when you need to review patients’ orders but that doesn’t do much good unless you are in front of a computer and logged in to the EHR.  An informatics colleague was telling me about a situation where he watched a nurse stand in front of her WOW repeatedly pressing the refresh key.  When he asked what she was doing, she said that she knew a new order was coming in that she needed to act upon as soon as it arrived, so she was refreshing her EHR view so she could see it when it came through.  What is wrong with these situations?

To me, the answer is pretty obvious; the order process is bottlenecked at the computer.  No matter if the computer is fixed to a wall or on a cart, if the nurse isn’t looking at the screen then the ordering process stops cold until the next time s/he logs on.  Some organizations are using airport type monitors strategically placed through the unit, but again, if the right nurse isn’t looking at the board, then the order can go unnoticed.

Think about how you get your notifications of new messages in your personal life – for most of us, it’s via our smartphone. No matter where you are, your smartphone, beeps, vibrates, or even plays special songs depending on the person sending you the message.  If you are near me and hear ‘Sweet Home Alabama’ then you know my husband has sent me something.  But thus far, only the lucky clinicians have this technology as they move through their day…and that would be PatientSafe Solutions’ clients.

When I visit our clients – it makes me very happy to see the positive impact that mobility has on their workflow.  No standing in front of a computer or WOW waiting for that order–they will be notified when it comes through no matter where they are.  No wonder one RN called PatientTouch her BFF!

And RNs aren’t the only happy clinicians – next time we’ll focus on how mobility is improving life for phlebotomists.

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