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Three Decades of Nursing
Looking Back to Move Forward

· Kathleen Harmon, MS, RN, CENP, Chief Clinical Officer

Kathleen Harmon's Finlandia University (Suomi) School of Nursing graduation photoI graduated in 1986 from the Finlandia University (Suomi) School of Nursing. The practice of nursing was a different world then. My first position was on a medical surgical unit in suburban Detroit. At that time, the med surg unit consisted of several wards with four patients per ward. We prepared medications on a serving tray like the food trays used in cafeterias. We carefully divided the trays into four quadrants with masking tape, one square per patient, to help ensure we had the right medicine cup for the right person. One particularly quiet day, I carefully prepared the medications for one of the four beds in my ward and triple-checked for accuracy. As I walked into the ward, I inadvertently mixed up the medication position for bed 1 with bed 4 and gave the wrong medication to a patient. Horrified, I quickly reported the error, disclosed to the patient and family, and observed the patient for any adverse reactions. Thankfully, there were none. This event left a mark on my heart and has stuck with me over the years, driving my determination for safer nursing practice. It substantiated in my mind the need to stay vigilant always, even on days that seem unusually calm. 

In those early years, we used paper charts with handwritten physician orders. My colleagues and I would find ourselves reviewing orders attempting to determine if the order was for .1mg or .01mg. As new nurses often on night shift, we were uncomfortable waking up the physician, so we’d come to consensus and move forward based on our manual interpretation. Lastly, I recall the dial-a-flow IV medication administration system. IV drip rate and volume were set manually. No beeps, no alarms, and much room for error. 

During the 90’s, I moved into mental health and substance abuse nursing, and then settled into emergency/trauma, where I found my true fit. I spent several years as a staff nurse, working mostly night shift. Emergency nursing was me. I loved it. When the ED Director position opened, I knew it was meant to be. Our team of caregivers was outstanding, and we consistently exceeded safety and satisfaction goals. During this time, we implemented Cerner’s EMR FirstNet ED Module. We diligently prepared and followed the recommended steps for a successful deployment. The team was well-trained, and I had no doubt Go Live would be successful. We launched at 7 a.m. on a Tuesday morning. A call came in on the emergency response radio that the fire department was bringing in a cardiac patient. I observed as the patient arrived in one of our trauma rooms. As the physician assessed the patient and ordered STAT interventions, I saw one of our top-performing nurses freeze. Her eyes went from the patient to the computer on wheels, back and forth, over and over. She looked at me and said, “What do I do?”. I responded, “Do what you did yesterday.” It was then that I realized how paralyzing technology can be, even with the best preparation. From that moment, I understood that we must implement technology to support workflow, and not the other way around. Technology must be the silent enabler of best practice as best practice is what springboards caregivers to be their best. 

In the 2000s, I had the opportunity to move into an Information Systems leadership position in which I had responsibility for EMR implementation for Emergency Departments, Pharmacies, and Clinical Decision Support across 32 hospitals and urgent care departments. I was excited to be the voice of nursing as we looked to optimize the EMR and supporting technologies. We made progress, but workflow fragmentation remained. Paper chart nursing stories were replaced by checklists, which made it harder to do the right thing. There were sixteen drop-down choices to describe urine color! It became difficult to complete consistent, accurate documentation from caregiver to caregiver, further complicating patient charting. That said, we were making strides in care delivery safety, specifically through CPOE (computer physician order entry) and the integration of supporting technologies, like vital signs and physiological monitors, directly into the EMR. The EMR quickly became the source of truth due to federal mandates, ensuring all aspects of care were documented in a single place. However, there continued to be a strong connection between sentinel events and communication errors — specifically, fragmented, delayed, or gaps in communication.

Moving into consulting in 2010, I’ve participated in Clinical Communication and Collaboration system planning, design, training and deployments across the country in small critical access hospitals, large academic medical centers and IDN’s. I’ve seen the impact of technology-first implementations that are not guided by workflow use cases. These projects often stall, stretch resources beyond sustainability and lack the adoption needed to improve clinical outcomes. These experiences and my 33 years in Nursing serve as the foundation for PatientSafe’s clinical vision and our Outcomes-First, Use Case-Based implementation methodology. Our approach aligns with The Nursing Process and Kotter’s Change Management Model enabling our implementation consultants speak a common language with our clients and their frontline caregivers.

As PatientSafe helps bring about a future of technology-supported best practice workflow, we embrace the following core principles in our product and implementation strategy:

  1. The EMR is the source of truth; we will augment and never compete with it.
  2. We will make care team collaboration simple and effective.
  3. We will make every design decision knowing that technology is the silent enabler of care delivery and serves as the foundation for best practice.
  4. We believe that technology implementation, when done correctly, allows caregivers to be their best for every patient, every time.

Thank you for reading this post! I invite you to share experiences from your personal journey in healthcare. Just post your comments below. To me, there is nothing more inspirational than connecting with healthcare leaders and understanding what motivates them to improve the collective experience of our caregiver, patient and patient family communities.

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