Wednesday, November 28, 2012

So we have this new computer system.

The whole damn thing's been reworked, top to bottom, and it's rumored to be the best, most efficient, most amazing computer system in the history of EVAH. Lab tests and MD notes and medication administration and tiny bits of lint from the dryer are all linked together; all that's linked to some magical whoozit that records when a nurse enters a room, what equipment s/he uses while there, and when s/he leaves. It's rumored, in short, to be the best. damn. thing. since SLICED FUCKING BREAD, MAAAN.

Except, well, it doesn't work.

And I mean, all joking and superlatives aside, it doesn't work.

For instance: let's say you have a patient who wants only one Lortab, rather than the two that were ordered. Instead of pulling two out and wasting one, or just doing an RN override on the Diebold that holds the meds, you have to now call the doctor and get an order for only one Lortab. And then wait for that to be entered and linked and so on.

Yeah.

Let's say you have to waste a partial dose of a medication, like when a patient gets two milligrams of morphine but the morphine comes in four-milligram ampules. The old way to do it was pull, waste at the machine, chart. The new way is pull, have two people scan the med at the bedside, waste at the bedside, do an override to administer 2mg of an ordered medication, then go back and enter the waste at the machine.

And, because everything is now coordinated, Les Machines keep track of how long it takes you to get *back* to the Diebold and waste. If it's more than about a half hour, your administration will get flagged for investigation, because you might be huffing morphine. Which is fine and dandy unless you have five (or six, or eight) patients to deal with. Nurses with huge patient loads often waste everything at the end of the shift.

Let's say you have a person on a heparin drip. Even if you only want to enter the same drip rate hour after hour after hour, you still have to scan the person's armband, scan the bag, and get a witness. This is the new rule for every titrate-able drip in the system. For us, it's not a big deal: we might have one or two drips running in the NCCU on a person. In the med-surg CCU or in the neurosurgical CCU, though, it's a big deal: imagine having to scan-scan-witness-verify for eight drips on each of two patients. Every hour. On the hour.

And, finally, let's say you go into a room that holds a person who's been admitted for a TIA. They're neurologically intact, fine and dandy, and on only aspirin and an antacid. If you leave the room before a certain number of minutes have elapsed when you're giving those meds, you get flagged for not doing sufficient patient teaching on the Tums and Bayer you just administered. If you take too long--that is, if your patient is on six different meds, five of which are new, and the person has questions--you get flagged for inefficiency.

THIS IS WHERE I GET ALL CAPSLOCKY. The trouble with setting up difficult failsafes in a time-crunch-prone profession like nursing is this: once the new checks are set up, all the older ones get scrapped. We no longer have the pop-up windows on our med records that alert us to possible double-dosing. Instead, we have a huge, long, convoluted process to go through that guarantees nothing, as most of our peers are too time-crunched to double-check us.

We learned, less than four hours after the system was implemented, how to get around it. By the end of day shift on Monday, most nurses had copied the scan-codes from med labels and stuck them to the back of their ID cards. We'd also figured out how to copy the med-admin codes from the patients' armbands and stick them to the charts. We worked around the new, cumbersome failsafes. . . .

. . .but we didn't have any other checks or warnings to alert us when we'd fucked up. In other words, our system now has only one point of warning for each patient, and that point has already been sabotaged in the name of saving time.

So we have this new computer system. It reminds me a lot of a story I heard from one of my colleagues. He and his wife bought a gorgeous, brand-new house where everything, from the computer to the thermostat to the hot-water heater, was controlled through the Internet. Their online service provider suffered an outage that lasted three days (he's in the boondocks). During that time, they had no heat. Or hot water. Or air-conditioning. Or TV, phone, Internet, or burglar alarm service. Reprogramming things manually wasn't an option. Why should it be, with this shiny new system?

No system should ever have only one point of failure. Even muskrats and beavers have a back door out of their homes. Manglement's reduced a perfectly workable checks-and-balances system to something with one point of failure, in the name of Patient Safety, and we've already figured out workarounds.

In other news, the hospital-wide campaign to leave our badges in the bathrooms for extended periods of time seems to be working. Manglement might be monitoring our pee-breaks, but we'll work around that, too. (I wonder what they'll say when they see that four of us were in the public men's restroom on the ground floor for six hours on Tuesday?)

19 comments:

bobbie said...

HOly Sh*t! There are times I'm SOOO glad I'm out of the rat race... and this is sure one of them ~ what a balls up!

Meanwhile, LMAO at the badges in the bathroom...

jimbo26 said...

It's called progress . Not . If Manglement had to oversee , they would find out why it was useless .

Penny Mitchell said...

And thus it was further revealed why God put massive roadblocks in my way when attempting to start nursing school.

Good LORD, honey!!!!!!

Jack's Mom said...

I love being a nurse. It sucks that people wearing ties and cute shoes work so hard to take the joy out of bedside nursing. I was treated better as an employee when I was a secretary and I sure wasn't titrating heparin drips or running codes.

If you think about the how effin' vital the bedside nurse is (critical labs, rapid response calls, blood administration,etc. and the patient's overall impression of the healthcare organization!) it makes ya wonder why managlement does so much to tell us we're unimportant, replaceable cogs.

And, I took a big (!) pay cut more moving into nursing...

Comrade Physioprof said...

This is exactly what happens when business processes are designed by people who haven't the slightest fucken clue how the real business actually gets done, and they are so fucken deluded by their own cleverness that they don't even realize how fucken clueless they are. And yes, the people who actually have to get the fucken business done *will* find workarounds for your bullshitte broken processes because THEY ARE SMARTER THAN YOU.

Cr0w$C@lling said...

You brilliant hacktavist you!

Agnes said...

I'm really curious about what EHR you have. We've got a less-than-excellent one right now, but will be changing in the next few years to another. This post makes me curious and nervous.

MamaPontius said...

Please tell me this great new system does not start with the letter E and end in pic...

Eileen said...

@Comrade Physioprof - you said it before I got here. cf the big NHS computer mess-up in the UK. They didn't know how the system REALLY works. So it broke before they switched it on - result: chaos.

woolywoman said...

Come to California, where the law is 2 ICU patients, Five med-surg. We have unions, and they save lives.

Scrub Ninja said...

What stops you from pulling two Lortab and wasting one? If you pulled two and accidentally dropped one down the sink, would you have to call the physician for another order just so you could administer the full dose of the med that was already ordered?

Anonymous said...

had to lol at mamapomius.. that system seems to be an epic fail, imo. the thing i especially hate about it is the teeny tiny warnings you get AFTER the fact (med administration) but god help you if you overlook a best practice guideline. :/ computers may make the bean counters happy but i haven't seen an improvement in pt care because of them.. :(

Elliott said...

It's often not because people who design the system don't know the jobs they are supposed to do, it's because people who design systems are unlikely to have real system design experience. They think they know more than they really do about the jobs and they know much, much less than they really need to about software and systems. This is propagated throughout the system because everyone in a position of authority in healthcare IT is trained as a clinician first and picks up the technology in OJT. It's a royal mess and you can read the financials of the major healthcare organizations to see the tens of billions of dollars of write-offs this results in. Of course, you are living it now.

Sara said...

Granted, I'm only a student nurse and I just finished my first semester working with the system that rhymes with apic, but the system Head Nurse is dealing with doesn't sound like it. Frankly, I kind of like the-system-that-rhymes-with-apic.

Dr. Alice said...

What Comrade Physioprof said. That is ridiculous. And I love, LOVE the badges in the bathroom. :D

Jess said...

Our badges won't even pick up until you've been in the room for 5 minutes. I have my user instruction sheet *the whole 2 sentences of it* that basically says it's an unreliable source of information and can't be relied on as legal proof.

Stefanie Graves said...

All this makes me tired, doesn't it you? We work around all sorts of things, too. Like we're supposed to scan the pt's id badge first, then the meds. This is supposed to be safer than scanning meds first and then the pt's id.Which is what we used to do, which allows us uninterrupted time to make sure we have all the meds on the list to be given at said time and in said amount. Without visitors or the patient trying to talk and ask questions when you're trying to concentrate. So. Many of my fellows-in-crime simply make copies of their pts' id labels and scan them and then the meds while in the comfort of the hall.

Manglement doesn't have a clue.

Scrub Ninja said...

Awesome.

This post is a couple of months old now, but I'd love to hear an update on what has happened since. Have any changes been made to the system? Or does it now show the entire nursing staff crowding into that restroom for their entire shifts?

Nikki Yeager said...

I was just going to second Scrub Ninja on that one - any updates on how you guys are holding up? There are a lot of EHRs out there that don't make the job that miserable, I'm sorry you ended up with one of the less user-friendly ones :( Sounds like a nightmare!

Do you think it would've helped if you would've been introduced to electronic health records while you were still in Nursing school? So at least you knew what you were getting into?