RE: [ihc] FWD: Why Doctors and Nurses Wont Use IT

Fulton,

 

Many thanks for this.  This is indeed insightful - and
corroborates the work I just did on the patient hand-off sheet.

 

Another problem is hand-off from like-to-like.  The paper has to
bridge this gap too.  Likelyhood is that the SBAR cannot occur in
all situations - since the nursing staff skills vary widely.  Then
the paper needs to function in another role - carrying the SBAR until
more experienced staff need it.  Hence the paper must also allow
for critical information to be readily acquired - and typically this is
hand written notes.  Computer screen design needs to reflect this -
so you would want the patient to wear an RFID - which when scanned
instantly brings up that same information.  Perhaps writeable
tablet technology is the bridge between paper and computer - or a
simple paper hand scanner...?

 

We could break this down into three sections:

 

1) Patient basics - condition - vital signs - demographics, etc.

2) Patient treatment history and drug details

3) SBAR information - critical factors to be aware of

DW

-------- Original Message --------
Subject: RE:
[ihc] FWD: Why Doctors and Nurses Wont Use IT
From: Fulton Wilcox
<>
Date: Wed, June 28,
2006 9:32 am
To: "'David RR Webber (XML)'"
<>,


The article in
today's Wall Street Journal referenced below is interesting from two
perspectives. 

 

First, it
highlights "handoffs" as being a critical weak point, where lack of
knowledge access/sharing can jeopardize patients. The fact that paper
and personal memory/observation "works" for individuals is not the same
as saying that those approaches work for the healthcare
system.

 

Second, it
describes a hand-off model based on concise checklists which improve
the situation although still relying on "oral tradition" and the
varying abilities of people to deliver or absorb handoff information.
 For system developers, the concise checklist approach perhaps a
model to be emulated.

 

 

                                                                                               
Fulton
Wilcox

                                                                                               
Colts Neck Solutions LLC

 

 

http://online.wsj.com/article/SB115145533775992541.html?mod=todays_us_personal_journal

 

Hospitals
Combat Errors at the 'Hand-Off'

New Procedures Aim to
Reduce
Miscues as Nurses and Doctors
Transfer Patients to Next
Shift
June 28,
2006; Page D1

For hospitals, the "hand-off" has long been the
Bermuda Triangle of health care: Dangerous errors and oversights can
occur in the gap when a patient is moved to another unit or turned over
to a new nurse or doctor during a shift
change.

…

 

But a few hospitals and health-care quality groups
have been ahead of the pack, borrowing communication strategies used in
aviation and the military, where hand-off failures can lead to
devastating accidents. The non-profit Institute for Healthcare
Improvement, for example, is working with hospitals on a communication
model known as SBAR -- an acronym for Situation, Background, Assessment
and Recommendation -- adapted from a program used to quickly brief
nuclear submariners during a change in
command.

 

 

From:
David RR Webber (XML) [mailto:] 
Sent: Friday, June 16, 2006 11:02
AM
To:
''
Subject: [ihc] FWD: Why Doctors and Nurses Wont Use
IT

 

 

Bob Lewis writes a column
on IT, project management and whatever

else peaks his
interest.

 

The following link is to
the particular piece.

 

http://weblog.infoworld.com/lewis/archives/2006/06/why_doctors_and.html?source=NLC-ADVICE2006-06-14

 

And there are many good
comments and postings to this as well - including why paper is better
than screens in a clinical setting.  

 

Personally I noted the
following -> add to that slow operation, poorly conceived functional
role, badly designed UI defaulting, no time set-aside for training, and
its amazing that any software gets used at all.  Notice the
reverse applies to clinical devices – heart monitors, IV pumps,
etc – that are much more “soldier proof” and mission
critical.  Even there however the amount of “smart
intelligence” in those devices (ability to detect if someone has
selected a whacko drip rate on the pump for example) – coupled
with difficult to read settings (yes average age of a nurse is 46 years
– so go figure tiny read outs are useless).
 
But of
course the nursing staff members are not the ones in charge of the
budget and selecting the software and tools – so don’t
expect this to change any year
soon…

 

DW