Robots, electronic records and hand-held devices streamline care but hinder bedside manner, some say

Nurses cast wary eye on high-tech advances

August 27, 2007|By Sindya N. Bhanoo | Sindya N. Bhanoo,Sun reporter

One nurse is pushing a computer on wheels into a patient's room; another is meeting up with Harriet, a robot that has arrived bearing medications. In a pleasant female voice, Harriet is repeatedly saying, "Your deliveries are here."

One floor down, another nurse at the University of Maryland Medical Center is writing patient notes onto a clipboard-size computer. And throughout the hospital, nurses and others are making the switch to online prescriptions.

The equipment relies on wireless connections available since 2001, and the transition to electronic health records began almost four years ago. Prescription orders were the latest conversion, with the majority of the hospital online by last Tuesday.

"With anything, it's a change in work flow and processes. The more you do it, the more confident you get with it," said Anna Schoenbaum, project manager for nursing informatics at the center.

Steadily, hospitals around the state and the country are moving toward technology-heavy systems for managing patient care. Yet as this use of technology grows, nurses say they have been overwhelmed with documentation, much of it requiring them to sit in front of a computer screen.

Some are counting on a flow of sophisticated new hardware or software to streamline their tasks. For now, they are juggling the demands with patients' expectations for a traditional presence at their bedsides.

Charlene Breckenridge, a transplant patient at the medical center, sees a lot of technology around her in the intensive care unit. She received a double-lung transplant that requires constant monitoring. Even in circumstances where recording vital signs is, in fact, vital, she longs for more personal attention.

"I'd prefer more checking on my comfort than a lot of paper and computer work on vitals," she wrote in a note, prevented from speaking by a ventilator that controls her breathing. Breckenridge, 59, who has worked in health care, said hospitals offered more of that 10 years ago.

Nurses remain the main point of contact for the patient, overseeing medications, meals and other aspects of personal care. Despite that role, nurses spend less than half their time working directly with patients, one study found.

At a recent American Nurses Association town hall meeting in Baltimore, nurse after nurse expressed concerns that cumbersome technology gets in the way of fulfilling the mission.

"I didn't become a nurse to be chained to documentation," Patricia A. Abbot, an assistant professor at the Johns Hopkins School of Nursing, said at the meeting.

On top of those demands, nurses are stretched thin by a shortage that is expected to worsen. Maryland hospitals need 2,340 more nurses to be fully staffed, the state hospital association reported this month. Nationwide, hospitals are understaffed by 6 percent, according to the American Hospital Association.

"You end up spending 30 minutes doing documentation for one patient on some systems," said Ronnie Ursin, a former nursing director at Suburban Hospital in Bethesda. He called the input "tedious," and some systems, clunky. Ursin recently resigned to begin doctoral studies in nursing practice.

Often, nurses said, they enter the same data twice, into a medical-record software program and then a prescription ordering system. They said software programs need to be simplified and better integrated with one another, requiring a single log-in rather than several.

There is a need for patient care models that are more efficient and effective, said Peggy Neidlinger, a 30-year nursing veteran and clinical systems manager at Johns Hopkins Hospital. She said powerful, user-friendly technology can help nurses manage patients faster and better.

Ursin noted that computers can prevent errors resulting from illegible handwriting or lost paperwork. Prescription-ordering software also warns if someone improperly alters a dose or prescribes medications that can react with others or cause allergies.

Computerized prescription systems designed to prevent errors were found to improve accuracy by as much as 55 percent, according to eHealth Initiative, a nonprofit organization promoting safety through technology.

The adoption of electronic health records is at an early stage. A quarter of U.S. hospitals had such systems in place in 2006, according to the Healthcare Information and Management Systems Society. The Maryland Hospital Association was unable to provide state data.

"Historically, medical records were quite loose and undisciplined in quality and type," said Dr. Peter B. Angood, vice president and chief patient safety officer for the Joint Commission, which accredits health care organizations. For quality-control and legal reasons, rules have been tightened.

"If it's not documented, then the care is considered not provided," he added. The requirements for careful documentation "will not go away," but the use of technology might improve the stress on health care providers, he said.

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