Sault, North Bay introduce electronic charting

The search for missing patient charts is about to end in North Bay and Sault Ste. Marie as both hospitals make the transition to electronic charting.

"It's a huge change for us," said North Bay General Hospital's Cathy Park, project manager for advanced clinicals. "The day we went live with the first phase of the rollout was January 26 and I think everyone could have used a good shot of valium. They had 12 hours of training, but they were like deer caught in the headlights. They couldn't remember."

Super users were available for coaching and extra staff were scheduled to help out, but "it was very stressful," said Park. "The second day was a lot better and the third day, with a new crew on the unit, wasn't anywhere near as bad as the first. Now, it's like a no-brainer. I can't believe how quickly they've settled into it."

Electronic charting allows nurses, doctors and other authorized health-care professionals to access a patient chart without having to look for it or wait for a colleague to return it to the nursing station.

"Right now, there's only one paper chart and only one person can have their hands on it at a time," said Park. "With patient documentation online, anyone with the right privileges can view it. We call it a patient care inquiry system."

Sault Area Hospital began training staff February 22 for a phase one go-live date of April 1. The second phase is scheduled for May 1, and by June 1, patient charting for the entire hospital will be online, said Johanne Messier-Mann, chief nursing officer and director, maternal child program and nursing practice.


Change

"This is the biggest change we'll ever implement aside from building a new hospital," she said.

"Most documentation is now on paper. It's fragmented. You can't read some of it and it's hard to access because, if you have a paper chart, you have a physician wanting it, a nurse wanting it, a physical therapist wanting it. When you go electronic, the chart is accessible to everyone and multiple people can view it at the same time."

Nurses at Sault Area Hospital will be assigned workstations on wheels, or WOWs, with laptops and medication drawers, but when they're in the new hospital next year, they'll be able to use bedside terminals that also provide TV service, Internet access and health-care education for patients.

Electronic documentation will streamline patient care and improve efficiency, said Messier-Mann.

"If I'm calling a physician because I'm concerned about a patient's status, the physician can go into the chart and have access to all of the information. It doesn't matter if the physician is in the hospital, in his office at the Group Health Centre or elsewhere in the community."

Hospitals that have already made the transition to electronic charting report efficiency gains of 30 per cent, said Park.

Pick lists and drop down menus will cut down on the time it takes to enter data and, with computers on wheels, nurses will be able to do their charting right at the bedside instead of making notes and then re-entering the information at the nursing station.

North Bay General looked at bedside terminals, but decided to go with conventional TVs to save money.


Policy review

Both hospitals took advantage of the opportunity to review their policies, practices and standards of care and to ensure they were reflected in the electronic documentation system.

"Every department came up with its own standards of care, specifying how often vitals are taken and things like how often you get a bed bath," said Messier-Mann. "It's all based on best practices and evidence-based care. This has been a huge opportunity for us to improve our charting."

Sault Area Hospital opted for charting by standards, while North Bay General decided to go with exception-based reporting, so the modules had to be customized to comply with each hospital's preferred methodology.

The Patient Care System at Sault Area Hospital has built-in triggers that automatically generate data entry fields based on information already entered. If the patient is immobile, for example, a skin assessment scale will pop up.

The system also allows for focused inquiries.

"If I'm a physician and I want to look at the dietitian's notes or the social worker's, I can click on them and see them," said Messier-Mann. "If I want to look at all of the charting relating to a cardiovascular focus, I click on cardiovascular and get all the nursing notes, respiratory therapy notes and relevant information."

Neither hospital is moving immediately to implement modules for physician notes and orders, but they too will eventually be adopted, as will bedside electronic verification systems for fail-safe administration of pharmaceuticals.


www.nbgh.on.ca
www.sah.on.ca