Thursday, December 17, 2009

The blue glove medical record

From a close friend, about an experience in another hospital:

So, Mom is taken to the ED over the weekend for treatment of an infection. On one side of the room is the computer terminal for EMR access, with ever-changing screen savers touting the benefits of using the electronic record: safer, faster, more accurate, easier for the provider, better for the patient, etc. On the other side of the room, connected to Mom, is the electronic vital sign monitor: heart rate, blood pressure, oxygen, etc.

Half a dozen times, the tech came in to record her vitals. The procedure is: Put on one blue latex glove, take a Sharpie, write down the vital signs on the back of the gloved hand, leave the room, repeat a few hours later.

Does the blue glove go into the paper record? I dunno, but I guess the fancy EMR and the fancy electronic monitor don't talk to each other, because we have to rely on double manual transcription to record vital signs.

By the way, they use the same procedure up on the floor. Plenty of opportunity for improvement in health care.


Anonymous said...

It's no fun on the nursing end either! There's also no such things as a USB thermometer.

Jeremy said...

Having worked at facilities where the equipment does and does not "talk" to one another I would like to offer some insight. The monitor and the computer can communicate but software is the problem. When my hospital was investigating obtaing new monitors many people asked the reps if the information from the monitor could be transcribed to the EMR and 1 rep said yes with new software as well. The other rep mentioned they did not offer that at this time. Great! the nurses picked the equipment that could communicate. The problem, although many nurses commented they would like to see the hardware bundled with the communicating software to move toward the future this was not what we got. Additionally, my hospital tested tablet pc's with barcode scanning. Awesome, we can start scanning id bands, meds, and increase safety. Now the tablet pc's sit in physician charting areas, no barcodes on id bands. Still using the addressograph to make id bands, labels and stamp forms for the paper chart.
Working in a Cardiac Surgery ICU I see many things that have the potential to communicate with the EMR. IV's, foley's, Chest tubes, ventilators in addition to vital signs. When these patients return to the ICU from surgery they are basically in shock. Our job as the nurse is to connect the wires to the bedside monitor, which is another problem, and begin copying on to a paper chart vital signs, urine output, chest tube output, any iv medications infusing and spend time caring for this critically ill person.
I as well see the benefits of the EMR, the problem is the focus is elsewhere, medicare not paying for skin injury, healthcare acquired infections but the ICU is understaffed because of other financial burdens. People do not stop coming to the hospital but nurses have to write vital signs on gloves in the case of people with drug resistant organisms.

Anonymous said...

Cheer up, I once discovered, as blood bank medical director, that the OR nurses were writing the patient's medical record # on the thigh of their scrubs for when blood was transfused intraoperatively, because the wrist band was hidden under the surgical drapes. They were actually grateful to me for initiating the formal process to find a better way, because they knew this wasn't right.
My question is (and was then), why aren't the supervisors aware of this and working to fix it??!!
Answer: a) they see nothing wrong with it, or b) they sit in their offices and don't know it's happening.
It's no wonder there's a bunch of angry patient advocates out there. (I've encountered them recently).
Improvement is just too slow.


Andrew said...

Oh, so many problems
- ER chart is paper, only after admitting the patient is the data collected electronically (this is the status at my hospital)
- patient has cooties, tech wants a chance to wash hands before typing up info
- bedside computer has so many firewall controls in place, to prevent unauthorized access, that it is actually faster to do the glove-to-next-room thing (also the status at my hospital),
- tech has never been trained in the use of the computer, and has no incentive to do so ("Use the computer correctly or find a new job.")

Anonymous said...

I don't think that anecdote sounds like "meaningful use", does it?

Harry Mattison said...

What a sad irony that on the same day you write this post, David Pogue over at the NYT writes about how gracefully and effectively new devices can track how many steps a person takes each day. Clearly something is wrong based on this difference in how technology is being developed and deployed.

Getting Fit With 2 Bits of Help

Jim Fackler said...

There a a couple of companies that specialize in the data communication between POC diagnostic devices as well as between POC monitors and therapeutic devices. The data can also be presented to EMRs in real-time so access is immediate and ubiquitous. The blue-glove strategy needs to die.

Anonymous said...

Jim and others;

Yeah, but - I keep thinking here, where is the basic recognition on the part of those in charge that the blue glove is not the way to do things???!!! And then the action which should follow such recognition? I think sometimes it's easier to sit still and blame the computer vendor, or someone else, or something else, but take no action.


Anonymous said...

We use CareFusion which allows us to scan the patient, take the vital signs, obtain blood work, give medications, or give blood transfusions. They are then scanned and then automatically download into the EMR. It is all possible and works extremely well but is expensive to implement.

Paul Levy said...

Transferred from Facebook:

Emily: Is this a trend? The EMT did this when Andrew's dad (in London) fell a couple of weeks ago. It seems cute on the face of it, and may address fears of infection, but you're right, how is this potentially important information going to get into the official patient record?

Jean: Is this an assumption that the fancy EMR and the fancy electronic monitor don't talk to each other? Or do they talk to each other at a different level than the person that wrote the vital signs on the blue glove. With all the HIPAA rules maybe the blue gloved person does not have access to the electronic record. Maybe a root cause analysis is necessary before we jump to conclusions.

Equbal: We have come a long way but we still have a long way to go. Welch Alyn makes wireless vitals monitors that can be integrated into the EHR. It takes time and a lot of $$$$ for such transition. Unless you are willing to donate all your vitals monitors to the third world countries now and upgrade! Even then, full integration is not here yet. :)