Computer Charting's Effect on Nursing

Computer Charting's Effect On Nursing And Health Care Technology has changed every significant industry on Earth, and perhaps the industry most affected outside of telecommunications and travel has been health care. Medical innovation goes hand-in-hand with technological innovation, and so many of our most technically advanced procedures depend solely on technology for their success.

For instance, the balloon angioplasty has saved countless cardiac patients' lives, but the procedure does not exist without the technology to produce and insert the catheter and the computer imaging that guides the cardiologist in its implementation. One such innovation in health care is computer charting. One of the major advantages of computer charting is that a patient's medical information can be accessed from anywhere within the hospital. Another advantage is that computer charting eliminates the problem of interpreting poor handwriting and suffering from the resulting errors in interpretation.

But perhaps the greatest benefit of computer charting is that it leads nurses to comply with "good nursing" methods by providing the essential template for their daily work. A recent University of Edinburgh study out of the United Kingdom dealt very methodically with the advent of computer charting in nursing. The study compared charting of physiological parameters manually by nurses and automatically by computer to decide whether the task could accurately be performed by computer.

(Cunningham, 1996) The study tested 101 consecutive patients admitted for tertiary neonatal intensive care and resulted from 48 hours of data collected from both nurses and from computer charting mechanisms. (Cunningham, 1996) More specifically, computer data stored each second and the resulting hourly median were compared with the single hourly value calculated by the nurses. (Cunningham, 1996) All patients were monitored by a standard patient monitor and by a computer. Four physiological parameters were compared between the nurse reports and the computer reports.

(Cunningham, 1996) Both derived their information from the standard patient monitor: This included information on heart rate, transcutaneous oxygen, mean blood pressure and central temperature. (Cunningham, 1996) random 51% sampling of patients had the computer data displayed as trends at the cotside. (Cunningham, 1996) Comparison of the hourly nurse observations and a computer hourly median value was the critical determining factor in the study. Computer data was compared before and after the removal of the data collection artifact, to provide the most controlled conclusions from the data.

In addition, the study measured the effects on nursing observations of either display or non-display of the computer trend data. (Cunningham, 1996) The study found that the nurse-observed and the computer-charted data were significantly statistically different. (Cunningham, 1996) However, the critical observation of the study was that these differences were not clinically significant. (Cunningham, 1996) According to the study's authors, "Nurses tended to note a higher figure than the computer median. The cotside display of computer data improved consistency between the nurse and computer observations.

Artifact present in the data had little influence on the accuracy of the computer median value." (Cunningham, 1996) In other words, the computer charting proved eminently successful. According to the study's authors, "Computer systems can accurately chart physiological data, providing a more flexible record with a minimal risk to data reliability from artifact." (Cunningham, 1996) This is a tremendous discovery for those in the health care profession.

In my experience, I have found that devices such as palm-WebMD and other innovations truly help in organizing patient data and keeping various treatment methods at the health care provider's fingertips. Another recent study also focused on the benefit of computer charting. In this study, a respiratory care computer-charting system was developed and implemented as an addition to a hospital's computerized information system. (Andrews, 1985) Medical personnel charted and reviewed respiratory care procedures at nursing station computer terminals instead of the traditional method of using the patient's traditional paper chart.

The computer automatically performed several billing and provided management as well as clinical information. (Andrews, 1985) in an attempt to isolate specific benefits or shortcomings, we evaluated charting systems both before and after the advent of the computer implementation. Four assessments were made: (1) a survey of therapists' attitudes, (2) an observation of work patterns, (3) an audit of the content of charting, and (4) an analysis of productivity statistics. (Andrews, 1985) The study found that computer charting was well accepted by therapists.

"Charge capture was reduced from a four-step manual process to a single-step computer documentation of the procedure. Computer charting was more complete and informative. Productivity increased 18%, although it remains unclear to what degree the computer was responsible." (Andrews, 1985) In conclusion, the study determined that computer charting streamlined the process of documentation and allowed more beneficial use of clinical information.

(Andrews, 1985) In other words, the study fell in line with the later Cunningham study in that they both noted that computer involvement in various stages of health care provision via computer charting truly benefits the health care provider and the patient. In addition, it streamlines costs and eliminates costly errors. College health systems benefit especially from computer charting, according to Carol Mulvihill, R.N.,C., CQ Editor and Director of Health Services, University of Pittsburgh at Bradford.

She notes that there are several advantages of documenting nurses' notes on the computer rather than by hand. As noted above, first, charts are always legible. (Mulvihill, 1997) Time is saved and errors and avoided by eschewing bad handwriting gaffes. Second, computer charting saves time. Charting can be done more quickly once the technique is learned, and it does not take too long to learn. Saved time can then be reallocated to patient care or administrative duties. (Mulvihill, 1997) Third, according to Mulvihill, "You can avoid repetition and misspellings.

Instead of writing the same protocols and treatment plans over and over again on different charts, frequently used phrases or protocols can be stored in AutoText in Microsoft Word and added to a patient's chart with a few clicks of the mouse or a few keystrokes." Fourth, there exists consistency in the charted protocols and treatment plans and procedures, but they can still be modified for each individual patient according to his or her needs. (Mulvihill, 1997) Fifth, computer charting data can be stored more easily and called up more easily.

According to Mulvihill, charts can be stored on the computer hard drive or on diskette, and printed out, signed and placed in a file drawer. (Mulvihill, 1997) With the advent of HIPAA, the privacy benefits of computer charting must be noted as well. "It is easier to maintain the confidentiality of the record in the midst of numerous interruptions, which occur in the office. The chart can quickly be put out of sight using File Save and Close if someone walks in or.