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Nursing I.T.: From Stations to Bedside


By Bill Briggs, Senior Editor July 2006
Sometimes short answers say the most. When famed mountaineer George Mallory was asked why he wanted to climb Mt. Everest, he replied "because it is there." Similarly, ask many nurses and hospital executives why I.T. is increasingly needed at the bedside and they'll say "because that's where the patient is."

It sounds logical, but until I.T. took a few steps down the hall in recent years, nurses couldn't enter or access electronic data at the patient bedside.

It wasn't long ago that tasks such as recording fluid input and outflow were noted on a paper form and copied to another form at the nurse's station. The process was upgraded to documenting on paper forms and entering data into an electronic charting system at the nurse's station. A sign of progress, but there clearly was untapped potential.

Over the past decade, hospital computers started to migrate from nurse stations to patient rooms. But they entered the room gingerly, fearful of spooking patients with too much machinery and inattentive caregivers.

Recently, however, increasingly stable wireless networks and a slew of highly functional mobile devices have sent many facilities racing to the bedside. And nurses who have successfully used technology at the bedside have growing expectations and are beginning to demand more functionality at the point of care.

But moving I.T. to the point of care is no simple feat. Staff preferences, and space and technology limitations, complicate the task and often force organizations to juggle multiple types of hardware and software while trying to get to the bedside.

Nevertheless, the combination of improving technology and heightened caregiver expectations is driving organizations to devise far-reaching technology strategies.

WellSpan Health in York, Pa., for example, plans to push the bulk of its clinical processes to the point of care using wireless networks and an electronic medical records system.

Sue Thomson, R.N., is clinical process redesign consultant at WellSpan, a two-hospital delivery system with 556 beds. She says bedside documentation is in its early stages there, but more is in the offing. Nurses are now using computer carts and Tablet PCs.

Early stages

"We're in the infancy of documentation," she says. "We now have nursing assessment available via computer at the bedside. If a patient is admitted today, goes home and comes back, all their data is retrievable."

That means not asking patients repeatedly whether they smoke or drink or about their medical history. Such information is available at any computer in the two hospitals, but most importantly at the bedside. "Now nurses can just ask if there are any changes," Thomson adds.

Such improvements go far toward customer satisfaction, but also improve patient safety and save nurses time. "As we go further with accessing more processes we will be able to bring up daily nurse assessments and any condition changes can be confirmed from shift to shift," Thomson explains.

Thomson expects most nurse documentation to be done at the bedside at WellSpan within the next two to three years. That includes pharmacy and emergency department data as well as basic information such as vital signs. Point-of-care "dumping," or downloading of data such as blood pressure readings, also soon will travel wirelessly to WellSpan's electronic medical records system, from Cerner Corp., Kansas City, Mo. Wireless technology is from Cisco Systems Inc., San Jose, Calif.

"The shift to the bedside is in gear," says Ruth MacCallum, R.N., senior consultant at Healthia Consulting, Minneapolis. "It's not in overdrive yet, but nursing as a profession is embracing the concept of having information available to them where they need it."

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