Medanets news

Documentation: Always Performed for a Good Reason, Not Just to Pass the Time

Hoitotyön kirjaamisen tärkeys

There is no getting around documentation. It is indispensable to patient care.

During a treatment period, the patient may have several different doctors and nurses. How could the care staff keep track of the patient’s condition and the procedures performed without exchanging information? The answer, of course, is that they couldn’t. Documentation is a prerequisite for safe, high-quality care.

According to an article in Sairaanhoitajalehti [1], a magazine published by the Finnish Nurses’ Association, point-of-care documentation still has some shortcomings, however.

Not Documented Means Not Done

The reason, why not all information related to patient care might not be documented, is related to the workload of the documentation and the time it takes. One study [2] shows that documentation consumes no less than 31% of a nurse’s working time. According to the same study, only 21% of the working time is left for interaction with the patient. There is no good reason for undocumentation, however. Each documentation entry is important.

Research [3] has shown that sub-standard documentation leads to prolonged hospital stays and even increased mortality among patients. There will be consequences when communication among healthcare professionals breaks down.

Failing to document not only undermines patient care, but also makes nurses more vulnerable to legal claims.

A Case of Absent Documentation

A nurse measures the blood pressure, the temperature and the oxygen saturation of a patient during the medication administration round. The values are slightly outside the normal reference values, but since the patient appears to be doing very well, the nurse is not concerned. The nurse is called to provide some urgent care and forgets to document the measured values.

Later, the evening shift nurse checks the patient’s data and does not find any mention of the patient’s differing values. This nurse administrates the patient’s evening medication and moves on to see another patient. The night shift nurse does likewise, deeming the patient’s condition normal since the patient appears to be doing well and the patient data indicates no differing values.

Is the patient’s condition deteriorating? No one knows because no one perceives that the measurement values are, indeed, sinking more than they should.

On Behalf of Better Care

Documentation enables better care both now and in the future.

  • Now – the people caring for the patient have up-to-date information on the patient’s condition.
  • In the future – documentation will bring content to clinical decision support systems, whereby patients in a similar situation can receive better care.

References:

[1] Sairaanhoitajalehti (03/2019). Kirjaamisessa yhä puutteita. <https://shlehti.sairaanhoitajat.fi/share/13671/276a72> 28 Feb. 2019.

[2] Ascom & Wilke (2015). How do nurses spend their time? An analysis of tasks and time use.

[3] Mathloudakis A., Rousalovia I., Gagnat A.A., Saad N. & Hardavela G. (2016). How to keep good clinical records. Breathe 12(10), 371–375.

Avoid Risk, Avoid Damage

Preventive measures make the most effective way of avoiding risks in human and economic terms. A variety of indicators have been developed to support caregiving, helping to identify the risks at an early stage and target medical resources properly.

Among the risk assessment tools used most commonly in Finland are the Braden Scale assessing pressure ulcer risk, Nutritional Risk Screening 2002 (NRS 2002) predicting the risk of malnutrition, and the Falls Risk Assessment Tool (FRAT) predicting the risk of falls. However, the practical implementation of these risk assessment tools (i.e. paper forms, mental scores calculation, table interpretation and the challenge of documentation) as well as the busyness of caregiving often cripples their use.

Treatment costs when risks are realized

Risk assessment by nurses should be systematic and continuous in both hospital wards and home care. Recurring risk assessment takes its time, but considerably less in terms of cost than having the risk realize.

  • Annually, the cost of pressure ulcers in Finland is more than 400 million euros, or about 2–3% of Finnish healthcare expenditures. About 95% of these pressure ulcers would be avoidable with preventive measures. [1.]
  • Malnutrition lengthens a hospital stay period by 3–6 days, up to tripling the cost of treatment [2].
  • In 2000, the cost of acute outpatient and inpatient treatment of falling injuries sustained by people over the age of 64 in Finland was about 39 million euros. The expenses are expected to rise up to 72 million euros by 2030. [3.]

Moving to Digital

Completing risk analyses and forms along with filing risk scores ought to be brought into this decade. The practical implementation of risk assessment tools should support caregiving and not burden it. Paper forms are a burden to work.

In the autumn of 2018, Seinäjoki Central Hospital began utilising the Medanets application in risk assessment. The mobile solution steps through the assessment criteria of the selected risk indicator (e.g. Braden, NRS 2002 or FRAT) and automatically calculates the total score. In addition to this, it shows the nurse the instructions for action corresponding to the score. The risk score itself is filed via the mobile solution directly into the Electronic Health Record. When work that was previously done manually is automated, the nurse can focus on patient care.

Mobile Forms Lower the Threshold

As the patient risk status can be assessed quickly and easily, it is also assessed more frequently. A smart phone goes along with the nurse not only in terms of work flow, but also in terms of other duties. Thus, the threshold for completing a mobile form is not big. Regular risk assessment, in turn, helps to prevent harm to the patient.

In addition to Seinäjoki Central Hospital, the solution is being used at Satakunta Central Hospital, Kainuu Central Hospital, and Raahe Hospital. Kanta-Häme Central Hospital and Päijät-Häme Central Hospital will be introducing the risk assessment mobile function in the early part of 2019.

Moreover, Päijät-Häme Central Hospital is introducing not only the Braden, the NRS 2002, and the FRAT mobile functions, but the following other risk assessment functions as well: Geriatric Depression Scale 30 (GDS30), Alcohol Use Disorders Identification Test  for the over 65s (AUDIT65), Alcohol Use Disorders Identification Test—Consumption (AUDIT C), Pain Assessment in Advanced Dementia (PAINAD), Beck Depression Inventory 21 (BDI-21), Mini Nutritional Assessment (MNA), and Complementary and Alternative Medicine (CAM).

References:

[1] Harjumaa, M. 2013. Painehaavat käyvät kalliiksi. Sairaanhoitaja 13, 10.

[2] Karuvuori, A. 2013. Ruoka on nostettu pöydälle. Sairaanhoitaja 12, 16–25.

[3] Piirtola, M, et al. 2002. Iäkkäiden kaatumisvammojen akuuttihoidon kustannukset. Suomen Lääkärilehti 57, 4,841–4,848.

Mobile Photos Used for Fast Remote Consultations, Let’s Also Do It Data-Securely

A patient is showing some alarming skin symptoms and needs a dermatologist consultation. Instead of sending the patient to another unit to be examined or having them wait for the dermatologist to show up, the nurse takes a photo of the patient’s skin and sends it to the dermatologist for a remote consultation.  After viewing the photo, the dermatologist can then provide advice on what course of treatment to take. However, photos of a patient cannot be taken or distributed without taking the correct information security measures.

Clinical photography is an invaluable tool for healthcare professionals. The old proverb a picture is worth a thousand words is extremely apt when it comes to areas of medicine that use visual diagnosis, such as dermatology. Photos are included with treatment data and are used for, among others, consultations, monitoring the healing of wounds, examinations and future training functions.

Many healthcare professionals already use smartphones in their work, so it is only natural that the same phone can be used for taking and sharing clinical photos. Naturally, a digital camera/computer combination also works, but it takes time and care to ensure that the photos are not left on the device after sending them*.

*Example: If the patient’s skin is showing symptoms on different parts of the body, multiple shots must be taken to provide an overall idea of the patient’s condition. In such cases, a large number of photos might be made, which would thus increase the amount of work to manually transfer the data and ensure that none of the photos are left in the device.

Due to the sensitive nature of clinical photos, attention must be given to the proper documentation, storage and sharing of the images.

Data-Secure Use of Photos Taken of the Patient

The patient’s verbal or written consent is required prior to taking photos of them. This is particularly important when taking photos of faces, tattoos or other identifiable features. In order to safeguard the patient’s rights, clinical photos must never be stored on the smart device itself – they must be transferred directly to a secure photo archive used by a hospital or health care centre.

Maintaining confidentiality is more difficult when photos are stored on a smart device (this also applies to digital cameras), thus making them accessible to people not authorised to view them, whether intentionally or unintentionally. Data must also be transferred using a secure connection. The only people who have access to the photo archive are the healthcare professionals involved in treating the patient.

Mobile Photos Help in Making Treatment Decisions

For the aforementioned needs, Medanets has developed a new addition to its product line. The Photos-feature can be used by healthcare professionals to take a photo of a patient with a smart device, add detailed information to the photo and, using a secure connection, store the photo directly in a photo archive at a hospital or health care centre – no photo is kept in the smart device itself.

Because the photo is stored electronically, the information will be immediately available for use by other professionals involved in the treatment. Read more about the benefits of real-time patient data. The primary benefit of this feature is its ability to take and share photos of the patient’s condition quickly, easily and securely in order to monitor the progress of treatment and allow other clinicians to assess the situation.

With remote consultation, the need for the patient to move from unit to the next is also reduced, thus allowing the healthcare resources to be allocated more effectively.

Treatment Situations Served by the Use of Photos

1     Skin diseases

Dermatologists are often responsible for a large number of patients over an extensive area. In cases where there is only one dermatologist in a given area, patients may spend hours waiting for a consultation or moving from unit to unit. Dermatologists can often provide advice on the best course of treatment for a patient simply by viewing a photo of the skin condition.

2     Plastic surgery

The conventional before-and-after photos used in plastic surgery can easily be produced with the Photos-feature. The photos contain detailed information on the patient, the person taking the photos and the procedure, along with timestamps.

Plastic surgeons are often consulted on the treatment of patients brought into the intensive care unit to treat wounds. A remote consultation based on the photos provided will convey information on the recommended course of treatment more quickly than waiting for the surgeon to arrive.

3     Wounds

Photos of all types of wounds can be taken on a regular basis to monitor the healing progress. This information helps in making treatment decisions, whether this involves a request for a second consultation and opinion or simply a confirmation that the wound is healing properly.

4     Assault

If the patient has been brought in for the treatment of injuries resulting from an assault, the photo must be taken to determine the treatment situation, protect the patient and document the injuries. Treatment progress can also be monitored by examining the photos.

5     Eye disorders

A preliminary case study shows that smart devices can also be used in eyeground imaging when a specialized lens is mounted to the device’s camera lens. The result is sufficient enough to determine the best course of treatment.

How Can Thousands of Mobile Devices and Their Features Be Implemented in Hundreds of Wards?

Utilizing mobile devices in hospitals is in line with behavior associated with the technology of today. Bringing mobile devices into the hospital environment for the first time is not an easy task, however. It requires in-depth examination of device policies, existing systems, technology implementation, as well as impacts on patients and personnel. This article describes how Medanets solutions are introduced in wards and how they are customized for various needs.

1.        Policies

The organization should formulate clear policies and procedures on how mobile technology can and should be used, as well as on how the devices and applications are managed. The formulated policies must also address the questions of which data is at stake, who uses it, for what reasons and where. Mobile policies are as good as their enforcement, which is why carrying them out in practice should also be monitored. Furthermore, to ensure commitment, it is important to involve the care staff in the decision-making process already at an early stage.

A mobile policy does not have to be made from scratch since support for the process is provided, for instance, by Medanets, which has several years of experience in mobile policies. The tried and true procedures of our existing customers are also worth gold to others grappling with the same issues.

To give an example, one of our customers established a steering group comprising professionals from various fields to coordinate, direct and evaluate the various digitalization pilots, commissioning processes and the needs of professionals.

2.        Compatibility

In terms of smooth functioning, it is essential for the new systems being introduced to be compatible with existing systems. Integrations between systems enable seamless data transfers without manual intervention, among other things. Moreover, the work flow of the care staff becomes easier if they are able to use a single user ID to log in at each technology platform requiring a separate login, be it a working station, a mobile device or some other equipment.

Medanets solutions are always integrated with the customer’s existing systems, such as the Electronic Health Record and patient monitoring systems. Medanets application login is also always adapted to the customer’s infrastructure to utilize existing login methods.

3.        Customizability

Due to the varying needs and policies of hospitals and wards, the tools introduced in the organization should be separately modifiable. When the wards are able to personalize their solutions, caregiving does not have to be modified to meet the system, but rather the system can be modified to support current caregiving processes.

With the Medanets administration tool, entering and displaying data can be defined ward-specifically. For example, the location, the name and the visibility of each parameter in the application can be defined separately so that there is no interference from unnecessary parameters. The various features of the application can also be hidden if their purpose is not suitable for the ward in question.

4.        The Choice of the Mobile Device

Naturally, the needs of the organization and the availability of resources affect the choice of the mobile device. When choosing the device, one should consider what kinds of features the organization needs to access and the kinds of conditions the device should withstand. The user-friendliness of the device should also be taken into account. Options include smart phones, mobile devices designed for professional use, and tablets.

Medanets solutions work mainly on Android devices. This year, our solutions can also be used on iOS devices. This will give our customers the opportunity of choosing from several device options. Currently, our solutions are most commonly used on Samsung J5, XCover 4 and Ascom Myco.

The care staff has found the smart phone a pleasant tool since it is easy to carry along. Furthermore, a smart phone leaves the caregiver with one hand free to proceed with the caregiving. We would be happy to tell you more about our experiences with mobile devices suitable for various purposes.

5.        Management Solutions and Infrastructure

The centralized management solutions of mobile devices enable determining the necessary data security level of the devices for their secure use. This applies to the workspace of both trunked and individual devices. You should be able to install, update and configure mobile applications centrally and remotely. With risk management in mind, it is also advisable to ensure that the application can be updated quickly regardless of the location or the user of the mobile device. For example, the most common operating systems, Android and iOS, are updated at a rapid pace with updates often requiring changes to the applications running on top of them.

Furthermore, one should keep a list of the devices being used and take an inventory of them periodically so that any loss of a device can be detected and protective measures taken. Utilizing personal devices requires Bring Your Own Device (BYOD) support from the management solution while the BYOD itself requires a systematic mobile policy in other respects as well.

With regard to infrastructure, the customer may, at the worst, have to renew the entire wireless network in order to support the latest means of connecting mobile devices to a network, which is secure and compatible with the device management solutions, or just to improve poor reception.

Medanets supports all mobile device management solutions (Master Data Management / Enterprise Mobility Management (MDM/EMM)) that include an application configuration feature. With regard to the Medanets solution, implementing a new device has been made as easy as possible so that the application can also be successfully installed by ward personnel if necessary. The distribution and configuration of smart iOS applications is so developed that a device delivered by the supplier can be opened in the ward and the personnel can begin using the Medanets application immediately.

Due to its offline functionality, the Medanets application will also work in dead spots, so the application does not need a continuous network connection. If a device is lost, access to the Medanets application can also be blocked for the device in question.

6.        Piloting

Before any comprehensive implementation, it is advisable to pilot the new mobile solution at selected wards. The functionality of the solution can thus be ascertained with an early response to any suggestions or feedback from the user group on how the solution could be used its members in the best way. When piloting is conducted well, implementation at other wards will succeed even better.

The Medanets solution includes a variety of different features that can be piloted separately before the official decision-making process. Moreover, we are constantly developing our operations according to the feedback we receive so that the solutions can be integrated with caregiving processes as seamlessly as possible and that at their best the solutions will further develop those processes.

7.        Implementation

After a successful pilot, implementing the solution can begin at other wards. Implementing the new solution in the organization will not happen in an instant, but once the stages in accordance with the paragraphs 1–6 are performed in an exemplary manner, each implementation will become less complicated. In addition to the points mentioned above, implementing can be facilitated by emphasizing active communication, training and member commitment, as well as management support for system use. In addition to internal communication within the organization, there should be open communication with the suppliers as well.

Medanets supports the customer at each stage of the project – with a fine, constructive partnership excellence can be achieved. The project culminates in training sessions that are carried out as non-stop training. Medanets trainers will then personally teach the wards how to use the solution. The issue of which of the various application features will be introduced at which wards is defined depending on the needs of the customer and the wards. After the training session, application use support will be available from key users and our Helpdesk.

8.        Monitoring

The end of user training in the wards does not mean that the implementation of mobile solutions is over. In order to ensure the success of the project, implementation should be monitored afterwards. Any problems can be addressed immediately with the help of user reports. For example, if the utilization rate is low according to the report, the end users can be asked to provide a reason for this and efforts can be made to remove any obstacles.

With the help of the Medanets reporting tool, the customer can view observation values, medication administration entries, as well as the number of devices being used and the number of individual users. The data which identifies the users and patients is not saved. In addition to this, the system produces reports on the number of patients by risk category based on the Early Warning Scoring (EWS) and the risk assessment indicators.

Implementing new technology in wards successfully requires the project to be planned, carried out and managed with care. New tools also bring in new policies and procedures. The process does demand practice, but the benefits to the hospital, the healthcare professionals and the patients are proven to be real. – And hey, we are here at Medanets to help you in every situation especially when you face a challenging one!

Closed Loop Medication Administration: Electronic Verification of “the Five Rights”

“The five rights”: This is how many things should go right in order to be able to ascertain proper medication treatment. If you wish to put closed loop medication administration (CLMA) in order, electronic verification should be used to ascertain “the five rights”. These include the right patient, the right medicine, the right dosage, the right time and the right means of administration. Electronic verification can be achieved through data systems and technology.

Only one of the central hospitals in Finland has been granted stage 6 of the Electronic Medical Record Adoption Model (EMRAM), which entails the CLMA, by the Healthcare and Information and Management Systems Society (HIMSS). Close loop medication means that the whole dispensing chain of medication should be electronic and that at no point in the chain is the data transferred via printed matter. Medication data is thus in real time at every stage and immediately available to the people participating in the patient’s care.

The purpose of the electronic medication care process is to eliminate information breaks and minimize errors. In practice, an error can occur at any one of four different stages of the medication process, namely while prescribing, processing, dispensing or administering medication. As a consequence of a medication error, a patient may receive inappropriate medicine, the wrong dose or medicine intended for another patient. Medication may also be administered, for example, at the wrong time. In the worst case, erroneous medication can lead to the patient’s death.

Nowadays however, data systems and technology can be utilized at the various stages of the medication care process, thereby eliminating many of the most common medication errors.

1.)   Prescribing medication via mobile device or computer

As the prescription of medication shifts to an electronic and, above all, a structured format, handwritten prescriptions go out of use and the number of common errors caused by misreading illegible handwriting is reduced. When the prescription tool is integrated into the Electronic Health Record, the clinician receives information on any allergies the patient may have and other safety factors immediately while prescribing the medication.

2.)   Receiving and checking electronic prescriptions

The safety factors, contraindications and appropriate dosages of electronic prescriptions received by the pharmacy are checked automatically. In addition, the alternative medication dispensed by hospital pharmacies (depending on the stock situation) are saved in the Electronic Health Record. At the administration stage, precisely the correct trade name of the medication is shown.

3.)   An automated administration system

The bar-coded packs of medicines are stored in a smart medicine cabinet, which electronically directs the caregiver to take the right medication for the patient. The medicine is then documented with the help of the bar-code and machine sealed into a sachet. The sachet is not opened until the patient takes the medicine.

4.)   Electronic verification and documentation

Before administering a medication, the electronically identified caregiver checks the medicine, the dose and patient compatibility by reading the patient wristband and the sachet containing the medication dose. The tool accessed should be easy for the caregiver to take along and it should be integrated with the Electronic Health Care so that the updated patient and medication data is unambiguously available to the care staff. The entry for each administered medication is made by electronic means, whereby the information about this is saved into the Electronic Health Record at once.

In order to achieve the EMRAM stage 6, the medication care process should be without gaps and automated as far as possible. The solutions to reaching this stage exist already, so the next step is to introduce them within the organisation and put them into practice. No transformation happens overnight, however, and it is likely to be met with opposition as well. By understanding the transformation, however, the situation is easier to appropriate and implement within the organisation.

Learn more about how to do away with papers in the health care sector, how the public IT projects of the health care sector can be successful ja how the Hospital District of Southwest Finland utilizes mobile medication feature.

Digital Caregivers Talk about Their Mobile Experiences

The Hospital District of Southwest Finland has been using Medanets mobile point-of-care solutions since 2015. Now the users of these mobile solutions, or digital caregivers, are talking about the suitability of mobile tools to their care giving routines. This blog article was compiled from the Medanets experiences of caregivers employed in the various units of the Hospital District of Southwest Finland.

A Change in the Right Direction

The exploitation of point-of-care technology is a major advancement and mobile documentation is the cutting-edge clue to a modern workplace. Clearly, work equipment has to bring work some added value, meaning that it has to lessen the work load and make things easier. Mobile documentation does this by advanced means. When caregivers do not have to take the time to open the computer to do documentation separately, working becomes more efficient. For once, there is change for the better.

Mobile documentation has been received positively. It is good for the things involved in documentation to become faster. The time saved by mobile documentation can be used for care giving, which provides more interaction between caregivers and patients. This also facilitates the flow of work as caregivers can mark everything down and check previous measurement results straight away. They have to go to the office less often, which means less strain on their feet.

The Caregiver’s Mainstay

Without a doubt, mobile documentation improves the quality of documentation. Scanning through the patient data ascertains that the data being recorded concerns the right patient. Values measured earlier can be browsed easily, for example, while the caregiver is beside the patient. The values are displayed in the Electronic Health Record (EHR) immediately, being visible to all who access the system. Having the present situation thus visible eliminates the chance of giving a medicine twice, for example. The data is quickly accessible to physicians as well—and not on some piece of paper in the caregiver’s pocket. If patient data can be kept pretty much in real time, it promotes patient safety.

For example, the monitoring of an acutely ill patient is displayed immediately since the data is displayed in the systems in the time it takes to record it while beside the patient. It is then easier for others to continue working after the shift changes. The appropriateness of having right timing has often proved advantageous to caregivers, for example, in the event of an emergency. The application functions as the caregiver’s mainstay in many respects. For example, caregivers do not have to remember the figures and this reduces the chances of erroneous documentation.

Mobile documentation is also significant in terms of occupational safety, for example, during a power outage or software update. After a system interruption, the data recorded via the application is transferred directly to the right place in the EHR without anyone having to engage in tiresome copy and paste work.

A Wonderful and Perfectible Reform

When developing new work equipment, sufficient orientation and reasonable introduction time must be allowed. Using the mobile documentation application can be learned quickly, however. For users who are accustomed to smart phones, it is fairly easy. Orientation and training seem to have been sufficient and even now knowledge passes quickly from one person to another. After all, the best way of learning how to use a mobile device is by using it.

Mobile documentation is a wonderful reform and it would be good to develop it further. For instance, access to mobile documentation should be encouraged more and its potential should be expanded. One day, perhaps, stationary computers will become entirely a thing of the past and all documentation can be done beside the patient. Caregivers have been asked to give their opinions about mobile documentation and to talk about its pros and cons. Generally, this has also had the effect of improving the product.

What to Do When the Electronic Health Record Goes Down?

Potilastietojärjestelmä nurin

Electronic Health Records have enabled significant change to the healthcare system as patient data can be found in aggregated electronic form instead of among piles of paper. But what happens when such systems crash? Will the whole foundation of patient safety crash?

In recent months, there has been relatively frequent news about problems with Electronic Health Records (EHRs). Disruptions in EHRs hinder patient care considerably since the patient data is not available unequivocally. In such situations, patient safety is inevitably endangered. Real-time data is vital to patient safety. This also leads to physicians and care staff having to search for data, which means time taken directly away from patient care.

Introducing Plan B

When the EHR is unavailable, access to the patient’s medical reports and medication records is lost in the same instance. Patient data is no longer printed so often; everything is in electronic form.

If the EHR cannot be reached, alternative practices must be introduced. Hospitals and healthcare centres have access to backup systems for these kinds of situations. If the disruption is extensive, even the backup systems may be unreachable, however. In the event of a failure in both the EHR and the backup system, papers and pens are very often introduced.

New data is recorded on pieces of paper and previous patient data is often established by asking the patients themselves. As for establishing the medical reports, this is a little more difficult considering situations where the critical condition of the patient prevents you from obtaining the information directly from the patient.

Delays and Congestions in Patient Care

Ignorance about the patient’s care history and the doctor’s orders causes patient care delays and congestions. Without patient data, it is simply difficult to provide care. Any delay in care poses a serious risk especially when caring for a critically ill patient is at stake.

The next few days and weeks will see days filled with problems. Surgeries may have to be postponed and queues at Emergency grow. Delay is also caused by having to enter the data written on paper into the electronic system once more when the system is restored. In addition to this, the double entries of data may cause documentation errors.

Ascertaining Data Availability

Healthcare professionals wrestle with these same problems regardless of the EHR. Since it is often hard to prepare for interruptions in advance, the situation becomes all the more difficult. Even fully tested systems cannot necessarily prepare for problems in the infrastructure and the data blackouts they cause.

So, here is our tip: ascertaining data availability on three levels, namely the mobile device, the Medanets server and the EHR.

1. The mobile device

The work of the care staff can continue despite losing the connection to the EHR, the backup system and the Medanets server. The patient data preceding the failure is available through the mobile device and the Medanets application. The healthcare professional participating in the patient’s care can then view, the patient’s valid medications and the observation values measured earlier, for instance. As for the new data to be entered, this is saved on the mobile device application synchronised automatically with the system when the failure is repaired.

This practice is based on transferring the patient data to the device when the caregiver logs in to the application as the shift begins. All the patient data needed by the unit in question will then be available and displayed. The data is prepared for the device so that the data does not need to be searched again every time it is accessed and so that it is available regardless of the wireless network dead spots.

2. The Medanets server

If the connection to the EHR is lost, but the connection from the mobile device to the Medanets server remains, patient care can continue with the data available. Newly entered data on the patient will also be displayed among the other professionals participating in the care even though the data is not yet synchronised into the EHR. The data is saved on the Medanets service and, in turn, from there it is transferred to the mobile device for display to caregivers.

3. The EHR

The Medanets system utilizes the patient data in the EHR and brings wireless data for display to caregivers. Not all the data in the EHR is brought into the mobile application, but only the data needed by the unit in question.

The data entered during a system interruption remains saved in the mobile application and will be transferred to the proper place in the EHR once the connections are restored. When the system is restored, the data becomes real-time data immediately without any need for the extra double entries of data.

Ascertaining the availability of the data on three levels enables accessing patient data even in the event of an extensive blackout. The foundation of patient safety improves when you have real-time data and can give the patient the right kind of care in accordance with the latest patient data.

Early Warning Score Improves Patient’s Prognosis

Most in-hospital adverse events, such as heart failures, emergency transfers from inpatient wards to intensive care units and unexpected deaths, are not sudden events [1]. Up to 80% of in-hospital adverse events are preceded by hours of critical disorders of the basic vital functions [2].

These functional disorders are revealed by changes in physiological measured values of pulse, blood pressure, temperature, respiratory rate, etc. Most adverse events could be prevented if the patient vital signs were monitored and any changes in them were met with a timely response [2].

Early Warning Score (EWS) was developed for this purpose and it was based on the principle that clinical deterioration can be observed through changes in the physiological measured values. The measured values are scored according to how much they deviate from normal ones. The total score indicates the patient’s risk class (low, medium or high), for which the hospital determines corresponding clinical measures, such as alerting the medical team.

Starting Adequate Care in Time

EWS is a simple and easy caregiving tool, which helps identify patients whose condition is deteriorating acutely. In combination with available care, EWS can be used to begin adequate care immediately after detection, which can have a positive effect on the clinical results.

Utilizing EWS scoring in the area of caregiving also reduces hospital costs. The early detection of the patient’s deteriorating condition reduces the factor that most commonly raises costs, namely the number of transfers to intensive care. When the patient’s care can be started earlier, hospital stays are more likely to shorten as well.

Furthermore, research [3] has shown that timely detection of critical vital sign changes reduces the hospital mortality rate. The seriousness of a disease in itself cannot be influenced, but care quality and any delay in the commencement of adequate care are things that can be influenced.

Change of Procedure Demanding Cooperation

Various occupational groups should be up to date on the EWS practices of the hospital. Everyone should know what is involved with EWS scores: calls to the unit’s own doctor concerning these and alerts to get the Medical Emergency Team (MET) to intensive care. Information should therefore reach both doctors and caregivers and , in order to reach a consensus, the operating guidelines should be as clear as possible. Above all, this is a question of cooperation, which will seem to increase the number of duties at first.

When EWS scores have to be calculated several times a day, it does take up extra care time. In addition, caregivers should have a pen, paper and an EWS score card with physiological parameters and threshold values that determine ranges for those parameters. Then the total score is calculated. However, any quick mental calculation may cause documentation errors. Despite all this, the benefits are greater than the harm.

Nevertheless, this is a good example of a situation where technology can be utilized to facilitate caregiving. With the help of technology, the score calculation can be automated and instructions for action being displayed to the care staff immediately, whereby human errors are minimized and patient safety improves. Technology also makes it possible to have this data on the patient’s condition up to date and available to everyone participating in the care.

For proactive patient care, however, it is essential that the basic vital functions are evaluated and not merely measured. So, it is not enough to record the patient’s vital signs, but to also know how to evaluate them systematically. The response to the vital signs is based on this evaluation in accordance with the agreed practices of the hospital. Thus, the best possible patient care can be made possible.

References:

[1] Tirkkonen 2015: Detecting and Reacting to In-hospital Patient Deterioration Studies on the afferent and efferent limbs of the Rapid Response System

[2] Berlot et al. 2004: Anticipating events of in-hospital cardiac arrest

[3] Schmidt et al. 2014: Impact of introducing an electronic physiological surveillance system on hospital mortality

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