Recent and Upcoming POE Improvements
Remote access to clinical applications being tested in pilot project
First phase of process redesign is over; changes now being implemented
Internet policy established to safeguard computer performance
Stanford, Packard hospital announce new chief information officer
New editor named for Medical Staff Update
Process Redesign Changes
The pharmacy is working with the IT department to improve the user interface with the physician order entry system and to reduce order turnaround time. With the recent POE upgrade, physicians can modify orders rather than deleting the order and creating a new one. Several revisions to the Pyxis system are being made to ensure that medications are available when and where they're needed. Pharmacy and nursing have reaffirmed turnaround standards for medications: up to 10 minutes for STAT orders, up to 45 minutes for routine IV orders and up to 60 minutes for routine medications.
ICU Care Delivery Team:
A window is being installed between North ICU rooms 17 and 19 to allow for a 1:2 nurse-patient ratio; this approach may soon be applied to other ICU rooms. Nurse assistants are being cross-trained to function as unit secretaries. Respiratory therapists have taken on tasks previously done by registered nurses, including oxygen administration, drawing blood gases and tracheotomy care.
Patient Flow Team:
For patient transfers and admissions, new rooming guidelines specify that the accepting unit must have a room ready for the patient within 45 minutes of notification. A nurse manager has been assigned on a rotating basis to facilitate the daily rooming of medical/surgical patients. A daily interdepartmental rooming meeting has been established to facilitate improved patient flow. A new nursing shift has been created, from 11 a.m. to 7 p.m., to better cover the hospital's peak periods of admission and discharge activity.
New protocols have been implemented to reduce the use of patient sitters in cases where sitters are not clinically warranted. A written form has been developed for patient transfers from all units. This will reduce the number of phone calls to nurses and will facilitate prompt patient transfers by eliminating the time spent '"playing phone tag'" to convey information verbally. A pilot program is under way to have physicians write discharge orders as soon as possible - generally no less than 24 hours in advance Ð to reduce discharge delays.
Operating Room Team:
Efforts are under way to educate physicians on the importance of scheduling cases appropriately, and on the negative impact of scheduling too little time for a case. Efforts are being made to start all cases on time, particularly the day's first case at 7:30/8 a.m. On-call utilization has been reviewed and modified to maximize available staff and improve availability of staff. Nurse recruitment has been stepped up, reducing the hospital's use of costly agency nurses.
Emergency Department Team:
A staffed ED supply center will be established in mid-May. This will save nursing time and will assign charges for all equipment. An LVN recruitment effort is under way, which will help bring about a more appropriate skill mix and will reduce reliance on costly agency nurses. Staff is being trained to reduce the hemolysis rate. This will promote more efficient patient transfer out of the ED by reducing duplicate blood draws and lab tests.
