Vital Time Savings Evaluating the Use of an Automated Vital Signs Documentation System on a Medical / Surgical Unit

Vital signs documentation was the focus of this study, because multiplication errors, transcription errors, illegible results, late data entry, misidentification of the patient, undocumented readings and missed readings can lead to faulty data, as well as unnecessary and potentially dangerous interventions or withholding of treatments. Technology is now available to medical/surgical units that automate the vital signs documentation process. This study compared the accuracy and time efficiency of manual-entry vital signs documentation with workflows that use a data management system to automatically transfer vital signs assessments from a bedside vital signs device into the electronic medical record. The study found that the automated vital signs documentation system was more accurate than manual documentation and errors were reduced by 75 percent. The wireless automated vital signs documentation system saved time compared to manual documentation: and combined vital-signs acquisition/ documentation times were reduced on average by 96 seconds per reading. FoCus Quality outComes and Patient saFety A t Anywhere Hospital it is 7:30 a.m. and the day shift is just beginning. Sue, a nurse’s aide, begins to collect patients’ vital sign assessments. She starts with room 5106 and moves through her assignment. She gathers the results and writes them on her assignment sheet to be documented in the electronic medical record (EMR) after she completes each of her five patients. Mr. Couldbeu is in room 5108 by the window. Sue notes that some of Mr. Couldbeu’s readings are above his baseline, however the patient looks fine. She will mention it to the charge nurse when she sees her. Sue moves on to her next patient, but she is interrupted by Joan, a nurse taking care of patients on the other side of the unit. Sue is asked to help move a patient on the other side of the unit to a chair. At 7:39 a.m. Mr. Couldbeu pushes his call button. He has chest pain. The RN who answers his call takes his vital signs, administers his medication and checks the EMR to compare his current status to his morning assessments. They have not been charted and she cannot find Sue. Vital signs (blood pressure, pulse, respiration, oxygen saturation and temperature) are indicators of body system health. They provide information on how patients are adapting to the changes brought on by illness and disease.1 Treatment decisions are routinely made subsequent to the assessment of vital signs, one of the hallmarks of nursing care. Vital Time Savings Evaluating the Use of an Automated Vital Signs Documentation System on a Medical/Surgical Unit By Meg Meccariello; Dave Perkins; Loretta G. Quigley, RN, MS; Angie Rock, MBA, CCRP; and Jiejing Qiu, MS jhim n FAll 2010 n volume 24 / number 4 www.himss. org 2510_JHIM_Fall_COLOR. indd 46 9/23/10 12:38:32 PM Quality outComes and Patient saFety In addition, “Vital signs are a tool used to communicate patient deterioration to healthcare providers”. 2 (p478) Endacott, Kidd, Chaboyer, and Edington found that both nurses and doctors relied on vital signs when identifying patient deterioration.3 Assuring accurate and timely vital signs documentation may lead to improved patient care. Vital signs documentation accuracy and clinician time efficiency were the focus of this study because technology is now available to medical/surgical units that automates vital signs documentation, transferring results from the automated bedside vital sign machine to the electronic medical record. revieW of literature Hospitals have applied medical technology to reduce errors, but until recently have focused on the most critical care areas. Experience has shown that many hospitals undertake the move to new technology without fully understanding the impact on workload, patient safety and data accuracy. Healthcare providers are often told that a new piece of equipment will be safer for patients and a time saver for staff, only to find out that the system has a steep learning curve or takes more time than the “old way. ” This often results in frustration for frontline staff and a waste of scarce resources. In an era of spiraling costs, competition and the advent of evidence-based practice, healthcare practitioners expect research studies to aid them in their clinical practice decisions. Evans, Hodgkinson, and Berry4 found little evidence of study in the area of use of advanced technology in vital signs measurement and noted that these technologies have the potential to change current practice. Lockwood, Conroy-Hiller and Page5 (p208) also noted the need to research “the role of new technology in patient monitoring. ” accuracy in documentation While the vital signs acquisitions and documentation process is taught in the early weeks of most nursing programs, the documentation of vital signs can be fraught with problems. Patient identification is completed by asking the patient his or her name, and comparing one of two long series of numbers (potential patient misidentification). Results are gathered in 15or 30-second timeframes and are documented as per-minute results (potential multiplication error). Clinicians memorize vital sign results (potential for forgetting result or remembering incorrectly), then, after the measurements are complete, write them down on scrap paper or paper towel (potential illegible result), later transferring them to paper forms or manually entering them into the electronic medical record (potential transcription errors and transposition of results). When documenting a full set of vital signs (blood pressure (systolic/diastolic), pulse, respiration, oxygen saturation and temperature), there are six potential areas or errors. Further, what is often double documentation, first documenting on paper then in the electronic medical record, creates even more chances for human error. The most precise vital signs assessment may not lead to an accurate response if it is not documented correctly and in a timely manner. Cioffi, Salter, Wilkes, Vonu-Boriceanu and Scott, in their study of an emergency department, found that inadequate documentation was one of the main reasons clinicians failed to respond to patients with abnormal vital signs.6 McGain et al., when looking at vital signs documentation during the first seven days after surgery, found significant levels of incomplete documentation.7 Multiplication errors, transcription errors, illegible results, late data entry, misidentification of the patient, undocumented readings and missed readings can lead to faulty data, as well as unnecessary and potentially dangerous interventions or withholding of treatments. Chen et al., evaluating the Merit Study investigators, found in their randomized multi-site study “even in the hospitals that knew they were a part of clinical trials monitoring, documentation, responses to changes in vital signs were not adequate. ”8 (p2096) The authors further evaluated the Merit Study data and found that 77 percent of the patients’ studied were missing one vital sign measurement prior to an adverse clinical event. The use of technology may help decrease these errors. Technology has been applied to prevent errors in other areas of nursing care. Bar-coding is now being used to decrease the human error factor at the point of care, preventing misidentification of patients. Foote and Coleman found that, when used for medication administration, bar code technology reduced errors by 80 percent.9 Adding the use of bar code technology to vital signs documentation could assure correct patient identification, making certain results are charted in the correct electronic medical record. The advent of the electronic medical record system has helped the accuracy of patient documentation. Gearing et al., evaluated the use of the electronic record in vital signs documentation.10 They found that out of 613 sets of vital signs taken on a medical/ surgical unit and manually documented using paper records, 25.6 percent of the medical records had at least one error related to transcription or result omission. As for a cardiac step-down unit that utilized an electronic medical record system, 14.9 percent of the 623 records had one or more errors related to transcription or result omission. Smith et al. completed a post implementation study to using the Gearing results to determine the accuracy of an automated system that sends the vital sign measurements from the vital sign monitor to a PDA and then uploads them in the medical record.11 They found that the error rate decreased to less than 1 percent.