Bigfork Valley welcomes C.O.W.s

COWS...No, not the kind that come to mind when thinking of summer alfalfa fields. These COWs are a high tech way to improve patient care and safety.

They are Computers on Wheels. And they have a very special function.

Located on the nursing floor, the computers are the latest stage in Bigfork Valley’s transition to electronic medical records or EMRs. They are the link between the patient in the room, his medical history, his medications and an individualized care plan.

A computer at the nursing desk could also carry the same information, but the computers on wheels are wireless and mobile, and can be taken into the patient room.

What does that mean? That means that the nurse can enter admission information while sitting conversationally at the bedside. It means that a patient’s bar coded bracelet can be scanned and compared with prescribed medication. It means that a nurse can check allegies or previous X-ray results from the bedside.

And it means that nursing notes aren’t left to chance on a piece of paper, but entered legibly directly into the record.

The story of COWs is really three stories – the story of electronic medical records, the story of a convenient way to access them and the story of the software that binds everything together.

Electronic Medical Records

Mr. Z has been admitted to the hospital. The doctor wants to check a CT scan from a month before. The pharmacist wants to check Mr. Z’s allergy history and other medications he may be taking. The nurse wants to check the doctor’s orders to see whether there is a special diet.

With the old paper records, each caregiver would have to wait until the folder could be transferred. With electronic medical records, real time information is available to each one at the same time.

In anticipation of the transition to EMRs, patient data like lab results and doctor’s dictations have been entered digitally for the past three years at Bigfork Valley. The data is set up like a folder with tabs, so that a doctor could easily go back to an October 2006 visit, for instance, to check vital signs.

Accessing EMRs

COWs provide doctors and nurses a convenient way to access the patient’s EMR because it can be done right from the patient’s bedside. The computer itself can be raised or lowered so the caregiver can be seated.

But isn’t computerized information too easy to access? Is it really confidential?

The electronic medical record is actually safer than the paper record, explained Registered Nurse Georgia Heide, who has been training staff in the use of the COWs. The system requires a password entry, and can be locked when leaving the computer. All nurses are required to review and sign the privacy policies, which include penalties for violation. Nurses cannot access their own charts or those of family members. And, most importantly, there is a record of when files are accessed and who has accessed them, contrary to paper charts which may be left out on the nurses’ desk.

Software

In September, the Patient Care System (PCS) came online. Comprehensive nursing software, the system assists in taking medical histories during patient admission, offers basic templates to be modified into personal care plans during a hospital stay and provides a daily “to do” list with timing for basic care or monitoring (for instance, a daily weight check at 6 a.m.).

Best of all, it makes charting more consistent. “We’re all looking at the patient in the same way,” said Heide.

In April, another major computer system will come online, the Medication Administration Record or MAR. Medication errors are of concern across the country, Heide said. “Nobody,” she pointed out, “sets out to make a medication error.” Yet, they happen. The MAR is one safeguard to prevent them.

When a doctor prescribes medication, the orders are sent to the pharmacy where the pharmacist checks them against other medications being taken and possible patient allergies. Then each dose is marked with a bar code.

When medication is given to the patient, both the patient’s bracelet bar code and the medication bar code is first scanned. The COW computer checks the time and compares the patient and the medication, and notifies the nurse if there is something that does not match.