PAPERWORK.
I had an epiphany the other night at work and I think I've figured out a big cause of global deforestation. I blame the NHS. I wonder if there has been any research into the number of tree's sacrificed to the incessant need for documentation within healthcare? I would place money on it being A LOT, many many trees being cut down so we can duplicate patient information multiple times.
I have to confess that the "paperwork" issue I have is not based entirely on my concern for the environment. Having sat down and given some thought to the things that stress me out the most, paperwork tops the list by a long way.
As a newly qualified nurse, undertaking nursing interventions takes me longer than it would an experienced nurse. I don't have a problem with this. I appreciate that I am inexperienced and I need to follow processes, as i gain experience and confidence I am fairly certain it will take me less time to catheterise or to undertake a drugs round. The problem I have is the huge amount of paperwork I have to complete for everything I do. Don't get me wrong, I understand the principle of "if it isn't written down it didn't happen" and I'm as keen as the next healthcare professional to protect my own backside. But when a lot of the work i do is a duplication of information already gathered or it takes me away from being able to care because i have to sit at the desk to trawl through multiple sets of notes, i get stressed.
In order to explain myself I am going to give you a patient scenario, this is not an extreme case, rather this is the norm in regards to the written work that needs to be undertaken during a patient journey.
Meet Mrs Jones, she is an entirely fictional 75 year old female. She lives in her own home and has the district nurses visiting 3 times a week to dress a leg ulcer (thats 1 set of paperwork), she also has twice daily carers (thats the 2nd set of paperwork). She has multiple health issues including COPD for which she has home oxygen and is under the care of the hospital specialist respiratory team (3rd set of paperwork).
One evening her carer visits and finds Mrs Jones very short of breath, naturally the carer calls for an ambulance. Unfortunately, because an effective alert system is not in place, the ambulance crew are not aware of Mrs Jones's oxygen requirements. Luckily they are competent and experienced and treat her according to their knowledge on oxygen therapy for patients with COPD. The carer puts Mrs Jones community nursing notes into her hospital bag and off she goes to the local A and E department.
On arrival the ambulance crew complete their paperwork and hand over the the A and E staff (4th set of paperwork), the staff in A and E complete set of paperwork number 5. All this is gathered together and taken, with Mrs Jones, to the medical assessment unit.
Once admitted to the assessment unit, the nurses complete the admission paperwork. On the unit I work in this comprises, initially, of 2 booklets (one is 4 sides of A4, the other is 8 sides of A4) and a cardex (1 sheet of A4), the doctors then also complete their paperwork (not sure how many pages the clerking notes are but id guess its at least 8). So thats the 5th and 6th sets of paperwork.
On top of this, she may also need documentation of any cannula's put in, a stool chart, fluid balance, catheter, falls assessment, turn chart and wound assessment. There is a new drug chart (which doesn't necessarily take into account any drugs given my the ambulance crew or in A and E - for this you would need to check that specific paperwork.) and if she is on insulin or warfarin there are seperate drug charts for these too.
The nursing notes are kept in one place, the doctors notes in another. Observations such as blood pressure/heart rate etc are computerised so must be accessed via a tablet or main computer. We also have an admission folder where the admission paperwork is kept.
All this for one patient! Now, I am not in any way suggesting that any one of these documents is not important. BUT, i have frequently wondered why we need to duplicate the same information, sometimes up to 4 times. Why cant the doctor/nurse notes be combined, why does poor Mrs Jones have to be subjected to multiple rounds of questioning and examination?
In fact, heres a totally radical idea....why cant we introduce a system where by the patients information travels with them. It can be updated by any member of the healthcare team. This might be in the form of one "booklet" that is started in A and E and is added to, as appropriate, throughout the patients journey.
Or maybe we could go paperless.
I had a short placement in my second year on the intensive care unit. They are entirely paperless. The team add notes as and when required, this means that the doctor can see what the nurse has written, the nurse, if not at the ward round, could see what the continuing plan for the patient is (without having to rummage through mounds of paperwork - which in my experience is almost always elsewhere - normally the doctors office!). The dietician can access it, as can the OT, the physiotherapist, the pharmacist. It is all kept in one place and contains all the information about that patient. From the drug chart through to fluid balance and back to observations etc etc etc.
AND......this could even be extended into pre-hospital and community care too. So that the district nursing notes can be seen by the ward nurse who now needs to redress Mrs Jones's leg, the district nurses can be alerted that Mrs Jones wont need a visit tomorrow because she is in hospital. The ambulance crew could access information about her oxygen therapy and the assessment unit nurse can quickly see which drugs the ambulance crew gave so she doesn't give them again.
I know that people have issues with paperless systems. And I agree that they are not fail-safe. However, from my experience within Ambulance control, I know that with correct procedures in place systems failures can be managed without detrimental affect to patients. Going "onto paper" in the control room always came with a certain amount of panic but the calls were still answered and ambulances still sent.
Im sure that there are many arguments around the best way to manage patient information and every option will have its positives and negatives. For me though, the pressure to complete paperwork will, i think, always taint my experience of nursing because it puts me at a desk rather than at the bedside.
No comments:
Post a Comment