Wired on Friday/Carol Power: A 1999 report from the Institute of Medicine of the National Academies estimated that up to 98,000 deaths occur every year in US hospitals as a result of medical errors. Recent studies show that tens of thousands of additional errors occur in nursing homes and clinics.
Moreover, patients in all healthcare settings receive on average just slightly over half the tests, procedures, and other care recommended for their conditions, according to another study.
To reduce significantly the tens of thousands of deaths and injuries caused annually by medical errors, a recent report from the Institute of Medicine said healthcare organisations must adopt information technology systems capable of collecting and sharing essential health information on patients and their care.
Routine use of electronic health records would give healthcare providers and patients immediate access to complete patient information as well as tools to guide decision-making and help prevent errors, the report said.
To address these types of issues Columbia University's School of Nursing, based in New York city, is experimenting with technology to document patient care with what it calls the Palm Project.
"We were thinking about the appropriate use of technology for nurses who are so busy," said Sarah Sheets Cook, vice dean at Columbia University's School of Nursing.
"We wanted to see if they could carry an easy portable option so they could check and make sure they were doing the right thing at the point of care. We've been talking about nursing diagnoses for 20 years. We're trying to speed up the process to show that what doctors do is different from what nurses do."
Three years ago, staff gave first-year nursing students personal digital assistants (PDAs) and asked the second- and third-year nurses to come with their own PDAs.
There are about 460 nursing students at Columbia, 160 of whom are in the one-year Entry-to-Practice programme for non-nurse college graduates and about 300 are in the Master's programme for practising registered nurses whose programme lasts an additional 1.5 to four years, depending on whether or not they study full- or part-time. The university is affiliated to New York Presbyterian Hospital.
The PDAs use the Palm operating system and Columbia has developed its own software application, which uses common nursing language. "Generally, you can buy software for physicians but not for nurses," Ms Cook said. "As nurses we concentrate on what nurses do, which is critical to care but can be invisible."
The software application on the PDA allows nursing students to assess the patient's condition, give medication and enter what they did into the software program. As students, the nurse should acknowledge if she administered the medication herself, did it with physician supervision or watched someone else do it.
"This is the beginning of keeping a clinical log," Ms Cook said. "We don't want them to be staff nurses but to be advanced practice nurses where they have more autonomy and are independently interacting with patients. The nurse assesses the patient and develops the treatment plan."
Students can continue their Palm-based documentation of patient encounters as they progress through the Master's programme in their advanced practice nurse specialty area (nurse practitioner, nurse anaesthetist, nurse midwife). The application is customised for each specialty.
The student clinical log has undergone several changes to improve its usability so it can become a tool to help them make nursing diagnoses. According to Ms Cook: "It's evidence-based to make clinical decisions." At the advanced level, "when we're assessing students for professional qualification, we need to validate and see their logs for the number of patients they took care of".
Data transfer from the PDA is managed through a process of synchronisation using XTND Connect Server software on the student's home PC or at school via a Palm cradle or infrared device that can download data into the central database on the server at the nursing school. Staff can generate a report about each student, which they give to the student and to their clinical instructor about once every three weeks. At the end of one year, the school had 100,000 patient entries for the aggregate group.
The school of nursing has its own IT staff and Columbia's Centre for New Media Teaching and Learning has received a $10 million grant to use technology in education, which has been especially helpful to the nursing school in developing applications.
"It's clearly a different way of looking at things in healthcare," Ms Cook said. "We're using PDAs as a professional education tool."
