We all have experienced a system failure in our nursing careers. I can’t begin to describe the feeling of coming in to work only to be told “systems down”. Every time I heard those sweet words, I wanted to use a personal day. But this also the time that I am reminded that nurses rely on technology about 90% of the work day. I’ve worked at two different hospitals and each of them do things differently prior to the system going down. Both hospitals use downtime slips when the computers are not work. Nurses are still able to request lab work, use of prescription pads, and order, administer medication. I guess paper charting will never be a thing of the past. One of the hospitals did something a little different, it requires that nurses use paper charting daily alongside EMR. I thought this was a great idea, it keeps the nurses familiar with paper charting so when computers are not assessable patients can still be cared for without much delay. Also, those nurses wouldn’t be scrambling to gather information. My current organization uses downtime slips, this can hectic for some new nurses who are not familiar with paper charting. Although the hospital has backup generators, downtime slips are required to continue care until systems are back up operating. Patients can always be taken care of via paper charting. This practice went on for years before computer charting. For some of the older nurses this is a well-known and preferred method. Caring for the patient is still the number one priority, information can still be obtained and updated by the patient daily and each department is responsible for keeping charts on patients with services provided so that quality care is given until computer systems are up and running. I think the recommendation would be first to Start by creating an outline that delegates workflow in such an event, including selecting an individual whose main job is to inform staff that the system is down and what patients are most affected by it. It’s great if you have a backup plan in place, but it won’t do you any good if the plan itself doesn’t work. Like a fire drill, have trial runs every so often to ensure that your backup plan will, in fact, pull through for you if your EMR happens to fail.
Suggest staff keep paper charting on most recent task performed regarding patients. Information such as recent vitals and current medications with administration times, and allergies should be readily available. In case of an emergency this type of documentation must be known to avoid further harm. I think in the end working together in this stressful time will be the key in maintaining patient safety.
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Natural disasters happen all the time across the country of the United States and beyond the borders such as floods, tornadoes, hurricanes, and earthquakes. Hospital administrators need to have emergency plans in place to help counteract the chaos, and all staff needs training on how to react in such weather conditions. According to Horahan, Morchel, Raheem, and Stevens (2014), the National Planning Framework mentions there are five mission areas of preparedness: prevention, protection, mitigation, response, and recovery. As indicated by Memorial Hermann Hospital System (2017), several policies and procedures are listed on their website about the action plan of the failure of utility systems, the problem I have found is that many of our medical-surgical units at my campus have never received any training on how to complete the downtime forms and it expected of us. The access to electronic health records would not be available during such conditions and staff will need to know what steps to take.
Power outages can cause the staff to have meltdowns if not correctly prepared on what to do in such emergencies without access to computers. Clinicians need to be careful when taking the patient’s medical history, recording allergies, medications, and any recent procedures they may have had that cannot be accessed online. Pharmacy orders, diagnostic tests, and lab orders will need to be called in, or hand delivered because of no electricity.
The staff needs to have training on what to do in case of such disasters because they too will need to stay calm themselves to keep patients and families calm during an emergency event. My unit has an emergency kit filled with downtime forms, batteries, and flashlights. I think adding a two-way radio would be beneficial to keep in touch with the house supervisor for updates and information. I have requested the need for training to my manager and director, and they both said they would try to incorporate training at our next staff meeting for everyone to understand how to use the downtime forms and what to do in an emergency. My campus has backup generators that will turn on after ten seconds of no power is detected, and according to the maintenance personnel, they are checked every six months. There are red outlets throughout the patient care areas that critical medical equipment can be plugged into during power outages for continuous patient care. Quarterly emergency or downtime drills should be conducted regularly to keep staff trained on what to do and how to fill out the downtime forms and be aware of what to do for continuous patient care. Improvising with portable trailers or mobile satellite systems in the parking lot of hospital or somewhere safe may be an option.
Horahan, K., Morchel, H., Raheem, M., & Stevens, L. (2014). Electronic health records access during a disaster. Online Journal of Public Health Informatics, 5(3). Retrieved from doi:10.5210/ojphi.v5i3.4826
Memorial Hermann. (2017). Failure of utility systems. Memorial Hermann Hospital System. Retrieved from https://policytech.mhhs.org/dotNet/documents/?docid=32268
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