Current Projects

• Medication Management
• Clinical Documentation

Medication management

The Children's Hospital at Westmead (CHW) has been selected as a paediatric hospital to pilot the Cerner Millennium, electronic Medication Management (eMM) solution. The pilot is part of the NSW Health State strategy. The eMM adds functions to PowerChart to enable clinicians to record on the patient's record: orders; prescriptions; and administration of drugs. The main outcomes from the project include safer processes for patients.

A better practice project was conducted by the service improvement unit two years ago and this project will benefit from their work. Currently, CHW is engaged in trials for wireless and point of care devices and this will dovetail into the work of the project in a timely manner. Likewise, the hospital has implemented a benefits realisation process as part of implementation and these methods will be employed in the project.

Clinical Documentation

Background

Clinical documentation is a major part of the strategic plan to complete the delivery of an electronic medical record by 2007. Based on the positive experiences from ICU, where a multidisciplinary clinical documentation system has been in place for a number of years, there is strong support within nursing to achieve similar benefits in the rest of the hospital. A program of nursing process reform, point of care system access, and Cerner clinical documentation is aimed at transforming the way nursing delivers care.

Benefits

The proposed project will be benefits driven and has been initiated by Nursing to eliminate memory based practices, reduce duplication of data and improve the quality of care delivered. Benefits workshops were conducted to get input on the array of change and initiatives necessary to deliver the desired outcomes and benefits. Twelve major initiatives were identified. Most of the effort surrounds process re-design, policy and procedure development and training. Benchmarking is fundamental to measuring the benefits and some current state measurements have been conducted. Overall, there will be significant time saved enabling more time with the patient; a reduction in errors by eliminating memory based practices; improved communications and quality of information by providing access at the right time to the right people.

Change of Practice

The ability to record clinical documentation electronically will dramatically change the way clinicians practice in the Children's Hospital at Westmead. The clipboards with an array of paper notes used currently will be replaced by point of care data capture devices. The reliance on memory based practice will be greatly reduced. Through the development of PowerOrders, tasks, reference text, and linked information, the accuracy of documentation and viewing of patient's care will improve. The implementation of the Cerner clinical documentation system will improve flow of patient information, reduce the repetition of information and improve the ability to plan for the patient's stay and discharge.

Documenting electronically allows for enhanced nursing care by giving nurses the ability to remain close to the patients whilst entering information in the electronic record, replacing the necessity of walking to the nurses station, looking for the chart, documenting the information and returning to the bedside (or recording the information on a piece of paper which can be misplaced). Documenting at the point of care also facilitates validation of the information with the child or parent.

Wireless Technology

Clinical documentation extends the existing hospital wide implementation of PowerChart functions for viewing clinical information and activities, ordering nursing or multidisciplinary care team procedures. It has both a structured and free text approach. To record accurate and up-to-date documentation electronically there is a basic requirement that the various devices can be accessed at the point of care. This can only be delivered through a wireless network. The hospital is committed to implementing wireless technology.