“You are taking my vitals on a post-it note!?”
I said these words a few weeks ago during a doctor’s visit. When it was my turn to be seen, I was brought back to a very small room and the nurse said, “I need to take your vitals”. She sat me down and started with my blood pressure. I turned my head to my left to look at what she was doing and that was when I saw it:
the yellow post-it note.
I reacted with: “Oh my, you are taking my vitals on a post-it note!?” The nurse responded, “ Well yes, I have to put them (e.g., my vital signs) in the computer.”
My mind started to race… ‘My vital patient information that can potentially be used over time, to assess my physical health status while under the care of this practice, is being written down on a post-it note.‘
That experience was my second visit as a patient that I’ve had in the last year. The first visit was at an emergency room from a different health care organization. Each visit was for a different (and minor) health reason, but in both cases, a post-it note played a vital role in writing down (or exchanging) patient information.
I knew that the vital signs written on the post it-note that day were intended to be later transcribed into the computer (or more specifically the electronic health record (EHR)) when the nurse had available time between patients. I knew this because of my 15 years of combined nursing and health IT experience, education, and research. Yet, what if I was a patient without any prior knowledge of health care? How would that patient perceive this emerging standard of practice (e.g., post-it notes)? For those of you reading this, think for a moment how you would respond in this situation.
I cannot speak for each of you but I can speak from my professional expertise and experience. The use of post-it notes (or other scrap pieces of paper, paper towels, etc.) to exchange patient information reflects a system level gap in appropriate electronic tools for safe, efficient, and timely exchange of patient information in ways that support how nurses and other health care professionals work each day.
The health care industry continuously discusses the use of electronic health records (EHRs) for exchanging patient information with a greater goal of improving the quality of patient care. What is not as frequently discussed is how this health information exchange (HIE) often begins with the patient and the nurse (or more broadly the front line staff). Additionally, limitations to the ‘computers’ in our health care organizations for supporting these initial exchanges between the patient and the nurse are often minimized, not well understood, or are simply not known by key decision makers and stakeholder groups.
We, as an industry, spend significant amounts of time talking about the structure of how to capture the data (e.g., structured data fields and minimize use of free text fields) and subsequently how the data can be reported out for outcomes. Yet, far less time is spent discussing the process for exactly how health care professionals receive, collect, enter, access, and overall use this vital data in the day-to-day delivery of patient care. Thus, with such a gap between the structure and outcomes, how can we expect to delivery the highest quality care without also supporting the processes by which we interact and come to know the patient?
So, how do we eliminate the need for a post-it note and alleviate concerns from patients, families, and health care professionals? Well, the first step is in recognizing the problem and understanding why and how post it notes (and other scrap pieces of paper, paper towels, etc.) are being used. Once the problem is understood, then solutions can be formed.
I was fortunate enough to gain this understanding through my research several years ago.I’m proud to say that we at Nightingale Apps have a solution to the problem I identified on that day at my doctor’s visit. If that practice had Know My PatientTM for its nurses and assistants, I would likely not be writing about post-it notes. Until that does occur, we continue to push forward and bring attention to the needs of nurses and other health care professionals at the front line who are responsible for managing and exchanging patient data and information.
If you’d like to learn more about us at Nightingale Apps, our product Know My PatientTM, or simply how we may be able to help your health care organization, you may contact us at firstname.lastname@example.org