Thinking outside the box

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Excerpt

Like many of you, I began my nursing career before computers were pervasive in the clinical setting. In the mid-1980s, my first interaction with a computer at work involved painstakingly entering data into a stand-alone device in an ICU to calculate an acuity score. It was time-consuming and tedious. Fast forward many years...computers are now ubiquitous and invaluable for most aspects of patient-care delivery—to the point that the inevitable downtimes can really throw a monkey wrench into normal operations.
In the past few years, our information technology (IT) systems have evolved to offer high levels of patient safety through standardized electronic order sets, decision support tools, and a variety of alerts to prevent medical errors. While all these innovations are extremely beneficial most of the time, there's a dark side: When systems fail, even very smart people who've come to rely on technology can hit the proverbial wall and lose their ability to function effectively. I've seen providers who've never written orders on paper become stymied when confronted with a blank chart and a pen instead of the usual electronic medical record (EMR) templates that are prepopulated for specific patient populations.
Nurses and personnel from other clinical departments don't fare much better when the routine means of communication and processes intrinsic to patient care grind to a screeching halt. Downtime procedures are invoked, but often the subtle twists and turns of the particular type of outage make implementing these plans a challenge and add complexity. For example, is it only the EMR that's down, or is it the entire wireless network? Do the phones still work? How about paging, monitoring systems, electronic medication dispensing devices, and the ability to get diagnostic results? Unfortunately, there can be many layers of outage.
No matter the predicament, our best asset is always our ability to think critically and creatively. Yes, we absolutely have to practice downtime procedures regularly, but we also need to consciously develop our abilities to think outside of the box–especially when that “box” is the computer. Our patients will still rely on us when systems fail. We must never become so reliant on IT that we lose our ingenuity and forget how to care.
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