Keri, I guess some of the questions to determine the answers to are how do your current ratios compare to other Meditech facilities, and why would the ratio at Phelps need to be different than any other Meditech hospital doing online documentation and eMAR. There might be very valid reasons for it, and there might not be any reasons at all.
The facility I last worked intimately with had NUR and eMAR. The ratios looked something like this: Med Surg Ortho: 1 nurse to 4-6 patients, 1 CNA for up to 10 patients. One ward clerk for up to 40 patients (I'm not kidding) on days and evenings TCU: same - no ward clerk, but that worked out OK ICU: 1 nurse to 2-3 patients; 1 ward clerk/monitor tech on day shift Of course, acuity was a factor in caseload. What I can't tell you is whether that hospital made any changes in general caseload after eMAR implementation, as that occurred before my arrival. What I DO know happened is that nurses developed a whole bunch of inappropriate eBMV shortcuts to try to save time. So I think it's great that you and others at your facility are addressing the workload issue proactively. Don't let anyone forget to compare staff support mechanisms when comparing ratios from one facility to the next. What's the WARD CLERK/patient ratio? Is there a CHARGE NURSE who does not have a patient assignment, but who acts as "the nurse at the desk", keeping everything organized and sallying forth to patient rooms when the situation calls for another opinion? Are there enough workstations and COWS on the unit such that every nurse has his/her "own"? Are meal trays set out and picked up by Dietary or Nursing? Does Radiology come to get patients, or does Nursing have to transport them back and forth? Does hospital policy state that all meds should be given within 30 minutes of the time ordered, per the CMS reg that has recently been much-discussed on listservs? If so, a policy change to within 60 minutes could take some of the heat off (as I understand it, this is allowed; it's just that your policy has to so state). One colleague (somebody from the L, but I don't remember who) who has implemented eMAR 15 times told me he believes it increases the time needed for the med pass by 50%. I don't know whether any time studies have been done to validate that, but I'm sure there's some merit to his anecdotal observation. As an eMAR user, I personally experienced that it takes longer. But I loved feeling safer. I'm 100% convinced that electronic BMV takes longer. Even if leadership isn't willing to alter the nurse/patient ratio, maybe they would be willing to hire extra support staff, buy more equipment, or re-assign tasks (that do not require a nurse) to other departments to lighten the load of the nurses and make time for them to do things the right way. Sharon P.S. what turned out to be a really good thing at this hospital was to have eMAR retraining a few years after implementation. In retrospect, I'm sure everyone there wishes it had been done a few months later. Also, multidisciplinary (nursing, pharmacy) rounds for direct observation of the med pass to catch poor practices that nurses have developed to save time, without realizing how dangerous they are ________________________________ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Keri Heavin Sent: Thursday, July 05, 2007 2:07 PM To: [email protected] Subject: [MEDITECH-L] nursing staff ratios after implementation We are currently having discussions about changing our staffing ratios since we have implemented NUR and eMAR/BMV. I am wondering if there are any sites that faced this same issue after they implemented. Our nurses continue to express that Meditech documentation in combination with all of their other nursing duties has made their load to heavy with their current ratio of patients. Keri Heavin, BSN RN Nursing IT Coordinator Phelps County Regional Medical Center Office: 573-458-7842 Pager: 573-428-6057 Fax: 573-458-8563 ________________________________ CONFIDENTIALITY NOTICE: This e-mail communication and any attachments may contain confidential and privileged information for the use of the designated recipients names above. If you are not the intended recipient, you are hereby notified that you have received this communication in error and that any review, disclosure, dissemination, distribution or copying of it or its contents is disallowed. If you have received this communication in error; please notify Phelps County Regional Medical Center immediately by telephone at (573) 458-8899 extension 4357 and destroy all copies of this communication and any attachments.
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