Authors (including presenting author) :
Mok YT(1), Yuen MYV(1), Wong CH(1), Law NW(1)
Affiliation :
Department of Anaesthesiology and Perioperative Medicine, Hong Kong Children's Hospital
Introduction :
Patient’s perioperative record is not only consisting of collection of information, events, tasks, and processes; it is a mission-critical application to improve the workflow challenges associated with the perioperative pathway. In many hospitals, the Electronic Anaesthesia Documentation and Nursing Documentation are separate. However, when stakeholders placed differing degrees of importance on surgical safety checklist completion, it might actually antagonize team relationships. (Laltaksh et al, 2016) Inter-professional handovers in the recovery room are largely informal, both professional and organizational. (Smith, 2008)
Objectives :
The implementation of a new Clinical Information System (CIS) gives us opportunities to build a customized platform to implement perioperative communication on an integrated medical and nursing documentation platform, performing surgical safety check, and systematic handover within and between departments. To avoid input error and keep both anaesthetists and nurses on the same page, an integrated electronic perioperative record is commenced in the Operating Theatre of HKCH, from March 2019.
Methodology :
The Integration of CIS with HA CMS allows patient demographic data, laboratory results, allergy, alerts and adverse drug reactions information, OTMS information to be share with CIS. 1. Preoperative Management – OT nurse and anaesthetist use the same Clinical Information System (CIS) for pre-operative patient assessment and documentation of patient education. 2. Intraoperative Management The CIS serves as a platform for recording and communication on intraoperative patient events and management. This includes risk assessment, patient position, pressure point protection, warming strategies, blood loss, fluid and blood product management, anticipated postoperative problem and plan. Not only does this avoid errors arise from duplication of data entry in different forms or systems, it also enhances communication between the anesthesia and nursing team. 3. Electronic surgical safety checklist All important information is transferred to the sign-in and time-out checklist, so that they can be reviewed during the procedure. The checklists consist of mandatory items therefore members need to check them during the safety check, otherwise the form cannot be saved. These safeguard team members to go through all the necessary items during safety check. 4. Intraoperative blood loss monitoring is crucial in paediatric surgery. A calculator is built in the CIS. Manual calculation is not necessary and real-time display of blood loss on dashboard allows timely management by to be implemented team members. 5. Electronic Counting Record is going to be implemented in 4Q 2020. Advances have been made to facilitate data entry. Computerized systems with alarm function increase efficiency, safety and accuracy. Dashboard allow real-time review of counts, packing, tourniquet and vascular clamp duration. 6. Integrated anaesthesia and nursing report A comprehensive perioperative record incorporates all of the above data is generated in one report and is uploaded to EPR for easy and future reference.
Result & Outcome :
Till March 2020, more than 880 operations were performed at HKCH within 6 months. The compliance of use of CIS is 100%. All staff were engaged during safety check using CIS as the common platform for communication. From users' feedback, it obviates the need of manual entry and avoids human error, ensure accuracy with enhanced efficiency. It also facilitates effective team management of patient's perioperative journey and the continuum of care.
