Critical Care Beds and Clinical Documentation. Stephanie Allen Sukanya Bhattaccharya Sarah Manning Surabhi Satam Temidayo Yembra.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
Introduction to Critical Care BedsWhen it comes to life-threatening illness or injury, Critical care beds offer design enhancements and safety features that assist in the efficient delivery of care
Clinical documentation in a patient's record includes any and all documentation that relates to the care of the patient during the patient's stay or encounter.
In the inpatient setting, some of the important pieces of the patent’s clinical documentation include:
Patient History & Physical
Radiology/Nuclear Medicine Reports
Notes Provided by Nursing Staff
Patient Care & Quality
Operations and Management
Strategic and Financial Planning
Reimbursement & Revenue
EMRs are meant to facilitate more efficient work processes for staff by automatically gathering physiological data, allowing medical records to be accessed both at the point-of-care and at terminals throughout the ICU.
A CCIS is a computerized patient charting system that has been specifically designed for use in intensive care, providing a physician with access to a central data repository containing patent information including, demographic data and physiological data retrieved from bedside monitors.
Some of the problems identified as occurring during the note taking process are as follows:
Collecting relevant and correct patient information
The EMR systems are too rigid and time consuming to navigate
Information requested by the physicians is not known during the ‘rounds process, requiring after-the-fact lookup and documentation annotation
Repetition of patient treatment and observation information in different sections of the EMR
With respect to clinical documentation sophisticated ICU clinical information systems (CISs) must provide the remote care team with access to all relevant patient data, including lab test results, medication lists, progress notes, and bedside flow sheet documentation.
The patient’s EMR must be imported from the hospital information systems (eg, lab results, pharmacy) and ICU devices (bedside monitors, ventilators), and can be used by ICU nurses and physicians for establishing/tracking care plans, charting patient data, and generating progress notes.