By Suzi Birz, principal, HiQ Analytics
Over the past several years, advances in medical technology
have increased the survival rate for infants in the neonatal intensive care unit
(NICU). The number of babies treated in the NICU is rising as is the length of
stay, as the babies “arrive” younger. Coupled with ever-increasing time
pressure, nurses in the NICU may welcome the opportunity to improve
communication and patient safety and spend more time with the babies and
parents. Thanks to the new Crib Notes technology, this opportunity has now
Crib Notes was developed by the president of Grand Round
Software, Robert Stavis, Ph.D., M.D., chair of the department of pediatrics and
clinical director of the NICUs at Main Line Health in suburban Philadelphia,
Pennsylvania. About a decade ago while working at the bedside, Stavis wanted a
way to follow and track the outcomes of patients in the NICU. Since that time,
Crib Notes has developed into a complete electronic health record for NICU
babies, commercially available and in use at four NICUs.
“The primary goal was to improve the quality and safety of
care of patients in the NICU,” Stavis explained.
Crib Notes is organized around the workflow and documentation
already used in NICUs. The software serves all those who participate in the care
of babies. It provides tools to use the data to advance NICU medicine.
“Care begins with nursing data,” Stavis said.
The system is used at the bedside by nurses who are gathering
data. Calculations from nursing and summary data are defaulted into the
physicians’ admission notes, progress notes and discharge summary so that
doctors do not have to spend time gathering information about the babies.
Nurses are presented with familiar-looking, easy-to-use
screens for charting and data entry. According to Kim Flanagan, RN, BSN, this
allows the charting to be completed more quickly. Prompts are provided by the
system to ensure thoroughness while enabling the nurse to return to caring for
the baby. Quality-assurance reminders are built into the system in support of
key compliance monitors. In the event that certain data was expected at a
specific time, a reminder will be sent to the nurse if that data is not recorded
at that time.
Respiratory therapists, physical therapists and social workers
chart their progress notes in the system. Consulting physicians who had
routinely left illegible notes for the NICU nurses and physicians now enter
their notes in Crib Notes. Having all the data available greatly enhances
communication about the patient. Case managers review the data online and are
able to see all the data in one place from all the caregivers and over the
entire length of stay.
In an effort to enhance communication with the parents of NICU
babies, Crib Notes has a parent e-mail feature. Nurses review and personalize
the system-generated text, which summarizes the flow sheet data about the baby's
weight, I&O and other clinical variables. These e-mails, which are written in
“first person” from the baby, have been well-received by the parents, Stavis
Caregivers use the system when speaking with parents, browsing
through the record.
“One way to show a baby’s progress—in face of what might
appear to be no progress—is to show and give a copy of the growth chart,”
explained Cindy Cox, a neonatal nurse practitioner at Alfred I. duPont Hospital
for Children in Wilmington, Delaware. “Parents collect and keep the growth
charts and e-mails in their baby book.”
Stavis detailed that the data is available and useful across
the patient population as well as for the individual baby. The system provides
the tools that are critical to “understanding what is going on in the NICU and
tracking the results of patient care,” he explained. The data supports the peer
review and quality assurance processes. Structured diagnoses allow for morbidity
and mortality reporting, and the system allows examination and reporting of
condition combinations, treatment success, outcome follow-up and research
Ease of Use
Crib Notes requires very little training beyond an
orientation. The ease of use is evident by the wide variety of users of the
system. Consultants and therapists that spend only part of their day in the NICU
are using the system just as the ever-present nurses and physicians do. Flanagan
noted that float and temp nurses get an overview and orientation to the system
and then adapt very quickly to charting on the system.
The system does some of the repetitive tasks and tracking that
nurses are routinely required to do and that take time out of the patient care
hours. The system does I&O math, noted Cox, all but eliminating the calculation
errors associated with fluids and nutrition. There is a built-in breast-milk
identifier using barcode technology, allowing the milk to be labeled by the
mother and provided to the appropriate baby or babies.
Flanagan stated that the quality assurance aspect is improved
because the data represents information from all the caregivers and it is
organized, helping to ensure that what is supposed to be done is done.
“The system does not do the thinking for the physicians, but
it helps ensure that the caregivers are making informed decisions,” Stavis
“Crib Notes helps you do your job better and more efficiently
while increasing patient safety and compliance,” Stavis asserted. “The
integrated medical and regulatory documentation makes the work of taking care of
Cox added: “There is improved communication between
physicians, nurses, neonatal nurse practitioners, ancillaries and all
consultants, and therefore improved patient care and safety.”
Flanagan reflected on her four years of use of Crib Notes:
“[It] has made my job easier than anything else I have come into contact with in
eight years of NICU nursing. It allows me to focus on patients and spend less
time on tasks and documentation.”
For more information, visit the Crib Notes or Main Line Health
© 2005. AMN Healthcare, Inc. All Rights Reserved.