Facebook Pixel Code
About Sickkids
About SickKids

June 6, 2012

SickKids COWS eat paper

Less paper, reduced costs, fewer errors. More time, happier nurses and safer patients.

A recent paperless initiative piloted at The Hospital for Sick Children (SickKids) to reduce the amount of paper used on the units has proven to be so successful that it is being rolled out to the rest of the Hospital.

“We had a number of goals for the KidCare Paperless Pilot,” says Helen Edwards, Director of Clinical Informatics and Technology Assisted Programs. “We wanted to reduce the errors associated with delayed access of printed doctor’s orders and of outdated Patient Care Summaries, to reduce the amount of paper used on the units and to reduce the amount of time Information Clerks spend filing paper reports into patient charts.”

In addition, Edwards says, the team felt that more frequent access to KidCare, SickKids’ primary clinical information system, would lead to more timely documentation of care, particularly medication charting.

Until recently, for each patient, KidCare printed out three reports for nurses to check – the Patient Care Summary, New Medical Orders (NMO) and the Daily Order Summary. The printing of each of the reports had some issues associated with it, says Edwards.

“Patient Care Summaries may be out of date soon after they are printed, as any doctor’s order entered would not appear until the next printing of the report, which may be up to 12 hours off,” she says. As for New Medical Orders, the orders are printed at the Nursing Station when they are entered by a physician or nurse practitioner. The reports are then filed and flagged in the patient’s chart and often the Information Clerk would need to find the nurse to let him/her know that new orders had printed.  

During the pilot, the information printed on these reports was accessed directly on KidCare instead of being printed. Units were provided with portable COWs (Computers on Wheels) to ensure more timely access to the information. A brief one-page patient care summary was also developed to give nurses a sense of the patient’s condition at the beginning of the shift.

Jennifer Andrews, an RN who was a member of the project’s working group, says response to the paperless pilot from her colleagues was very positive. The unit received the number of COWs required to support this new paperless environment.

“There was some apprehension at the beginning, but we did a lot of education and phased in the pilot,” she says. “In the end, the nurses thought it was safer because they could access orders easily – and they were presented in the correct order, which doesn’t always happen. And, the nurses found not having to run to printer was wonderful!”

The pilot ran from Jan. 30 to March 23, and although the pilot is over, the practice of not printing continues. “It was a success,” says Edwards. “In our evaluation we found that of the nurses who were involved in the pilot, 84 per cent felt not having printed NMO either improved or had no impact on their awareness of the new orders.”

“Strategic investment in information management and technology solutions like the COWs enable our ability to improve the way we care for patients,” says Daniela Crivianu-Gaita, VP and Chief Information Officer. “They’re critical to our overall success as an organization.”

The paperless project is now rolling out through the rest of the units in the Hospital, says Edwards. Her team will be tracking red bin and paper and printer cartridge usage as well as user satisfaction to determine the overall impact over the short- and long-term.