I love the electronic consent!
In practice, not so much. I spent three hours fussing with the consent for two central lines, an incision and drainage, and a seroma aspiration yesterday. Is this an anti-technology rant? Nope.
As I struggled to find wheeling computers, the signature pad, and the USB port hidden behind the steel-plated theft protection, I thought hard about the challenge.
The wheeling computers are everywhere, so, no brainer, right? Wrong. Just like monitors at the nursing station, each is claimed by somebody who rightly feels entitled to use it as he or she must all day long. As the stranger arriving to put in a central line, I have to violate unspoken territories and ownerships by commandeering somebody’s beloved cyber side-kick. Already I’m making no points.
The signature pad, superfluous to regular staff, is missing. So find the person who knows the person who knows where the pads are kept and you’re halfway there. Now you need the person who knows who has the key to the room safeguarding items of high street value, like morphine, electronic signature pads, and chloraprep.
You get the idea.
The problem wasn’t the technology, but the culture of the ward – AKA human nature and corporate processes. The technology works okay, if you can find all the components.
It should, anyway. I found a couple of dud pads or bad connections, who knows. I just know I called two hours prior, asking that somebody please prepare to help me consent.
In my new job I’ve become aware of a phenomenon familiar to all large institutions. If you have a name for it, I’d be much obliged.
- During orientation you learn the process. Eg, ordering D5 ½ Normal Saline.
- Your first day on the job, you find out where the process fails: adding potassium to the maintenance IV.
- Those responsible for the process are in offices far away, so you consult the person next to you at the nursing station – the all-knowing resident.
- The resident shows you the work-around: Order the maintenance IV and a separate potassium supplement, adding a free-text comment that you really want D5 ½ NS with 20 mEq K+. The pharmacist will sort it out.
You’re back in business: a rigid system has created work for you and you’ve successfully offloaded it to the pharmacist.
In our electronic consent example, you slam shut your rolling laptop and consent your patient on a 12th-generation photocopy from 1977.
You pass that form to the ward clerk, who sends it to medical records for scanning, and you’ve created unnecessary, expensive work and an asynchronous medical record. Plus you’ve assured job security for positions designed for the age of papyrus.
We simply haven’t integrated the technology. Why? Because everybody knows it’s pain in the butt. We resist change. The first time our signature pad fails, we revert to a familiar system, however labor intensive (for someone else) and expensive (for someone else).
What will it take to get people engaged with a better system? It’s got to be easier than the familiar system.
Enter the innovators.