Giving Tuesday: Controlling Mistakes in the Health Clinic

Giving Tuesday is in six days is Giving Tuesday, an opportunity to give through social media to non-profits. The CDCA sets a goal for that day for a specific project. Though Nicaragua has suffered with two hurricanes in two weeks, the goal we set awhile back for this year was $5,400 to set up and maintain for one year an electronic patient record-keeping system for the Nueva Vida Clinic.

We are posting on social media about Giving Tuesday and I am writing blogs explaining why we chose to focus on this project and how you can help. Yesterday, we posted a blog about the two hurricanes, climate change, and why going green is important. Today, I want to talk about typing vs. writing. 

Each time a patient comes into our clinic, this is the process Clinic staff follow, printing or writing in cursive at each step:

1. We enter the patient's name and patient number and which doctor they will see on a roster.
2. We accept payment: either a coupon earned from volunteer work, or a token 50 or 60 córdobas (equivalent of $1.43 or $1.72) which goes toward the doctor’s exam, medication, and any necessary lab work. Then we write out their name, patient number, method of payment, check off what they need, and sign the receipt, giving them carbon copies.
3. The intake nurses take a clean daily check-in sheet and write out the patient's name, patient numbers, phone numbers and vitals. 
4.  If they are a new patient, then we add a medical history sheet and a patient card with name, patient number, address and phone number. 
5. The doctor takes the daily check-in sheet and fills in their medical evaluation and the prescribed treatment. 
6.  The doctor then fills out a prescription sheet with the medication that the pharmacy will fill for the patient and instructions for taking the medication. 
7. If the patient needs laboratory tests, the doctor fills out a separate lab exam order. 
8. The doctor then tallies symptoms or conditions treated on a separate pathology form for our records. 
9. The patient takes the prescription sheet to the pharmacy where our staff write separate printed slips of paper for each medicine, including the name of the patient, the medication, how to take the medication, and what condition it is for. 
10.  Afterwards the pharmacy staff write down in a notebook what medications were handed out to be entered into a computer later on to maintain the pharmcy's inventory.

We often see about 100 patients/day and hand out about five medications per person. Can you imagine writing all that down by hand? 

The more patients the clinic sees, the sloppier the handwriting gets…and we have had many doctors and nurses who cannot write legibly at all. This means that if a doctor sees a patient who was previously seen by a different provider, they often cannot read the patient’s chart to know what their medical history is. When we hire new staff OR have visiting doctors, this is a real problem.

We have had to track down patients who have already left the clinic to refill medicine orders because there was a mistake in dosing or the medication itself when the doctor wrote it incorrectly or the prescription was not correctly interpreted in the pharmacy. Amazingly, this has happened less often than you might think.

We often have problems filing or finding paperwork because in the hurry and with the patient moving from one area of the clinic to another, their names or their patient number get written down incorrectly.

With the new electronic patient records system, everything will be entered into a Cloud-based system on tablets or phones. How will this change work at the Clinic? It will:  

• eliminate confusion while trying to fill prescriptions
• eliminate the tedious writing and mistakes 
• eliminate the confusion with patient names and numbers and will eliminate physical filing work
• eliminate the confusion of trying to understand the written data when entering it into computers 
• eliminate the duplication of medications from one doctor to another if a patient has to see a doctor other than their primary care physician 
• reduce check-in time
• reduce the charting for doctors (after getting used to the new system) and allowing for better patient care 
• and mostly allowing other doctors to actually learn what has gone on with the patient by reading clearly typed notes.

For just $5,400, you and we can not only set up the tablets needed for this system, but also cover its internet and cloud-based costs for a year…amazing!

Together we can solve problems.

- Kathleen

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Donate here to the ongoing work of the CDCA with the poor in Nicaragua:

https://donatenow.networkforgood.org/jhc-cdca