CodeDoc Real-Time Code Blue Documentation

Medical Decisions Software, Inc. has unveiled CodeDoc for Palm OS. CodeDoc is a real-time documentation tool that keeps track of time for each event as you record it. The company has coined the term "docutimer" for this new technology and has applied for patents.

Now with one HotSync, CodeDoc transfers code blue data from your Palm OS device to the PC. Once on your desktop, you may shape code blue data into a formal medical record, build a local database for quality improvement, or transfer data elements to the National Registry of CPR. With the addition of printing software, you can print real-time patient data including fluid balance and total medication doses at the bedside.

Organizes code blue data

Ever have messy paper towel notes about the cardiac arrest after a code? Ever have to organize notes after a code? Ever have the palms of your hand dirty from ink notes of patient vitals? Use CodeDoc instead of the palm of your hand. Because CodeDoc is real-time documentation, it not only keeps track of the time of every event as you document it, but it keeps track of each medication you document, its dose, the number of times administered, and the total dose. Most of the ACLS drugs you will find already in CodeDoc's updatable drug database as a selectable item from an alphabetical list.

How many times in a code have you heard, "When was the last time we gave epinephrine?" With CodeDoc, the answer is immediately available along with dose and exact time to the second it was documented as being administered. This saves time from manually looking at hand written notes or flow sheets to find an answer. How many defibrillations have we done? How many joules did we use on the last defibrillation? What is the predominant dysrhythmia of the code thus far? CodeDoc shows the answers with one tap. How long has the code been going on? CodeDoc knows, for elapsed time is continuously viewable on every screen of CodeDoc.

How does CodeDoc organize the data to make it readily accessible to help with medical decisions when needed? First CodeDoc frees the documenter from having to look at a clock or watch. From the moment the user taps [START] with the stylus pen, the timer begins and each entry is automatically time stamped with a brief description about the event. CodeDoc is a "docutimer" so the user never has to worry about recording time. Everything CodeDoc does is in real time. Second documented data is organized by its time stamp into a scrollable master log. All input, editing, and changes to the record are saved and time stamped, so that the exact sequence of data entry can be recreated. The entire sequence of the code is viewable from the master log.
With long codes the master log may become larger than a Palm screen, so besides the scroll bar, through general and specific filters the organized data is readily accessible to help with medical decisions when needed. For example, the user may elect to view all orders and then further elect to view only all drug orders. If the user misses or forgets to document an event, don't worry. Just document the event on the Palm when you can because once CodeDoc hotsyncs to the desktop, your word processor can help rearrange the entry in the master log. Once the master log is on your desktop, you may edit it and add or change data to formalize it into a medical record. As a side benefit of organized code blue data, debriefing after a code is enhanced because at the bedside you can print a copy of the code¹s master log as well as the summary of the code for each code team member. CodeDoc¹s HotSync currently goes to a text file on Windows NT/ 95/98. In the near future, Cathy L. Schell, MLS, MD, President of the company, says the company plans for the data to also be exportable to an Excel database.

Builds in quality assurance to code blue documentation

CodeDoc does not give advice, but if the user taps on the [Info] button on the medication order screen, brief information about the drug dose is provided by adult/pediatric/geriatric divisions. Furthermore with CodeDoc¹s summary and filters, all code data recorded is accessible to help with medical decisions when needed. This saves time because the documenter does not have to look back to find where the answer had been written.

Manual log sheets are fast and neat, but they can¹t alert you to appropriate assessment time. CodeDoc has assessment alerts for most ACLS medications in its database (other can be added by the user). The reassessment timer connects patient assessments to medication actions. Hence the documenter may make patient assessments happen when they should in relation to a specific medication action, not just when they are convenient .

How many times after you administer Adenocard do you know exactly when the 1-2 minutes are up for ideal reassessment of the patient's dysrhythmia? Typically everyone on the code team is in a state of hyperactivity as they attempt to restart a patient¹s heart. A decision about the effect of a medication such as Adenocard on a dysrhythmia may occur before allowing enough time for the medication to reach its desired peak action. CodeDoc helps the code team adhere to appropriate reassessment times for each medication. CodeDoc does this through its "cooking" timer for each medication listed in its database. CodeDoc's drug "cooking" timer may be set to your preference. For example, normally in a code, epinephrine may be given every 3-5 minutes. CodeDoc uses one minute less than the largest time interval as a default to remind you that it might be prudent to document an assessment of the patient. So four minutes from the time you document administering epinephrine, there will be a pop-up alert. If you want to have an alert in three minutes, then you change the alert time. In other words, CodeDoc¹s timer is adjustable. So you may use it to time conscious sedation or a specific medication.

The user may edit an entry, but the edit will be given a real-time stamp so there is no question about when the edit was done. Once entered into the master log by the [Done] button, an entry is relatively permanent in time and place. If you see an error before you finish the screen, either change it or [Cancel] the screen. If you see incorrect data in the master log, select the screen from the master log, change only what needs to be corrected and then tap [Done]. This edited entry is given a new live- time stamp. This method of correcting errors eliminates messy notes above or below an entry. Legally it is not different from correcting a paper medical record, but is more exact and neater. Plus the master log will reflect any changes or corrections in real time. Code data can be transferred from one healthcare provider to another, because CodeDoc prints to any printer that Stevens Creek Software supports including portable printers like Paxar-Monarch and SiPIX; this may reduce errors from handwritten notes passed between providers.

CodeDoc does not stop until the user exits for HotSync to the desktop. So when a patient goes from emergency room to an ICU, medication drip calculation in real time provided by CodeDoc may be printed out to the receiving nurse in the ICU upon arrival. Hence CodeDoc provides continuous information in real-time and the receiving nurse knows exactly how much lidocaine the patient has already had when the medication summary is printed at the bedside. The receiving nurse also knows fluid balance and each medication given in the code, when each drug was administered, and will receive an alert for the next assessment for each medication the patient had. The company believes, that with no interruption in the process of these calculations such real-time information builds in quality assurance that may improve outcomes.

Saves Time

Manual input with a pen or pencil is fast for recording code events; but if you know how to use a Palm and you learn this software application, CodeDoc may be faster.

CodeDoc is a relatively simple program to learn because it is organized around the "ABCD's engraved in training of BLS. Each menu is organized by Airway Breathing, Circulation, Defibrillation. People who have never used a Palm and know nothing about codes have been able to navigate the program with little assistance. Like any software, the more you use it the faster you become with it. Is it quicker than writing? For those who use the program initially once a day for one to two months to learn the program before actually using it in a code, the company thinks so, but would like to hear from users with any suggestions to make it as fast as or faster than manual documentation.

Several features are intended to help reduce input time. Once you use an assessment screen, each time you select it again, the prior documentation data comes up so all the documenter has to do is to add the new and change only those items that have changed since the prior assessment. For example, on a prior basic patient assessment it was recorded that the BP was 140/95. Now it is 142/90. Only two numbers need to be changed. Using the stylus and CodeDoc¹s own keypad change 0 of the 140 to 2 and 5 of the 95 to 0. This eliminates tapping in the entire BP again, thus saving time. This saves the documenter time from having to re-enter the same data over again from one assessment to the next. Also all input data on a screen is recorded in one tap.
CodeDoc's code blue summary screens are in real-time and designed to save time lost in manually looking at hand written notes or flow sheets to find answers.

"When was the last time we gave epinephrine?" "How long has the code been going?" With CodeDoc, the answer to questions like these are immediately available for elapsed time is continuously viewable on every screen of CodeDoc. For example, "when was the last dose of atropine given and how many 'mgs' have been given thus far?" To find the answer someone has to look through the handwritten notes, find the places where atropine was ordered and then total each dose. By eliminating all three of these steps, CodeDoc saves time.

Another feature of CodeDoc built in to save documentation time, is its own number keypad. CodeDoc¹s number keypad appears only on screens where numerical data input is necessary. This also saves time from having to step out of the program go to Palm's Graffiti or keyboard. But even if you do step out of the program to use Graffiti for a unique event that you want to record into one of the many ŒOther screens CodeDoc furnishes, one tap brings you back to the precise screen where you came from.

Prints real-time patient data at the bedside

The program will continue even after you document the ŒStop Order because (hopefully) the the patient lives on and has to be transferred from ER to ICU, a print-out of the real time data with the latest total dose of each medication and fluid balance may be given to the healthcare provider taking over care of the patient. Again this saves notes and time between two healthcare providers and may reduce error as already mentioned above. The user may print directly from the Palm with choices of printing out the entire master log or printing out separate summaries. [Exit] the program only after everything is done. Once the [Exit] is tapped no more data about the code may be entered because it goes into the conduit ready for HotSync. The HotSync transfers code data to the desktop and you may print out from a printer already connected to your desktop. Multiple print copies of the sequence of the master log of the code may be provided to each code team member for debriefing. CodeDoc¹s printout has already been used in megacode training for ACLS students. Although CodeDoc is intended for clinical application, it may be used as an educational tool.

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