I've Got a Little List *

This notion of the value of lists is not mine alone. Recently, the New York Times and others have praised A Basic Hospital To-Do List [that] Saves Lives. A doctor at Johns Hopkins is revolutionizing the quality of care and vastly reducing errors by the simple introduction of checklists.

In the jargon of healthcare, a checklist is a simplified protocol, a precise description of a routine medical procedure. (Wikipedia describes protocols as Medical guidelines.) The idea of protocols for standard procedures is not new, but it's formal and not easily applied on the fly and when juggling a multiplicity of patients and activities.

Here's a quote from the NYT article:

To someone on the outside, [to-do lists] may seem like a no-brainer. But in the crush of crisis medicine, one or more... steps is often neglected, sometimes with disastrous results.

It is evident the need is present not only in crisis medicine but also in daily, routine care. In Using Technology to Improve Patient Care (Sipe et al, Nursing Outlook 51(3), 2003), the authors observe that, "...the nurse is challenged to manage a to-do list with pen and paper." Yet they name no alternatives, merely hinting that technology may offer a solution. With NurseMind this need begins to be satisfied.

Another excellent article -- more in-depth -- in the New Yorker, The Checklist by Dr. Atul Gawande (the sub-header asks If something so simple can transform intensive care, what else can it do?) says:

We have the means to make some of the most complex and dangerous work we do -- in surgery, emergency care, and I.C.U. medicine -- more effective than we ever thought possible. But the prospect pushes against the traditional culture of medicine, with its central belief that in situations of high risk and complexity what you want is a kind of expert audacity... Checklists and standard operating procedures feel like exactly the opposite, and that's what rankles many people.

Nurses included. But even the seasoned professional who has "paid her dues" will be helped by a pocket tool that replaces that wad of paper she calls her "brain" that every nurse carries. (For examples, please visit our brain museum.) She can get help remembering and prioritizing the myriad tasks demanding her attention. She can benefit from the seconds it pares from notating and recalling the myriad bits of data for which she is responsible. For newer nurses the task list will be the most valuable feature. For the old-timers the note-taking features will be most appreciated. For both, it's a long-overdue tool that provides much-appreciated help for the mental part of nursing work.

So what is the mental part of nursing work? To answer this question, I thought a lot about my own experience on my clinical rotations, and talked to a lot of nurses. The best hints came from looking at what they write on their brains. These are four types of things:

• Facts about the patient that drive activities, e.g. dysphagia demands crushing pills.
• Vital signs, jotted on paper for later data entry into EMR.
• Follow-up reminders, e.g. to re-page an MD after a half hour.
• Passwords and combination lock codes.

NurseMind supports the memory of these disparate scraps of information, provides a coherent structure -- a to-do checklist with timings -- into which to organize them, and improves the nurse's efficiency in capturing and recalling them. It is an answer to the New Yorker article's question, "What else can it do?" It is practical, improves productivity, and helps the nurse practice safely.

* With apologies to Gilbert and Sullivan