e-Prescribing, Charting, and Documentation for Continuous Renal Replacement Therapy: A Green Intensive Care Unit and Nephrology Initiative

Abstract

Background: Patient care informatics are becoming more advanced with digital capacity and server functionality. The Intensive Care unit (ICU) is becoming paperless for prescribing, charting and monitoring care. A further challenge is to include all life sustaining therapies in this digital space. Digital modules and options may be available, however continuous renal replacement therapies (CRRT) often require custom design for many nuances. Associated with the COVID pandemic, and a surge in the paperless and ‘Green’ ICU bedside, we gathered a team to design, develop and implement a CRRT orders, charting-documentation and monitoring functionality into our existing Cerner (ORACLE Corp, Austin, Texas, USA) software. Key messages: This included new approaches to the two-dimensional paper documents used prior and a live dashboard with new metrics and data. The design linked to other relevant CRRT pages such as the master patient fluid balance, pathology results and medication prescribing. The primary views and function are role related for medical, nursing and pharmacy with specific and sensitive input. Following the build and implementation initial evaluation was positive, and led to an audit trail or e-history for prescribers use, and provision for concurrent therapies. Clinicians use this digital ordering differently with live data available for ‘hand-over’ and case discussion. There is scope for research and further links to devices such as personal phones and via an App. Summary: This experience may assist CRRT users design and develop similar prescribing, charting and monitoring bedside computer opportunities in the desire for digital and Green nephrology in the ICU.