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Implementing CareFacts™
One Agency's Experience

By Becky Smith, RN, BSN
Rochester Branch Manager, Shamrock In-Home Nursing Care, Inc.
(Shamrock is the alpha test-site for CareFacts)

It was in the fall of 1994 that I was approached and asked, "How many of your care managers can type?" It seemed like a peculiar question to be asked since there was very little need to do our own typing at work. We had medical secretaries, administrative assistants, and transcriptionists to do that for us. For many years we did our client charting per dictation. Once dictated, it was typed by a transcriptionist.

After being proofed by the appropriate care manager, the documentation was signed and became part of the client's chart. It seemed to be an efficient process, which looked quite professional when complete. On an average, the complete process (client visit, dictation, transcription, proofing, printing, getting signatures, and filing information in the client chart) took approximately two weeks.

In the spring of 1994, we progressed to charting using the Omaha System. This eliminated the dictation and transcription processes. This allowed the care managers to fill out a visit report manually each time they made a client visit. The process could be done within 24 hours, but many times the care managers could not keep up with the manual detailed documentation; therefore, they were never caught up with their documentation. However, throughout all this, there was no need for the nurses to have typing skills. So, I wondered why was I being asked who can type.

I soon found out why the question needed to be asked... CareFacts™. I am the branch manager for the Shamrock Rochester Branch Office, which averages 1800 client care hours weekly. I have a large team consisting of: one intake nurse, nine care managers, two schedulers, one medical secretary, one administrative assistant, 115 clients, and 120 field staff. Shamrock and CareFacts had teamed up and decided to convert from manual to computerized client documentation and my first response was YIKES!!

In order to begin the process, we needed to find out the "comfort zone" of each care manager. It was decided that if a care manager could type, the process may be easier. It was true. One of my care managers was very proficient at typing and found the whole process easy to implement. However, I also had a couple of care managers on the team who had never typed. They have also implemented the process. It just took a bit longer, a bit more patience, and a bit of tender loving care by the rest of the team.

The computers were assigned and implementation began. In the first phase, we were instructed on the "Do's and Don'ts" when using a laptop computer. Among them were, "Do not feed the computer Coke, coffee, rolls, or cookies." Excuse me! Eating and drinking have always been an important part of documentation, or so we thought. Other instructions included, "Wash your hands before using the computer" (this was naturally easy for nurses to do) and "Do not expose your computer to extreme hot or cold temperatures." We were now ready to get down to the "nuts and bolts" of the CareFacts program.

The next phase included instruction on how to get around in the CareFacts program. This was very helpful instruction because none of us were "computer whizzes." We were introduced to words such as "pick lists," "diskette," "hibernate," "escape," and "windows." We were then told to take our laptop computers home and play games for the next two weeks. This was a great way to become familiar and comfortable with the computer. When we returned, we were ready to learn the program. The CareFacts program is simple to use. It scrolls instead of needing to get in and out of various screens, and it is organized in a logical sequence. The main menu has all the needed information for complete documentation of a client. It includes intake data, assessment, medications, care plan, visit report, communication log, and discharge summary. We entered a couple of fake clients and were then ready to do actual client data entry.

By this time, being the branch manager, I was really getting nervous. There had not been any problems yet, and I began waiting for the "shoe to fall." As a team, we calculated that it would take approximately two hours to enter a client. Our team had 115 clients to enter. Meanwhile, there was business as usual: clients to see, manual documentation to continue, care conferences to attend, scheduling tasks to complete, meetings to attend, and employee issues to follow up. Because no one had extra office time, we decided to data enter after office hours. Shamrock administration agreed to pay the care managers overtime to accomplish this.

We paired up a care manager who had good typing skills with another care manager who could quickly locate information needed from the client's chart. We had a great time data entering! We made it fun. There were moments of laughter, such as when one care manager revealed a Bible under her blouse to help her through this! Also, there were moments of panic, such as when it was discovered that one of the computers was not plugged in and it started beeping, threatening to lose all data (or so we thought).

Finally, approximately two months after the computers were distributed, all our clients were entered into the computer. From that moment on, the intake nurse data entered a new client and then transferred data to the assigned care manager. The care manager then completed the client care plan and was ready to enter information on her next client visit. She currently enters data while in the client's home. This eliminates the need to document back at the office or at home in the evening. The complete process of client visit to data-in-the-chart is 24 hours.

In the last phase of implementation a new and improved version was implemented, floppy disks were introduced, printing was discussed, as was the notion of backing up data (so data would not be lost and need to be re-entered... good idea!). And still, the "shoe did not fall."

As a matter of fact, the shoe never did fall! Nothing terrible ever happened. The care managers currently report that "CareFacts is the greatest thing that has ever happened to documentation." It has reduced their workload. As we look ahead, we will begin transferring client data from each care manager's laptop to a main computer over the telephone off hours, and set up easy access of vital client data for our on-call care managers. In conclusion, the entire process took three months. It was absolutely vital to function as a team, supporting each other and appreciating each other's different styles and speeds. We continue to make suggestions for improvement and to be open-minded as we go where we have not been before. When asked, "Would you do it all over again?" the answer is, "Absolutely!"

Citation: Smith, B. (1994). Implementing CareFacts: One Agency's Experience. The Quality Messenger, 1(3), 3, 6, 7.

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