Help staff become part of the computer age

Careful training can end the paper chase

For decades, your agency’s home care field employees have gotten by with paper documentation and reports, and now they will have to fill out their charts using a computer keypad. How do you help them make this scary transition?

Provide extensive training and follow-up, then make it clear that the paper chase is over and there’s no turning back once the computers are in place, says Maura Trilla, RN, BSN, director and administrator for MacNeal Home Care of North Riverside, IL, a hospital-based, full-service agency that serves seven counties in the Chicago area.

MacNeal Home Care ended all paper documentation two years ago, Trilla says. "We told the staff that this is the change, and we’re not going to run two systems — paper and computer. All we have on paper are lab results and physician orders that require signatures."

The training lasted two weeks and was followed with inservices and question-and-answer periods. MacNeal Home Care’s change to a computer documentation system was nearly seamless because the agency took the following important educational steps:

1. Provide mentors who are computer- literate.

The agency asked computer-literate therapists, nurses, and other employees to help their colleagues who had little experience with the technology. "Our staff members were so focused on the mechanics of computer skills that they weren’t focusing on the documentation issues," Trilla recalls. "We needed some liaison from their department to help train them."

The training classes were kept small and mixed according to skill levels, so employees could help each other learn the basics. For anyone who completed the training but said they still didn’t understand how to use a computer, the agency offered tutoring.

"Invest in your staff in the front end, and give them all the extra time they need," Trilla says.

2. Stress how much easier computer documentation will be.

MacNeal Home Care’s system uses a system in which the staff must fill out a screen before advancing to the next item. This way it’s well organized, more efficient, and easier because all employees have to do is follow the computer’s instructions. Now that they’re used to the machines, the staff love it, Trilla says.

"At the patient’s home they can pull out the computer, go to the interdisciplinary communication screen, and write to a therapist what’s happened today," she says.

The documentation note is stored in the laptop computer, and when nurses return home at night, they can send it by modem and telephone line to the agency’s main computer.

3. Give staff support when they need extra help.

First, find out which employees continue to have problems with the computers, Trilla advises. If their problems are because of some deficit in the initial training, then the education manager should examine how the orientation could be changed.

Then ask an employee who likes the computers to talk with the person who’s having difficulty. "It will have a lot more credibility than if you bring in an outside consultant," she says.

An agency also could show support by assuring nurses they won’t lose money during the training period. Since the documentation and training will take longer at first, the agency can pay the nurses a little extra to make up for the home care visits they haven’t had time for during the training period, Trilla suggests.

4. Have someone on call to answer computer questions.

MacNeal Home Care asked a computer-literate employee to be available if anyone had questions. "Then if anybody needed some extra help because they were slow, we’d have them come in and sit with the expert user to answer questions," Trilla says.