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WEB EXCLUSIVE: Digital Records An Important Tool for U.S. Nurses in Afghanistan

Monday August 25, 2008
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First Lt. Edward Pisarsky, an RN with the 328th combat support hospital, checks patient data in the intermediate care ward using an MC4 laptop.
(Photos courtesy of MC4)
In the ED of a combat support hospital (CSH) in Afghanistan, a multidisciplinary team assesses a soldier's wounds before he is transferred to the OR. In an intermediate care ward (ICW) in Iraq, nurses keep a watchful eye on a soldier before his evacuation to the U.S. Army hospital in Landstuhl, Germany. Meanwhile, a team of nurses treat severe dehydration at a forward deployed outpatient clinic in Kuwait.

Throughout Southwest Asia, military nurses remain at the hub of activity in military treatment facilities. They shoulder the heavy load of treating sick and injured patients, mobilizing soldiers from litters to beds, tracking lab results, and shuffling orders from one end of a hospital to another.

Besides administering care, nurses are charged with capturing critical information about patients. Given this responsibility, many nurses admit charting patient care is far from their favorite duty. But few will disagree on how important it is that a patient's information be recorded and shared.


Air Force Technical Sergeant Kelly Jette enters patient information into the MC4 system while at the 447th Expeditionary Medical Support, Camp Sather, Baghdad International Airport. Jette was one of the first to use the new MC4 inpatient medical recording system on the battlefield.
"No one likes to chart patient care because it takes away from the time we could spend helping other patients," says Capt. Kara Beattie, an ED nurse previously deployed to Baghdad, Iraq, with the 10th CSH. "But having this information allows others to know what treatments have been given. This also can provide insight about what care still needs to be done."

Today's standard for recording patient information in the military is electronic, so medical teams can access data easily and immediately. Results are delivered without flight of foot, and supervisors can mine legible data and output reports to pinpoint trends. This standard already has spread to tented hospitals, aid stations, and mobile clinics overseas ó more than 200 medical treatment facilities.

Army-issued laptops, hand-held data entry devices, computer servers, and printers reside in every Level III treatment facility and outlying Army and Air Force facilities in Southwest Asia. These systems, called Medical Communication for Combat Casualty Care (MC4), provide the deployed medical workforce with a means of digitally recording patient information in communication-challenged environments.

Patient information can be transferred to a worldwide accessible database, which provides commanders with visibility of medical operations they have never had before. They can use the data and the system to research, analyze, and report medical trends and move medical personnel and assets to the right place at the right time, based on battlefield reports or necessity. But the success of the system relies solely on the users, which places nurses directly in the crosshairs. By using MC4, they have contributed to the collection of nearly 3 million medical records. Also, being able to check patient data electronically allows for timely care, more so than paper-based methods for patient information.

"We had a patient admitted to the ICW for gastroenteritis, and the doctor ordered some routine labs, including a complete blood count," says 1st Lt. Mary Miller, RN, with the Army's 325th CSH in Al Asad, Iraq. "I was able to quickly access the electronic lab results, and I noticed this patient had very low hemoglobin and hematocrit. The patient was able to receive care for anemia in a timely manner. Had I waited for a printout of the results, the treatment could have been delayed."


MC4's Kent Wells (right) trains nurses on documenting inpatient care at Camp Victory, Iraq.
Having the ability to view a patient's deployed medical history enables every member of the medical team to make the best informed decision, thus improving continuity of care.

"One patient had a bruise on his back, and we noted this in the record," says Beattie. "It turned out to be a bruised kidney. Having this information in the EMR (electronic medical records) allowed other providers to watch the situation and test for additional injuries."

Using EMRs also helps eliminate records lost in transit, which helps eliminate the chance for redundant or unnecessary procedures.

"I think it's our job as a healthcare team to ensure that information travels with patients wherever they go," says Beattie. "EMRs allow nurses and physicians to make clear decisions on the care being administered to our soldiers as they go through the various healthcare facilities before they get back home."

While the collection of EMRs adds to the workload, nurses understand the importance of taking the time to electronically capture all of the patient's data, especially on the battlefield.

"We're the advocate for the soldier," Beattie says. "We're the ones making sure that soldiers' injuries and treatments are documented accurately so additional health care they receive is appropriate and accurate based upon the medical history."


Bill Snethen is a public affairs representative for the Army's Medical Communications for Combat Casualty Care (MC4) program. To comment, e-mail editorNTL@gannetthg.com.