HI300 Unit 8 Downtime Procedure Example

When the Screens Go Dark Mid-Labor: A Unit 8 Downtime Procedure Keeping Fetal Tracings, Interpretations, Orders and Births Documented on a Labor and Delivery Unit, and Bringing Them Back Afterward

[Student Name]

Purdue University Global

HI300: Information Systems for Health Care

Unit 8 Downtime Procedure

[Instructor Name]

[Date]

The hospital, its equipment and the timings are composite; the practices described and the sources cited are real.

Purpose and Scope

This procedure applies to planned and unplanned downtime of the perinatal documentation system, the network or the main electronic record on the labor and delivery unit. Downtime events in hospitals are associated with reported safety incidents involving delayed care, lost information and wrong-patient errors, and many of those incidents trace back to unclear procedures rather than to the outage itself (Larsen et al., 2018). The procedure is part of the hospital's contingency plan, a plan federal security regulations expect every covered hospital to keep, with procedures for continuing critical processes during an emergency (45 C.F.R. § 164.308).

Step 1: Declaring Downtime

The charge nurse declares unit downtime when the perinatal system cannot display current tracings at any bedside for more than five minutes, or when the information services department announces an outage. She calls the help desk, records the start time on the downtime log and announces the downtime on the unit. Planned downtime, such as an upgrade, is announced at least forty-eight hours ahead and scheduled for the hours with the fewest scheduled inductions.

Step 2: Tracings and Interpretations

The fetal monitors keep working without the network and print to paper. When downtime is declared, every nurse turns on the monitor's paper printer if it is not already running. Interpretations are written directly on the paper strip with the time and the nurse's initials, using the same terms used in the system, and on the paper labor flowsheet kept in the downtime box at each bedside. The surveillance system's read-only downtime station at the nurses' station displays tracings stored before the outage, so the history is not lost. The strip becomes the record again for as long as the downtime lasts. Every interpretation written on it is an entry that must later find its way back into the system, so the time and initials are not optional. The nurse also notes on the strip any event that the system would normally capture automatically, such as a position change, an epidural top-up or a vaginal exam, because the paper printer records the tracing but nothing about the care around it.

Step 3: Orders, Medications and Results

Physicians and midwives write orders on the paper downtime order sheet. Oxytocin rate changes are written on the paper infusion record. The pharmacy and laboratory follow their own downtime procedures and send results by phone to the charge nurse, who writes them on the results sheet and reads them back. Verbal orders are limited to emergencies and countersigned within the shift.

Step 4: Births and New Patients

A newborn born during downtime receives a preprinted downtime identification band and a temporary number from the downtime registration packet. The delivery record, Apgar scores and newborn assessment are written on the paper delivery form. A patient admitted to the unit during downtime is registered on paper by the unit clerk with a downtime number that registration will later link to her permanent record.

Step 5: Recovery

When the system returns, the charge nurse confirms that tracings display at every bedside before declaring the end of downtime and recording the time. Recovery happens in a set order. First, registration links downtime numbers to permanent records. Second, current orders are entered into the system and checked against the paper sheets by a second clinician. Third, each nurse enters a summary of interpretations and care for her patients during the downtime, labeled as late entry with the actual times of care. Fourth, all paper is sent to HIM, where it is scanned into the record and indexed to the right encounter. The paper is part of the legal record and is never destroyed until scanning has been checked.

What Usually Goes Wrong

Three failures recur in downtime reviews at hospitals like this one. Staff wait too long to declare downtime, hoping the system will return, and interpretations from those minutes are never written anywhere. The downtime box is missing forms because nobody checked it since the last drill. And recovery is rushed, so late entries are made without times or are never made at all. Each step above addresses one of these: a five-minute threshold for declaring, a monthly box check and a fixed recovery order with a second clinician checking orders.

Drills and the Bedside Card

The unit drills a simulated downtime twice a year, once on a night shift, timing how long it takes to start the paper process and to recover. Guides on contingency planning for electronic records recommend regular drills and paper backups kept current at the point of care (Sittig et al., 2014). The downtime box at each bedside is checked monthly by the night charge nurse for forms, bands and pens. A one-page card in each box lists the five steps in the order above, with the help desk number at the top.

References

45 C.F.R. § 164.308 (2024).

Larsen, E., Fong, A., Wernz, C., & Ratwani, R. M. (2018). Implications of electronic health record downtime: An analysis of patient safety event reports. Journal of the American Medical Informatics Association, 25(2), 187-191. https://doi.org/10.1093/jamia/ocx057

Sittig, D. F., Gonzalez, D., & Singh, H. (2014). Contingency planning for electronic health record-based care continuity: A survey of recommended practices. International Journal of Medical Informatics, 83(11), 797-804. https://doi.org/10.1016/j.ijmedinf.2014.07.007