Collaborative care documentation by exception system

Development of a workstation-based documentation system supporting collaborative care and nurse charting by exception has been underway for the last two and one-half years at Vanderbilt University Medical Center in Nashville, Tennessee. The Pathways system has undergone two major revisions and is currently implemented on three nursing units. The system supports collaborative care by providing a mechanism for entry and printing of collaborative care pathways and collection of exception data. Paper flowsheets for manual charting are generated based on the patient's collaborative pathway and individual needs. The Pathways system has significantly decreased nursing time and effort for documentation. This paper describes the development, implementation, and impact of the workstation-based documentation system.