Med-surg and device integration: Why not?

Posted by Susan Niemeier, RN BSN MHA on Aug 21, 2014 @ 03:11 PM

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  • Med-surg is a demanding, operationally intense care environment. The majority of a hospital’s patients are located in med-surg and generally, the unit provides most of its revenue. In fact, med-surg is described as the hospital’s “backbone”, and it can be argued that it is the most important department in an acute care facility.

  • Med-surg nursing units have the highest nursing turnover rate (>24%) compared to other nursing departments. Without intervention, med-surg will turn over their nursing staff every four years. The cost of turnover is two times the annual salary for this position, averaging around $100,000 per nurse. This has a profound impact on hospitals’ margins.

  • Med-surg units drive patient satisfaction opinions. Nurses cite work pressure and loss of control as the most common predictor of organizational work dissatisfaction. Med-surg nursing units are the last area in which patient’s reside and often the area that has the greatest impact on their perception of care. Consider the impact on measuring patient satisfaction through HCAHPS, which enables comparisons to be made across hospitals.

 

So, why talk med-surg and device integration? The frontline clinicians who work on the med-surg unit represent an essential and costly resource. Maximizing their effectiveness and efficiency is critical to hospital operations and the promotion of safe patient care, which is precisely what medical device integration is designed to do. I hope the data points above express the importance of supporting med-surg clinicians with the tools they need to do their job.

 

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Expanding Medical Device Integration to Med-Surg 

Wednesday August 27, 2014, @ 2pm - 3pm ET 

Susan Niemeier MHA, RN, Chief Nursing Officer at Capsule

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Tags: Medical Device Connectivity, Medical Device Integration, Medical Device Information System, Med-Surg

Safety First - Are You Automating Your Medical Device Data?

Posted by Halley Cooksey, RN on Aug 13, 2014 @ 12:59 PM

ID-100247920When I grew up, safety equipment like bike helmets and seat belts were few and far between. Some of the best memories from my childhood are of sitting in the back of my parent’s station wagon with my sisters untethered to either our seats… or to electronic devices. We passed the time by playing license plate bingo and trying to get truck drivers to beep their horns.

Fast forward 20 years, and the thought of allowing a child into a car without a seat belt, let alone in the “wayback” of a station wagon... err, a SUV... would land a parent on a DFACS (Department of Family and Child Services) watch list. The impetus behind these changes was research. Research found that when children are placed in the backseat of a car, and securely fastened, their chances of survival are greatly improved if they are involved in a car accident.

Nursing practice has followed suit. As a nurse, it is our duty to ensure that we provide the safest care to the patients we serve. Clinical, nursing-driven research has laid the foundation for what is considered to be “best practices” to support us in achieving that goal. But, what if those best practices aren’t enough?

I read an article last week that stated that in 2013, an estimated 440,000 patients died due to medical errors. That’s four times the population of my hometown! As nurses, what can we do to help decrease those errors? How can we be the driving force that saves one of those lives?

Sending data automatically from medical devices at a patient’s bedside into the medical record and other information systems, like clinical decision support, is a good first step in supporting the reduction of those errors.

Have you conducted any studies at your facility that have shown improvement in patient care when documentation is automated?

Let me know your thoughts! Share your story!

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Tags: Medical Device Connectivity, Medical Device Integration, Patient Safety, Nurses, Medical Device Information System, Medical Device Data

Timing is Everything - Especially with Vital Signs!

Posted by Michelle Grate, RN MSN CPHIMS on Aug 08, 2014 @ 12:25 PM

ID-10044848The age old saying, “timing is everything,” still rings true today with Clinical Decision Support (CDS). The most effective time to present a CDS alert is immediately at the point-of-care. But how effective is an alert if the data triggering it is entered hours after the actual event?

To achieve the greatest benefit from CDS, data needs to be entered in near real-time. This is why automated documentation of vital signs is essential, even with periodic vitals collection.

We have long tried to achieve the ideal scenario of real-time bedside documentation, but incorporating the necessary workflow is difficult. While many facilities have deployed auto documentation for continuous monitoring in the ICU or the OR, the med/surg environment, or any location where periodic vital signs collection is performed, is often overlooked or not evaluated for automating documentation.

But why? This is an important environment that can benefit by enhancing CDS with automated periodic vital signs collection.

For example, early detection of a patient’s declining condition in the med/surg environment can lead to early intervention and prevent untoward events. CDS is an essential element in early detection and vital signs are a key component of many CDS rules. When vital signs are not entered into the electronic record for minutes or even hours after they are taken, the opportunity to maximize the benefits of early detection is lost.

It is as simple as this: the sooner data is entered, the sooner the CDS rule can trigger an alert and the sooner the patient can benefit. All of this will help lead to better outcomes.

The med/surg environment should be the patient's next stop in a hospital before going home, not back to the ICU or to another critical care area. Maximize the benefits of CDS with automated vital signs documentation at the point-of-care. Capsule's SmartLinx Chart Xpress™ works with a variety of spot check monitors and sends validated vital signs to information systems in near real-time.

 

Do you have automated vital signs documentation with your periodic monitoring locations?
What are some other benefits you see to automating this workflow?
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Tags: Medical Device Integration, Alarms and Alerts, Medical Device Information System, Medical Device Data, Med-Surg, Low Acuity

The Right Technology at the Right Time

Posted by Susan Niemeier, RN BSN MHA on Jul 28, 2014 @ 10:46 AM

I find myself spending large amounts of time in airports, arriving early to get through strict security, or passing time in terminals due to weather or mechanical delays. During those periods, I seek refuge at a quiet boarding gate that has a high concentration of power outlets or Internet access. Finding these spots is often a challenge, as I peer under seats, circle support columns and poke around vending machines. Occasionally, if I'm lucky, I run across a re-charging station to at least take care of my power needs.

These recharging stations are becoming more and more popular as business travelers flock to them to charge a plethora of devices. There you can find the latest "must have" or "cool" device / gadget on the market. But as I glance at the array of devices, I wonder, "Is cool always smart?" As a nurse, what really matters to me is the impact a device has on workflow or how I do my job, not necessarily its "coolness."

By many estimates, the typical nurse spends approximately 2 hours a shift simply keeping numbers current in patient medical records. By the time the doctors and multidisciplinary care team actually receive the information, it's often already outdated. To me, "smart" gadgets should help me decrease the time I spend inputting data and increase the time I spend directly caring for my patients.

Mobile devices, such as tablets and smart phones, may be the latest technology, and what many hospitals are considering incorporating into every part of nursing workflow. But I'm not so sure these devices will help a nurse achieve what he/she intends. In my experience, adding to nurses' tool belts (which can include as many as 15 other devices) can sometimes weigh us down rather than increase the time directly interacting with patients. We should be "hands on" with our patients, not with another device.

As nurses, our focus should always be on delivering safe, competent, and compassionate care. We should take caution with becoming the first to use an innovative new technology. So, before moving ahead with the introduction of the latest and greatest mobile technologies, perhaps a hospital should consider the following items:

  • Is it easy to use? Has it been thoroughly tested in the care environment?

  • How many steps must the nurse complete in order to get data to its end location? Is it intuitive? Simple? Fast?

  • Does it need to be put down for best data input? Where do we put the device if the patient needs our immediate attention? Then what about the transmission of infectious properties as we go from room to room?

As with any technology purchase, good research and asking the right questions are musts to help assure the tools acquired are more than "cool," but actually useful. When it comes to nursing and patient care, that usefulness equates to quality care, so we must be aware of the shiny new gadget and be confident that we are implementing the right technology, for the right people, at the right point in time.

(Originally posted on www.advanceweb.com)

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Tags: Nurses, Healthcare Technology

Batched Vitals

Posted by Halley Cooksey, RN on Jul 16, 2014 @ 09:00 AM

doctor-stethoscope-patientNursing school…

Just hearing those words can make many of us cringe and flood us with a multitude of memories, whether it was studying the Krebs Cycle until 3 a.m. only to have to show up for clinicals at 7 a.m., or being convinced that you were going to be diagnosed with whatever disease process you were currently learning. All fond memories aside, nursing school was just that: school.

It gave me a foundation, but it didn’t give me the experience I was going to need to survive in the real world. We all talk about real world vs. textbook nursing. But it isn’t until you are on the floor – by yourself – that you really learn what being a nurse is all about and how to manage your time.

Time management is a critical component for any nurse to master. We must figure out how to be in six to eight patient rooms at nearly the same time and ensure we are providing personal, high quality, safe care. So, to “clone” ourselves, we learn to create shortcuts. Some of them are OK, but they often go against established hospital policy. One of the shortcuts I developed was “batched vitals”.

Batched vitals is a process I used when I would have a patient return from a procedure or who would require frequent vital signs monitoring. Knowing that I could not be in the room every 15 minutes, I would program the vitals machine to take measurements according to the doctor’s order and would promise myself to return and check on the patient, peek at the vitals, and then go on my way and repeat the process. Once I could steal away 15 uninterrupted minutes, I would wheel my computer in and manually enter the vitals in to the flow sheet from the vitals machine.

Is this shortcut safe? Have you ever “batched” your vitals?

I ask because I am truly curious as to what other nurses are doing. What is their real world practice as compared to textbook nursing? As a vendor who is out in the field, I get a lot of feedback from nurses and I have found that batched vitals seem to be a general practice. I am not saying that it is right or wrong (although I’m slightly comforted that I am not on an island of my own). But what I am asking is do we need to look at what the impact is on patient care by following this process?

I have read a few studies, but nothing says in bright red letters: “you must be at the bedside every 15 minutes”. But, if this is the case, does technology need to support real nursing practice and allow for sending validated batches of vitals? Or, should we continue with business as usual and embrace the adage of “we’ve always done it this way”?

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Tags: Medical Device Connectivity, Patient Care, Medical Device Integration, Patient Safety, Nurses, Nursing Stories, Vital Signs

Multitasking Nightmares? Tame Them with A MDIS

Posted by Karen Lund, RN BSN on Jul 10, 2014 @ 12:00 PM

ID-10083882Rising patient acuity and dramatically shortened hospital stays are threatening nurses’ ability to meet the needs of their patients. We are constantly on the move, switching from activity to activity, too often finding it difficult to spend enough time with our patients.

How many times have you had to tap your super-power multitasking abilities? Daily? Take, for example, the following all too common scenario. Patient #1 is coming back from surgery. The blood bank calls to say the packed red blood cells are ready for patient #2. You’re waiting for labs in order to give medications to patient #3. Your nurse aide has just informed you that your confused patient #4 has just fallen out of bed and requires immediate help. And patient #5 is waiting for you to complete brand new procedures for discharge paperwork so he can leave the hospital. Sound eerily familiar?

Nurses have adapted to the endless demands for our attention in order to meet both patient needs and their facility’s goals. Distractions may come in many forms on top of patient care, such as new equipment, increased education for new procedures, documentation requirements, and orienting new staff. Krichbaum (2007) reported 40% or more of a nurse’s workday is outside of direct patient care. So what happens when nurses feel like they’re no longer helping the patient and that they’re overwhelmed with non-value tasks? Burn out?

A Medical Device Information System (MDIS) can help nurses gain back more time by helping improve the efficiency of patient documentation. It automatically integrates your medical device data into your hospital’s information system(s), which can save documentation time, increase communication, all while improving accuracy and timeliness. Moreover, in addition to providing connectivity with the EMR, an MDIS delivers monitoring, management and analysis of real-time patient data, enabling nurses to recognize signs of a patient’s physiological deterioration.

Why is this important? An MDIS is one of the few IT solutions that can take some of the pressure off those who give care to our loved ones, while offering real enhancements to the quality of care we are so committed to deliver.

If your facility has already deployed medical device integration capabilities, what kind of impact has it had on your daily activities? And if you haven’t, what’s holding you back?

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Tags: Patient Care, Workflow, Medical Device Information System, Clinical, Clinical Documentation

Maximizing the Benefits of Your Medical Device Integration Strategy

Posted by Michelle Grate, RN MSN CPHIMS on Jul 01, 2014 @ 10:00 AM

ID-10061774A successful strategy is crucial to helping guide decisions throughout an organization, making it critical that it be in alignment with the organizational goals that it is designed to support.  If the strategy is developed without a clear understanding of those goals, then resources, effort, and money can easily be misappropriated. 

When it comes to information technology, a strategy would not be complete without a thorough architecture covering all aspects of an enterprise. However, one of the challenges for developing that strategy is to look into the future and make plans for current infrastructures as well as potential emerging technologies.  A good enterprise architecture will assist in keeping the focus on growth and the necessary predecessors to get there.

With respect to integrating medical device data with the electronic health record (EHR), the strategy needs to look at the current and long term needs of the organization in order to maximize the investment of the medical device information system (MDIS).  Gone are the days when the ICU is considered the only location for integration of medical devices. 

The vast amount of patient data that can be collected and analyzed for real-time clinical decision support can lead to better outcomes. The more medical devices that are connected to the EHR and other information systems, the greater the amount of patient data that can be evaluated for clinical decisions.  Developing a MDIS strategy will help guide the organization's goals and plans over a long term period and keep the organization focused on their patients as they pursue expanding their use of medical device data.

 

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Tags: Medical Device Connectivity, Medical Device Integration, implementation, Medical Device Information System, CONNECT, Medical Device Infrastructure

High Reliability of Data – A Key Benefit of Device Integration

Posted by Susan Niemeier, RN BSN MHA on Jun 25, 2014 @ 10:00 AM

ID-10070663The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 incentivized the adoption of the electronic health record and fast-tracked efforts to implement electronic medical records. The program motivated hospitals to meet deadlines for achieving meaningful use and adopting a wide range of capabilities within their EMR. The benefits gained by implementing the EMR are significant and promise greater efficiency, higher quality of care and safer patients.

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Tags: Medical Device Connectivity, Patient Care, Medical Device Integration, Patient Data, Nurses, Medical Device Information System, CONNECT, Medical Device Data

In Good Company

Posted by Capsule on Jun 19, 2014 @ 04:26 PM

HCI_100_SealMcKesson, Philips, Siemens, Epic, GE, Allscripts, MEDITECH... You don’t have to be a gambler to know it’s a sure bet that there isn’t anyone in health IT who hasn’t heard of these companies.

Recently, we joined these leaders on the annual Healthcare Informatics 100 list, which spotlights the companies with the highest reported revenue in the year prior. It’s our first appearance on the list and after multiple years with continued double digit growth and expansion, we expect to be on the list for years to come.

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Tags: Company News

The Face of Sepsis

Posted by Cyndi Coyne, RN on Jun 07, 2014 @ 10:00 AM

Sepsis is a truly devastating condition. As an ICU nurse, I have seen first-hand how it can ravage a body. I have cared for patients that, despite the best treatment and heroic measures, did not survive. It can appear, seemingly, from out of nowhere and can strike perfectly healthy individuals.

My first encounter with someone with sepsis was many years ago, as a medical assistant in family practice, before entering nursing school. I answered one of the hundreds of phone calls that came into the office daily. It was the father of a young woman; both were long-time patients that I knew them well. He didn’t sound particularly concerned and just went on to explain that his daughter had been having flu-like symptoms throughout the weekend.

At first, I accepted his “flu” assessment and began to give the usual instructions we tended to give patients with viral infections, but something in my gut told me this was something different. Instead, I told him to bring her in to the office so the doctor could see her in between his other scheduled patients.

When they arrived I could immediately see why I felt so uneasy earlier on the phone. She looked awful….very pale, extremely weak, not to mention confused. This was definitely more than just “the flu”. We escorted her into a room and while the nurse got her vital signs, I interrupted the physician who was seeing another patient. “We need you in room three,” I told him. He immediately went in to exam her and came out of the room a few minutes later and said, “Call an ambulance and get the ED physician on the phone for me.”  

After being transported to the hospital via EMS she was admitted with the diagnosis of sepsis. She spent several days in the ICU and for a while they thought she might lose her limbs, if she didn’t lose her life.

The cause was never determined.

Luckily, due to the skill, training and dedication of an entire treatment team of physicians, nurses, physical therapists, and more, she survived and without any residual symptoms. Sadly, though, there are so many who don’t.

The numbers tell us that every year millions develop and die from sepsis. It represents someone with a family and friends who love and care about them. They are your neighbor, your pastor, your sister, or your son.

Evidence links early intervention and treatment to better outcomes. Hours, even minutes, really count and can make the difference between full recovery and death. Advancements in early detection are being made through predictive analytics with the support of regulatory actions and sepsis-awareness community efforts. Healthcare organizations, such as North Shore-Long Island Jewish Health System, are seeing success with notable results of a 16.4% reduction in sepsis related mortalities as a result of modifying complex guidelines and metrics in the emergency departments.

Even those who survive can have life-long, debilitating effects including amputation of limbs, permanent organ damage, difficulties with cognition, and memory loss.  It is critical to provide tools to clinicians that will quickly and accurately identify sepsis in its earliest stages because it truly saves lives.

 

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Tags: Nurses, Nursing Stories, clinical analytics, sepsis, Predictive Analytics

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