Capsule by Qualcomm Life
Medical Device Integration Blog

Susan Niemeier, MHA, BSN, RN

Hometown: St. Louis, MO Role at Capsule: Chief Nursing Officer Degrees & Certifications: ADN; BSN – University of Missouri; MHA – Saint Louis University First Job in Nursing: Staff nurse at Christian Hospital BJC HealthCare Most people don’t know that I: Am an avid and passionate mountain biker One thing I want to learn: To play the piano If I had more time, I’d: Dust off the brushes & easel and paint again
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Recent Posts

The Documentation Paradox in Med-Surg

Posted by Susan Niemeier, MHA, BSN, RN on Sep 17, 2014 @ 11:44 AM

The med-surg unit is an operationally intense care environment with typically two out of three hospitalized patients residing in this area. The acuity of patients in this setting is escalating, along with rising co-morbidities and patient age. In parallel, the hospital's patient population is shifting more toward outpatient care, increasing the number of short-stay patients. Short-stay patients are those who stay in the hospital for approximately 23 hours or less and are then discharged to go home. Often, these patients are placed in med-surg units and require a heightened level of observation to assess for subtle changes in their condition. As acuity increases, so do the number of devices at the bedside, along with the requirements for entering data into a patient's record.

Despite these conditions the nurse-to-patient ratio in med-surg units has not changed. This results in more work and immeasurable stress. Add to that the regulatory, legal and hospital compliance efforts for higher degrees of documentation, as well as pressure to discharge patients as soon as possible, and you can see that there is a "perfect storm" of increased workflow requirements that could lead to errors putting patients at risk.  

The environment wherein med-surg nurses work has become incredibly complex and demanding. The result is that they must provide increased effort, energy, and attention just to perform their normal, daily activities. Many are close to the breaking point; they simply cannot take on any more work or responsibility without significantly impacting patient care.

One responsibility that steals substantial time from patient care is documentation. The increasing complexity of patients seen in the med-surg unit means that nurses are constantly moving (between one and five miles during a typical 10-hour shift), making decisions on the fly, and multitasking, all of which takes a high toll on performance and work processes.1 Given all this, nurses view documentation as a lower priority item on their list, choosing to document in batch mode when they have a few minutes rather than in the real time.

In fact, studies find that it takes between two to twelve hours after collecting data from patients' monitors before nurses enter it into medical record. The manual entry of data leads to error rates as high as 17%.2 Yet documentation is taking up an increasing amount of nursing time, with studies finding that 35% of a nurse's time is spent on documentation (147 minutes in a 10-hour shift), while less than 20% is spent on patient care and education, and just 7% on assessment and surveillance.3

The focus on quality in today's healthcare environment means the EMR must be fully integrated into clinical care and decision making. Among the benefits when used properly, for instance, are better decisions and better coordinated care. With physician order entry, physicians need an ‘information rich' record with real-time data. Ancillary departments such as respiratory, physical, occupational and speech therapy also require access to an up-to-date medical record so they may immediately know a patient's state. Such information is equally important for pharmacy, infection control and discharge planning.

However, while EMRs can bring numerous benefits to the hospital environment and improve patient care, they are impractical and even dangerous if the data is not accurate, timely, and complete. So, therein lies the paradox: much of the data entered into an EMR is on the shoulders of med-surg nurses. Yet med-surg nurses are forced to place this task towards the bottom of their list because of their patient care priorities.

The current system relies on the nurse to function as a "human bridge" between medical devices and the EMR. The med-surg unit is no exception. Med-surg nurses capture patient data throughout the day from a number of devices, manually writing the data on a clipboard, sticky pads, paper towels or even alcohol wipes. At a later time during the shift, they key the data into each of their patients' electronic record. The danger of this approach is the increased likelihood of errors and potential for omissions. Moreover, valuable time slips by - time during which critical decisions are made based on data that could be hours old. Just as important, all of this activity of capturing data from various bedside devices and manually keying it into a record takes the clinicians away from direct patient care and surveillance, which can affect outcomes. Very simply, under the current system, clinicians doing both clinical documentation and patient assessment simultaneously is ... well ... incompatible, to put it lightly.  

There are solutions to this "human bridge" problem that can remove the nurse as the "middleman". There is increased focus on the automation of clinical documentation, that is:  the electronic transfer of data from a medical device to the EMR, and other clinical systems. The integration of data in med-surg is even more critical as the patient acuity rises along with the number of number of bedside devices to assist in monitoring. Due to the fundamental nature of vital signs, devices that take these measurements are typically among the first to be targeted for automation. Integration, however, is not limited to devices measuring vital signs. Other types of devices that can be integrated in med-surg include (but not limited to) scales, smart beds, infusion pumps, etc. By not having to record and transcribe information into the EMR, a considerable amount of time can be saved. And, automating the collection of data ensures that all desired information is accurately collected. This eliminates the possibility of accidentally omitting essential data during documentation. Recording patient data at a higher frequency allows for catching subtle changes in a patient status much sooner. 

In an environment where information is recorded automatically into the patient's record, there is no need for a physician and the interdisciplinary team to wait on the med-surg nurse to complete rounds and transcribe the data.

In the end, bringing a flexible, documentation automation system into med-surg can help reinvest nursing time to direct patient-care activities, improve nursing productivity and satisfaction, enhance the completeness of the medical record, and ultimately, improve the delivery of safe, high quality care.

My question to you is, why do hospitals choose not to automate device documentation in med-surg when the evidence is clear?

 

References

1) Potter P, Boxerman S, Wolf L, et al. Mapping the nursing process. J Nurs Adm. 2004; 34(2):101-109

2) Wager KA, et al. Comparison of the Quality and Timeliness of Vital Signs Data During a Multi-Phase EHR Implementation Computers in Nursing. CIN: Computers, Informatics, Nursing. 2010; 38(4):205-212

3) Hendrich A, Chow M, Skierczynski B, Zhenqiang L. A 36 hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal. 2008;12(3):25-34

 

Originally posted on ADVANCE Healthcare POV Blog.

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Tags: Medical Device Connectivity, Patient Care, Medical Device Integration, Nurses, Clinical Documentation, Med-Surg, Low Acuity

Med-surg and device integration: Why not?

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

  • 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.

 

Register To Learn More

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

The Right Technology at the Right Time

Posted by Susan Niemeier, MHA, BSN, RN 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

High Reliability of Data – A Key Benefit of Device Integration

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


The 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

A Letter from Capsule's CNO

Posted by Susan Niemeier, MHA, BSN, RN on May 06, 2014 @ 03:06 PM

 

Happy Nurses Week, to You!

 

It’s time to celebrate and recognize the commitment of all nurses to delivering exceptional care in today’s changing healthcare environment. This year’s theme emphasizes your dedication as a leader in innovating and embracing new technologies, resolving emerging issues, and accepting evolving roles in the profession.

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Tags: Nurses Week