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Medical Device Integration Blog

PODCAST: Deploying device integration within med-surg care units

Posted by Capsule on Sep 24, 2015 @ 04:00 AM

Convergence & Collaboration Podcast: Episode 2

Listen to this podcast episode of Capsule’s Convergence & Collaboration Show and discover the positive impact medical device data can have on your clinical workflow. In this 14 minute podcast our guest will share how the implementation of advanced technology enabling periodic vital signs to be entered into the patient’s record electronically, before the clinician leaves the bedside, improved nurse efficiency aiding an academic medical center to deliver a higher level of care to more patients in less time and without any increased staffing costs.

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Tags: Medical Device Integration, Workflow, Clinical Documentation, Med-Surg, Podcast

The Pecking Order of Device Integration

Posted by Halley Cooksey, RN on Sep 26, 2014 @ 03:16 PM

When I first became a nurse, one of my favorite questions to be asked was “What kind of nurse are you?” The fine print of this question, of course, is “where in the hospital do you work?” I would swell with pride and proudly state that I was an “ER” nurse.

As far as I was concerned (at that time) an ER nurse was the best kind of nurse anyone could be. Sure, working in the critical care area must have its challenges, but how hard is it to take care of an intubated patient who I had so kindly stabilized for you? As for the nurses on the floor, I mean, really? These patients were of the walkie-talkie population. Hang a few bags of IVs, push a little Lasix and remind your nurse tech to measure their output. Obviously nothing compares to the ER.

Fast forward many years to today and I have to tell you what an awakening I have had. After leaving the ER for a myriad of reasons, I crossed over to the dark-side of nursing … also affectionately known as “HIT”. It was during my years working as a clinical systems analyst that everything I thought I knew about med-surg floors made me realize that I had no concept of what it was to walk in their shoes and understand what their workflow was all about.

The nurses who worked on the med-surg unit were taking care of a complex, diverse group of patients with varying degrees of acuity; more times than not, without the assistance or extra set of helping hands of a patient care tech, because the patient care tech was in a room with a confused geriatric patient who couldn’t be left alone. I watched these nurses document on napkins, scrubs and sometimes bed sheets all while taking phone calls from different doctors and receiving orders. Additionally, they were working with social services, the hospice nurse and every other visitor who decided to stop them in the hall and ask about their loved ones. I remember thinking, who signs up for this gig? To say the least, I was humbled by their dedication.

The big picture of this is that “floor” nurses are the ones in need of technology to complement their workflow and not impede it. Technology should not be seen as “big brother” watching over their shoulders, but as an extra set of eyes to help them do what they do best: take care of patients.

Interestingly enough, though, med-surg units are typically that last areas to be thought of for medical device integration. Walk into any critical care area and you’ll likely see monitors feeding to a central station that, in turn, feeds directly to an EMR. Ventilators are cutting edge and their data is flowing to the EMR, as well. Conversely, walk onto a med-surg unit and you’ll likely observe nurses with tattoos of vital signs up and down their arms, or on scraps of paper that they will later transcribe. Their patients’ data is just as important as the patients sitting in the critical care unit or ER, right?

So, here’s an interesting thought to ponder: Typically, there are more med-surg beds in a facility than ER beds and critical care beds combined; therefore, there are more med-surg nurses working at any given time than there are in all the other areas put together. The med-surg areas are the backbone of the hospital. As a general cultural oddity, why is it that these areas are the last to get connected? Why are they not seen as mission critical like other areas of the hospital?

I’d like to hear your opinion as to why this is the case and how we can change this thought process.

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Tags: Medical Device Connectivity, Nurses, Nursing Stories, Clinical, Med-Surg

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

Time. It’s What Med-Surg Nurses Need Most to Care for Patients

Posted by Cyndi Coyne, RN on Aug 27, 2014 @ 11:01 AM

I read an article a few weeks ago that truly blew me away. It first caught my attention in Becker’s Hospital Review, but I have since seen it appear in other publications, such as the Wall Street Journal. It was about bringing nurses back to the bedside. You may be thinking “Isn’t that where they are already?” But here’s the big surprise. The article was about Novant Health in North Carolina and their initiative to free-up nurses so they can spend more time doing what they do best: taking care of patients.

It all began when hospital leaders wanted to know how much time nurses actually spent in patient rooms during a 12 hour shift. What they found was shocking to me, at first. It was only 2 ½-3 hours! They weren’t alone; other healthcare organizations had similar findings. Still, that really floored me! But then I recalled when I was a bedside nurse and I have to admit, considering the nurse/patient ratios and all the activities involved in caring for the average med-surg patient, 2 ½-3 hours sounds about right. I often commented that although it may have taken me five minutes to complete a task, it took more than twice as long to gather the supplies … sometimes having to call or even go to another department … then round up a co-worker to provide an extra set of hands, and afterwards, of course, document it all. With shorter patient stays, quicker patient turnover, and older, sicker patients, med-surg nurses are really squeezed.

Novant decided to do something about it and set an ambitious goal—70% of nurses’ time (or 8.5 hours of a 12 hour shift) spent in patient rooms. To develop a plan to accomplish this, they gathered a group of 40 nurses from across their healthcare system. Wisely, they engaged their own experienced nurses to brainstorm solutions instead of hiring an outside consulting group to swoop in, do a big study, and then dictate a plan of action. The nurses studied process flow and discovered the top activities that pulled them away from the bedside: hunting for supplies, tracking down medications, filling out paperwork, and looking for test results.

The battle plan they developed involved implementing a care team approach that called for LPNs, CNAs, pharmacy techs, and other support staff, to rally around the RN to ensure all of a patient’s needs would be addressed. This included some adjustments in each person’s role so that each team member functions to the full extent of their training and licensing.

In addition, they relocated supplies either in or closer to patient rooms; brought medications to the point-of-care; and implemented an EMR with physician order entry, along with a computer workstation in each patient room. This was all aimed at reducing the required steps in caring for the patient along with documenting that care. Bringing everything the patient needs to the point of care—what a revolutionary idea!

Integral to this strategy was automating the capture of medical device data, which freed-up the clinician from the manual process of entering data into the patient record; not to mention increasing the accuracy of the data, as well. It’s an essential tool that allows nurses more time to focus on the most important part of their job—the patient.

Research proves the more time nurses spend at the bedside, the fewer patient falls, the fewer medication errors, the higher the patient satisfaction rates, and the lower the infection rates. Furthermore, nursing satisfaction also increases, leading to lower nurse turnover. Med-surg units are the backbone of any hospital. Easing the workload of this vital group can only lead to good things.

Oh, and by the way, Novant reached their goal. Nurses are now spending 72% of their time in patients’ rooms allowing them to not only care for their patients, but also keep patients and their families better informed regarding post-hospital care, ways to improve their health, and the prevention of subsequent hospitalizations. Very impressive Novant! Bravo!

How much time do you think nurses at your hospital are engaged in direct patient care?
What measures have been instituted in your organization to increase nurses’ time at the bedside?

We're Discussing MDI in Med-Surg Today at 2:00pm EDT!

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

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

Register Here.

 

 

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

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