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Medical Device Integration Blog

Wish List

Posted by Halley Cooksey, RN on Nov 13, 2014 @ 10:18 AM

The holiday season seems to have officially kicked off this past weekend. It seems to happen earlier each year. Gone are all the witches, bats, and ghoul decorations. In their place are festive trees strung with lights, with only the occasional Thanksgiving turkey to break things up. Soon we’ll face the barrage of commercials advertising the countless ways we can spend our holiday budgets. Many of us will spend hours listening to our children and grandchildren describe in very finite detail all the things they have placed on their wish list and how they promise to behave so they’ll get as many of the coveted gifts as possible.

Like our children, as adults we also have wish lists for our toys and that can extend into our professional lives. As nurses we have wish lists for things that will make our work life not only easier, but also allow us to truly practice our profession – caring for patients. Do you have a wish list? What sort of things do you wish for to help you in your daily practice? Do you wish for the kind of technology that can enhance your nursing practice and not hinder or slow it down? We know that no amount of technology will ever be able to replace our assessment skills, our ability to connect with a patient or their family members. There isn’t any form of technology that can console them during a very trying time; nor can technology wipe away a tear or put a band-aid over an injection site. However, we also know that technology can help free up the time for us to give our patients the kind of attention they need and that we want to provide.

If you could create a wish list of the things technology could do for you as nurse, what would you put on it and why? Would you wish for tools that could decrease the amount of time you spend documenting in a patient’s record? Or, perhaps a technology that could help you see the subtle changes in your patients and could alert you that they are beginning to decline and are in need further intervention? We want to hear your thoughts!

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Tags: Medical Device Connectivity, Medical Device Integration, Nurses, Health IT, Healthcare Technology, Nursing Stories, Medical Device Information System, Clinical, Clinical Documentation

Applying Technology in Nursing: Lessons to be Learned From Other Industries

Posted by Karen Lund, RN BSN on Nov 04, 2014 @ 10:17 AM

Technology will not replace nurses at the bedside, but applied appropriately can enable nurses to work smarter rather than harder, and help alleviate some of our complex practice issues. Yes, we need better staffing ratios, work environments and benefits for when our aging baby boomer population requires more care.  But we also need to provide nurses with the right technology tools and support to enable them to deliver the best care possible.  In fact, if we can make nursing “cool” from a technology perspective, then perhaps more young people would be attracted to the profession and help alleviate some of our nursing shortage. 

Just as nursing theory has drawn from professions like psychology, sociology, physiology, anthropology and other disciplines to create better nursing practices, we should also draw from cutting edge technologies to help us provide better and more efficient care at the bedside.  For example, just as manufacturing applied Toyota’s “lean” strategy, nursing has started applying it to health care by giving nurses the power to change their environment to support their ability to deliver better patient care.  But there are still many, many ideas we can borrow from other industries. Waiters in restaurants, for example, can order food from the kitchen using a handheld device while customers are giving their food order.

As nurses, we should be able to order and/or charge supplies, chart medications, take and post pictures and chart all from one device. Nurses should be able to monitor patient vital signs, and automatically record changes to the Electronic Medical Record (EMR) and receive notification of trending changes. 

The technology solutions to achieve these simple, yet time and resource consuming tasks is available today, but have sadly been slow to adopt. I challenge you to ask you hospital why not? Why aren’t they using the technology that would help nurse to give better, more efficient, safer care to patients?
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Tags: Medical Device Connectivity, Medical Device Integration, Healthcare Technology, Medical Device Information System, Medical Device Data

Slow Down To Achieve Expected Results with Medical Device Integration in Med-Surg

Posted by Ken Choquette on Oct 15, 2014 @ 03:00 PM


“Slow Down” may not be words people use when talking about device integration.  Not all device integration initiatives are created equal.  Achieving results within med-surg units requires a bit more clinical involvement than it does in a higher acuity unit. 

Frequently, organizations want to move too fast, which undermines the value of integrating devices in these units, frustrates the implementation team, and worse, destroys end user adoption.  Neglecting the clinicians’ workflow or not conducting a network assessment in the med-surg area could render the system as unusable.  Usually, this is the result of not involving the implementation team in the device integration roll-out and hence, they’re not understanding the issue(s) you are trying to solve.

The decision for device integration in med-surg is the “starting gun” to set goals and to set the finish line.  Start by finding a baseline. 

  • What are you trying to solve with device integration in med-surg? 
  • Who currently collects the data?  How is it collected? 
  • How is data entered into the patient record?  
  • How much clinical time does documentation take away from nursing? 

We know that these are not always the easiest answers to obtain prior to integration, but knowing the current state from start to finish will help an organization set the right expectations for how device integration can improve the efficiency and safety of the existing workflows – and better yet, quantify it.

By taking a little time in beginning of the project – by SLOWING down at the start – your implementation will stay on track and result in FAST adoption and a success story for all to share.

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Tags: Medical Device Connectivity, Medical Device Integration, Implementation, Medical Device Infrastructure

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

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