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Medical Device Integration Blog

Are you aware that your patient’s ventilator has just disconnected?

Posted by Monica Demers on May 19, 2015 @ 11:34 AM

Blog Series: Medical device integration addresses multiple health technology hazards

It’s a thorny issue that’s difficult to defend.  Bedside ventilators become disconnected with some frequency, and the results are often fatal. The device alarms that should notify caregivers about a problem may be incorrectly set or overlooked in the noisy bustle of the hospital floor.  ECRI ranked ventilator disconnection as a Top 10 Health Hazard.

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Tags: Medical Device Connectivity, Patient Care, Medical Device Integration, Alarms and Alerts, Health IT, Healthcare Technology, Clinical, Clinical Analytics

Healthcare IT: A Nurse’s Revealing Perspective

Posted by Cyndi Coyne, RN on Nov 19, 2014 @ 02:54 PM

Hey! IT departments, CIOs, CNIOs! Did you know that your nurses are NOT happy!?! The results of a survey by Black Book Market Research were just released and it isn’t good. More than 13,000 nurses were surveyed for Black Book’s EHR Loyalty Poll and, I’ll warn you, what they had to say may be very tough to hear.

Nurses’ dissatisfaction with their electronic health record system is at an all-time high with 92% saying they were unhappy with the EMR system in their healthcare facility. That’s a shockingly high number!

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Tags: Patient Care, Patient Safety, Nurses, Workflow, Health IT, Healthcare Technology, Nursing Stories, Clinical, Healthcare IT Departments

Patient-centered Care

Posted by Cyndi Coyne, RN on Oct 10, 2014 @ 05:00 PM

Patient-centered Care … it’s a phrase I’ve heard from the beginning of my nursing career.  But do our actions back up our words?  Is the patient truly the center of our care?  It is certainly what nurses strive to do, what we all want for our patients, and what we expect when it is a loved one who is the patient. But with all of the distractions during any given shift—some necessary, some not—it’s difficult to keep the focus on our patients.

Complicated workflows, redundant, time-consuming documentation, inefficient hospital unit design, unproductive processes can all pull the clinician’s attention away from direct patient care and create unnecessary steps to complete tasks.  There are so many tasks that must be performed during any given shift that it can be difficult, if not impossible, to get it all done. It can be overwhelming. 

With so many responsibilities, there is a risk that nurses may resort to prioritizing the many tasks required and possibly leaving some undone, known as “missed nursing care”, in order to just make it through their shift.  Activities such as ambulation, turning, patient education, and discharge planning are very important duties that, if missed, can cause complications such as blood clots or pressure ulcers, or worse, lead to increased length of stay and a greater chance of re-admission.

As we move from a fee-for-service to a value-based care model (where hospitals are paid a fixed fee according to diagnosis), it is increasingly important to provide the absolute best care possible.  We can’t afford to have anything missed.  Payers will not cover complications, extended inpatient days, and readmissions.

Fortunately, technology is available that can help by reducing obstacles and assimilating seamlessly into clinicians’ natural workflow.  Wearable communication devices aid in locating staff, asking for assistance, and can even alert staff to alarms or call lights.  Rapid sign-on devices can speed up the process of logging in to a computer workstation.  Automating the capture and documentation of the vast amount of data emitted by the medical devices used to monitor and treat patients is very effective in assisting clinicians.  I can speak from experience.  I worked in critical care prior to device integration and it is very time consuming to manually key in all that information.  I can tell you there is a world of difference after the deployment of device integration. 

Capsule has solutions to accomplish device integration.  SmartLinx Vitals Stream can acquire all the continuous data from the devices used in critical care, OR, endoscopy…wherever these type of devices are used.  Even med-surg can benefit from integrating mobile vital signs monitors with Capsule’s SmartLinx Chart Xpress.  And with the addition of the Early Warning Scoring System, the clinician can be alerted to a patient who is at risk of serious decline early so interventions can be set in place to help prevent a serious event.  The outcome of medical device integration is accurate data sent directly to the patient record nearly simultaneously with its collection and greatly reducing the number of necessary steps to complete the process.  This results in the recovery of time that can be redirected to patient care, enhancing the ability of nurses and the rest of the care team to perform the duties essential to helping patients recover.  Time also helps them stay tuned in to the patient’s condition so they can recognize changes that can lead to the development of serious complications.    

Keeping the patient in the center of what we do is what contributes to the overall patient experience and leads to better patient outcomes, as well as higher nurse and staff satisfaction. Most important, though, it’s how we want all patients treated.

Does your hospital promote patient-centered care?
What initiatives have been instituted to ensure the focus is kept on the patient?
What obstacles have you seen that hinder this effort?
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Tags: Patient Care, Medical Device Integration, Nurses

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

Batched Vitals

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


Nursing 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

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