Healthcare Informatics

Streamlining Nurse Mobility: Hospitals Move Forward on Devices

Everyone in healthcare knows that nurses are among the most time- and task-stressed professionals working in today’s hospitals. Not only have studies shown that nurses are among the most interrupted of all hospital staff members; they also face a dizzying array of tasks to accomplish during every nursing shift, and as a result, have also become among the most device-encumbered, as technology provides them with more tools to assess, document, and communicate patient conditions during their work.

But some pioneering hospital leaders are moving forward to try to streamline nurse mobility. Among these is Steve Shirley, vice president of information technology and CIO at Parkview Medical Center, a 350-bed community hospital in Pueblo, Colo. At the beginning of this year, Shirley led the implementation of the PatientTouch 3.2™, a wireless handheld solution from the San Diego-based PatientSafe Solutions that enables nurses to access patient data and clinical workflows, while communicating with all appropriate clinicians in the hospital, and automatically forwarding their information into the hospital’s electronic health record (EHR). PatientTouch 3.2 runs on the Apple iPod Touch ®.

So far, Parkview is live with several elements of connectivity using the PatientSafe Solutions application, including bedside electronic medication administration (eMAR), and blood specimen collection tracking; soon, the hospital will go live with documentation for blood infusion administration. Shirley spoke recently with HCI Editor-in-Chief Mark Hagland regarding the ongoing implementation of capabilities using the PatientSafe Solutions application, and the lessons learned from working to enhance nurse mobility. Below are excerpts from that interview.

What prompted you to move forward in this area on behalf of nurses and improved patient safety and efficiency?

I have an interesting perspective, because I’m one of those rare birds who came out of a different industry. My previous industry was banking; I came onto the board of directors of Parkview in 2005, and eventually in 2009, to the CIO position. Back in 2005, we started working with the PatientSafe Solutions people, who were then known as IntelliDot. And we implemented their bedside medication administration (eMAR) solution in 2005. Back then, all it was, was a bedside eMAR. But we had the opportunity with PatientSafe to go to the next level, which was a great opportunity for us. The thing is, it was a device that was single-use, but we also wanted bedside blood administration management as well.

And then, having the iPod Touch, we looked at getting rid of device redundancy. The nurses had a SpectraLink phone in one pocket, and then the bedside device in the other pocket, and then rolling COWs [computers on wheels] forward. And that was just too much. And we’d had such a phenomenal success in reducing medication administration errors, so we saw more opportunity. I went around day and night with the nurses, and they said, don’t you dare take that functionality away from us. So we saw clearly that we wanted to extend the capability of the product.

So we went through a standard RFP product and picked these guys. And we had had some discussion with labs, pharmacy, and radiology, to see what we could achieve. We want to minimize the number of hours they have to drag a COW around. And an order might be as simple as, walk the patient three times a day. So rather than having to track it on a computer, the device will just alert them to do that. And there are new CMS [Center for Medicare and Medicaid Services]requirements around infection surveillance; they literally want to surveil to see that the nurse comes in the room, puts on gloves, handles the blood, and then puts on gloves again.

So it’s going to be a case where we’ll randomly have folks in the hospital randomly surveilling others. And they’ll follow a nurse, and they’ll document on the handheld that the nurse has put on gloves, etc.

So you continue to find new uses for the handhelds?

Yes, that’s right, and at these team meetings, we keep hearing new ideas, and a whole lot of them make sense.

So healthcare is moving forward towards greater functionality, but with fewer devices, correct?

Absolutely, and with ease of use, where the device is no longer tethered.

Listening to the clinicians is a key part of doing this, right?

I learned in a different industry  that if I sat behind a desk, it was going to get me in trouble. So I round all the time with doctors and nurses—actually, our whole IT staff does.

What makes for greater functionality and for greater ease of use in mobile devices?

The previous device that nurses had been using was top-heavy, so it was easy for a nurse to bend over and have the thing topple onto the floor. So my concern when we started with the iPod was that the older nurses might have a problem manipulating the device. But just the opposite has proven to be true. Sure, we see the young ones flying through things with this, but the older ones have totally embraced it, too. And the other thing is, they get that the sky’s the limit on these things. So they keep encouraging things like alerts, so they don’t have to run back to the nurses’ station to get the vitals. So that’s kept them engaged, especially the young ones. They take to these things as quickly and easily as you might expect.

Do you have any explicit advice for other CIOs?

I think the biggest thing that we needed to do, and it was pretty much our standard practice, was, all of us are in this conundrum now between best-of-breed and enterprise-centric systems, and I’m an enterprise guy all the way. But you have to go on a case-by-case basis with things. And we built a multidisciplinary team, including nursing, pharmacy, lab, radiology, pharmacy, medical records, and IT, on this. So there were a lot of people at the table who could work through the RFPs, pay attention to the demos, and go on the site visits, to make decisions. And I’m an enterprise-centric guy, but this is a great example of where I think we’re going to make strides.

How many nurses do have deployed in your hospital?

We have about 800 nurses, and we’re running almost 250 devices, on all the med-surg floors. And that’s day and night shifts, and a lot of people share devices. And we’ll be putting it in respiratory therapy and the emergency department.

Will nurses be inputting vitals into this application?

That’s one of the objectives we want to get to. Or better yet, the ability to have some of the monitoring devices networked, so they go from the devices right out onto the handheld devices. And if we want to do things like rounding or vitals, that we had something like that, capable of doing that.

Is there anything else you’d like to add?

One thing that we liked about the vendor we chose was that their devices pushed notifications to end-users, while some of the other devices we looked at required pull; you had to request notifications. And we liked push a whole lot.