The hospital environment has often been described as organized chaos — loud, hectic and complex — especially for nurses, who have one of the most stressful jobs in healthcare. In addition to the emotional toll of dealing with suffering and the needs of patients and their families, there’s the physical fatigue that comes with shift work, making rounds, tracking human resources, equipment and medication, and other pressures related to the work nurses do, including patient safety and care. Despite being needed at patients’ bedsides for identifying changes in patient conditions, studies indicate nurses may spend fewer than two hours of a 12-hour shift, or less than 20 percent of their time, on direct patient care, largely due to technology that doesn’t support their workflow, administration, care team coordination and communication needs.
Parkview Medical Center, a 350-bed nonprofit health system located in Pueblo, Colo., found that workflow and documentation processes were taking away from the time nurses were involved in direct care at the bedside. Moreover, reliance on manual processes for care team coordination and activities such as medical administration revealed gaps in information, delays and near-misses. Hospital leaders decided to implement mobile health solutions at the point of care as a means to bridge gaps in communication, increase efficiencies and improve patient outcomes and satisfaction.
Closing gaps in communication
Nurses need to be provided with the appropriate tools to perform their duties efficiently. Without them, many clinicians resort to “workarounds” — temporary, non-standard fixes to problems that can be in violation of hospital policy. For example, a 2014 survey conducted by Spyglass Consulting Group found that more than two-thirds of nurses use their personal mobile phones to support clinical communications and workflow, despite hospital policy restrictions, raising concerns about HIPAA compliance and data breaches.
As more and more clinicians were bringing their personal smart phones to work, the desire to have an all-in-one system that included voice and secure text messaging was a natural one. Nurses complained about having to carry multiple devices — a barcode medication administration tool and a hospital-issued phone — during rounds. Parkview selected a smart phone application that integrated with the handheld device the organization was already using. The technology facilitates communication among clinicians and pairs with clinical decision support system to send alerts, alarms and escalations. The system is device agnostic and includes Voice-over-IP and HIPAA-compliant text messaging for maximum outreach.
Making patient safety a priority
Medication errors, such as omission, wrong dosage and infusion rates, are among the most common mistakes that lead to longer hospital stays and drive up treatment costs. The Institute of Medicine reports that these errors injure 1.5 million Americans every year at a cost of $3.5 billion in lost productivity, wages and additional medical expenses. While these mistakes can be made by any member of the care team, nurses are usually at fault since they spend an estimated 40 percent of their time administering medicines.
In 2007, Parkview saw a need to automate barcode medical administration in order to streamline processes, and reduce medication errors and harm. It leveraged a wireless handheld device that enables clinicians to perform safety checks, safely administer and document medications at the bedside through positive patient identification. The device works by scanning and linking barcodes on patient wristbands and medications to ensure that the right person is receiving the right medication or service. The technology also scans the barcode on the clinician’s ID card to log in and record the nurse’s identity, provides care team members with access to real-time patient data and enables clinicians to upload information into the hospital’s information systems without having to leave the patient’s room.
As a result of implementing the system, the number of medication errors was significantly reduced. An internal study of more than 250 medication administration procedures both before and after implementation revealed that Parkview was able to reduce total medication errors from 20 percent to 8 percent. In addition, the number of serious errors (for example, the wrong patient, drug or dose) was reduced from five to zero.
Dialing up patient engagement, outcomes and satisfaction
Studies have found that as much as 80 percent of medical information provided by clinicians is immediately forgotten due to factors such as complex terminology, whether it was spoken or written, as well as patient education and expectations. However, in order for patients to adhere to treatment plans and participate in their health, they need to understand their condition, remember their medications and follow instructions.
In order to facilitate patient education and engagement, Parkview leverages educational video applications installed on the hospital’s tablets, medical carts and other mobile devices. Clinicians can select from a variety of images and short videos to explain specifics related to patient injuries, diseases, medications, procedures, tests and evidence-based treatments. The information can also be sent to the patient via email to review at home.
Implemented in 2013, the patient engagement tool has already been credited with saving the hospital money by reducing lengths of stay for knee replacement surgery by one day as well as lowering the percentage of no-shows for routine colonoscopies from 19 percent to nine percent.
Parkview not only experienced increased engagement and savings, but patients’ experience of care also increased. Following the rollout of the device, ratings from the Hospital Consumer Assessment of Healthcare Providers and Systems survey showed improvement. Most notably, gains were achieved in the category, “Communication About Medicines” — the second lowest scoring domain on the survey — raising positive satisfaction scores from about 20 percent to 70 percent.
The empowered clinician
Nurses need smart, portable, point-of-care solutions for capturing and transmitting data, as well as routine communication. They also want technology to reduce demand on nursing time by eliminating waste in care resulting from inefficient workflows.
Parkview has received positive feedback from its nurses who are able to quickly connect to physicians, seamlessly integrate with the lab departments, and facilitate communication with care team members and ancillaries for smoother hand-offs and transitions of care.
Improved clinical communication, care and efficiency greatly reduce the physical and emotional stress of the job, and empower nurses by giving them greater control of their schedules and workflows. This enables them to spend more time in direct care of patients and to improve patient safety by reducing medication errors.
Parkview is currently piloting the upgraded system, which will begin roll out house-wide within the next few weeks. As it does so, the hospital is already looking ahead to determine how it will use the mobile platform in the future, including expanding its use to a suite of nursing intervention features, from rounding to documenting patient interventions and assessments.
Steve Shirley is CIO and vice president of IT for Parkview Medical Center in Pueblo, Colo.