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Debi Sampsel, RN, and RP-7
Bar-code scanner at Mercy Medical Center, Baltimore
Dialed in With an iPhone
Sheila Cortes, RN, BSN, a nurse educator, has come to rely on her iPhone as an indispensible nursing tool. Whether in the classroom, at a meeting, or at the bedside, the iPhone gives her the ability to ensure her teaching information is always up to date. As the nurse educator and a nursing clinician III at Wilmer Eye Institute at Johns Hopkins Hospital in Baltimore, Cortes also is helping to lead the way in an initiative that will put iPhones in the hands of all the facility’s perioperative nurses.
“I see a lot of potential in using iPhones for nurses,” says Cortes. “It’s better than a computer because you can access information at any time from any place, such as at the bedside.”
Plans for the iPhone include loading the most up-to-date policies and procedures and educational materials onto an iPhone application for all nurses to access. These include the facility’s orientation materials, notes on surgeon’s preferences, patient positioning, troubleshooting equipment, PowerPoint presentations, and videos about surgical equipment, instruments, and procedures. Applications also can be developed for quick references for lab values, drug information and calculations, medical terminology, best practices, and numerous other teaching tools.
For example, a nurse who would like to confirm a patient’s cardiac rhythm could type SVT into the iPhone, which would show an actual SVT rhythm and description for the RN to compare with the patient’s rhythm.
“The iPhone can quickly arm nurses with the most current references and evidence-based practices so they can focus on the critical elements of their care, such as verification of the operative eye,” says Victoria Navarro, RN, MAS, MSN, former director of nursing. “It also makes nurses independent thinkers. They don’t have to depend on other people to learn but have the power in their own fingertips.”
Infusion Nursing Goes Hands-Free
Infusion nurses are playing a key role in the development of a wireless, hands-free voice recognition documentation and communication system at Butler (Pa.) Memorial Hospital. Called AccuNurse, the system allows nurses to dictate their documentation and provides patient information and instant access to other team members on demand anytime, anywhere within the facility.
AccuNurse consists of a wearable computer headset, a speech-recognition engine and a software application. The infusion nurse team and Cindy Esser, RN, BSN, MHA, MBA, director of emerging technologies, helped create the system, specially designed to help infusion nurses better manage interventions. The system prioritizes interventions on a task list and allows nurses to rapidly dictate documentation into the EMR (electronic medical record) system. It also can remind nurses and staff when interventions need to be done, such as when to assess or change an IV site.
“In the past, when an IV was ordered, the unit secretary had to call the switchboard to call the IV nurses who had to call the secretary back,” says Esser. “The voice-activated system tells the IV nurse directly about the order and promotes an effective use of our nursing resources.”
For developing the system, Butler Memorial is the winner of the 2009 Health Data Management Nursing Information Technology award, co-sponsored by CARING. The system pilot demonstrated an effective use of nursing resources, significant reduction in documentation time, more complete information in orders and on documentation, and less time needed to request IV starts, according to Esser.
Robot Teacher and Mentor
One of the newer members of the faculty at The Nursing Institute of West Central Ohio in Dayton is a robot. Known as RP-7, the remote presence robot helps address the nursing faculty shortage, according to Debi Sampsel, RN, MSN, executive director of the institute, which is headquartered at Wright State University.
The human-sized RP-7 integrates digital cameras, audio microphones, amplification circuitry, and custom software to create two-way, audio-video communication between professors and nursing students.
“The remote presence robot is a technology that we can use to engage the brain trust of seasoned PhD-level faculty, even if they retire to other locations,” says Sampsel. “With this technology, faculty who want to continue to work in semi-retirement can lecture or work at the simulation center without physically being on site.”
The nursing institute is also exploring how the RP-7 can be used to help address the nursing shortage in the clinical setting. The RP-7 may allow facilities to continue to use the expertise of seasoned clinical nurses who may have physical limitations.
The RP-7 robot has telescopic vision and technology that can transmit such vital elements as a live image of a patient, EKG tracings, urine output observations, chart notations, and heart and lung sounds. Using this technology, nurses off-site could provide real-time critical thinking, mentoring, and educational resources to less experienced nurses. This could be especially beneficial for off-shifts, when in-house resources may be less available, according to Sampsel.
“The remote presence robot can also be used in research when a PhD expert is needed to lend their expertise and teach nursing staff about conducting research at the bedside,” says Sampsel.
Medication Safety in Hand
Nursing is at the core of an initiative that brought advanced, specialized hand-held personal digital assistant technology to Mercy Medical Center in Baltimore. Since last year, every inpatient nurse in the organization has used a bedside medication system on a PDA device that was customized and implemented by the nursing staff.
“We selected this system for the quality and safety features it offers,” says Susan MacMillan, RN, MSN, senior vice president patient care.
Nurses use the bedside medication administration system to scan patients’ bar-coded identification bracelets and medications. The PDA brings up all the necessary medication information, such as the critical five rights: the right patient, drug, dose, route, and time.
“It’s an all-in-one portable device with all the functions of a paper medication administration record, and then some,” says Beth Kilmoyer, RN, BC, MS, informatics project manager.
The PDA allows nurses to document medication administration at the bedside and also features automated alerts for such information as vital signs, pain score assessments, and lab results. In addition, nurses can communicate with pharmacy via the PDA about orders and missing medications.
The system also has been adapted for use with breast milk administration in the NICU, where it is important to ensure newborns receive stored milk from only their own mothers and that it is not expired.
“The system provides us with a better ability to get a confirmed breast milk match,” says Ann Johnson, RN, BS, CRNP, NICU clinical nurse III.
According to Kilmoyer, the system also is helping improve care and patient safety by eliminating legibility errors and providing automated warnings when any of the five rights of medication administration are not being met. The system improves communication because all medication administration information and documentation is accessible to any appropriate professional through the facility’s health information system.
Star Trek Communicator Badge
Affectionately known as the “Star Trek badge” by the nurses at Phoenix Children’s Hospital, the Vocera B2000 communications badge is not science fiction, but a real innovation that’s helping them save steps and nursing time.
The Vocera B2000 communications system includes a small wearable device that is controlled using natural spoken commands and enables hands-free instant two-way voice conversation. For example, to locate and initiate a conversation with Jane Smith, the user would simply say, “Find Jane Smith.”
“When you don’t have to wander all over to find someone, you can keep on nursing,” says Deb Green, RN, nurse manager. “It saves so much time in trying to locate people and get assistance.”
The system allows nurses to answer calls using their voices without breaking sterile technique or stopping what they are doing. In addition, the system can relay text messages and alerts to a display on the back of the badge.
Badge communications are programmed to automatically alert or talk with groups or teams, including the code team, housekeeping team, rapid response staff assist team, high risk delivery team, and every physician group on staff. The system also is integrated into monitoring systems and call lights to instantly alert a nurse to a patient call or an activated alarm.
A study done at the University of California Davis found the system eliminated two miles of walking per nurse per shift on the nursing units, according to Christine Gamlen, RN, MSN, chief nursing executive for Vocera, which developed the badge.
Catherine Spader, RN, is a freelance writer.