Innovative technologies are rapidly entering the healthcare space and are redefining how nurses practice nursing, which in turn is changing the way nurses deliver care to their patients. Preparing nurses for the impact new technology has on clinical workflow is front and center at Kaiser Permanente (KP) - and, the Sidney R. Garfield Health Care Innovation Center (Garfield Center) is one place where KP nurses and multidisciplinary teams come together to evaluate, simulate and redesign clinical workflows for new technologies. In fact, the American Academy of Nursing strongly suggests clinical workflows be considered when evaluating new systems for adoption to ensure meaningful use of healthcare information and information systems by nurses and other clinicians.
In 2006, to continue its healthcare innovation legacy, KP opened the Garfield Center, a 37,000-square-foot simulated-care environment for testing new ideas, technologies and building designs where multidisciplinary teams at KP go to innovate.
Space to Grow
Located in industrial space in San Leandro near the Oakland airport, the Garfield Center boasts inpatient clinical mock-up space that includes a full-sized med/surg unit with patient rooms; a labor, delivery, recovery and postpartum setting; an operating room; and an emergency department treatment bay. Outpatient clinical mock-up space includes a home health environment, an innovation laboratory, open prototyping space and learning, conference and meeting space - all used by KP staff to safely test new ideas in a simulated environment first.
To ensure nursing had a voice in technology innovation and research, Marilyn P. Chow, DNSc, RN, FAAN, vice president of national patient care services at KP, created a position, in collaboration with KP's information technology (IT) national division, to support shared goals. The current technology focus is delivery of real-time healthcare to transform the care delivery model and member experience. This focal point aligns well with KP's nursing vision, which is advancing the art and science of nursing by employing a patient-centered healing environment through professional practice and leadership - to ensure extraordinary nursing care for every patient every time.
The Garfield Center is leveraged for technology previews, demonstrations and simulations to engage front-line nursing and clinical staff in technology exploration. This includes involving nurses in Garfield Center sessions with multidisciplinary teams for technology innovation to create the vision, generate ideas, develop and test prototypes, create operational plans and evaluate technologies for refinement or replacement.
Nurses & Technology
In a 2008 article,2 the Advisory Board Company pointed out hospital leaders now realize the benefits of nursing IT, which does more than just provide greater efficiencies and access to data. Rather nursing IT elevates nursing practice by directly influencing quality outcomes.
Also, a 2008 article by Chow, Ann Hendrich, MSN, RN, FAAN, vice president of Ascension Health; and colleagues found that 35.5 percent of nursing practice time is spent on documentation, 17.2 percent on medication administration and only 7.2 percent on patient assessment. The authors indicated, "changes in technology, work processes and unit organization and design may allow for substantial improvements in use of nurses' time and safe delivery of care."3
Evidence for a patient-focused, integrated healthcare technology system in our hospitals is key to improving the hospital work environment and patient care, according to Hendrich, Chow and Goshert in their article, A Proclamation for Change: Transforming the Hospital Patient Care Environment. They suggest inefficiencies in hospital design and technology systems take precious nursing time away from patient care. Furthermore, these authors indicated evidence strongly validates there is a link between registered nursing hours per patient and patient safety.4
"The Garfield Center gives us the opportunity to test advances in technology that can improve patient care and safety as well as streamline indirect patient care to help free up nurses' time for more time with their patients," said Dick Daniels, senior vice president and business information officer of health plan and hospital operations. "For example, advances in mobile communication and point-of-care solutions allow nurses to use smart phones and tablet solutions to provide them with faster access to patient information, hospital services and key colleagues.
"In addition, KP is currently exploring and testing a patient room of the future, which incorporates integrated sensors, mobile technology and a flat screen television to instantly alert nurses to changes in patient status, scheduled medication and relevant information from the electronic health record," he added. "Ultimately, these solutions could help us have even faster response times and more resources at the point of care."
Research is done at the Garfield Center to find ways to best leverage technology to improve efficiencies in clinical systems, patient care, safety and nursing practice.
"Technology can be used to improve efficiencies in information and clinical systems to free up nurses and other healthcare workers to improve care coordination, provide safe, quality patient care and work more efficiently," said Diane M. Hedler, MSN, RN, director of quality with The Permanente Federation LLC, KP.
Some of the technologies explored at the Garfield Center by front-line nurses include virtual worlds (VWs), medication adherence and telehealth. KP staff explored VWs technology to determine their viability as an educational method for nurses. In the pilot study, education in a VW was compared to the traditional, face-to-face, real-world (RW) education method, for a specific new patient-care technique - Nurse Knowledge Exchange (NKE) - that KP is implementing throughout its organizations. NKE is the communication handoff that nurses utilize at shift change that brings the nurses to the bedside for shift change, and involves the patient in the experience. Participants in both the VW and RW groups gained knowledge of the NKE protocol and improved their performance of NKE as a result of the education. These results are being used for ongoing VWs research in nursing at KP. A current project includes a KP Southern California pilot study using a virtual discharge nurse to explore the efficacy of using VW technology for patient discharge education.
Medication non-adherence was researched to gain an understanding of the extent of the problem. In the research, 21 different medication adherence technologies were evaluated, including those that can be used to store, organize and dispense medications, and some that can be programmed to deliver medication reminders via phone, text and email. Medication adherence is a complex problem with many contributing factors, including patient; provider-patient and healthcare system; and therapy-related factors. Because of the research done at the Garfield Center, a KP Southern California medical center is designing a medication adherence device that will be piloted to understand more about patient and provider adoption of technology.
Additionally, the team hopes to learn more about medication adherence relative to the use of technologies that provide reminders to patients. A second annual medication adherence grand rounds event will take place this year, to bring together multidisciplinary staff from across KP, including physicians, nurses, IT, other clinicians and innovation experts for a full day of information sharing and education at the Garfield Center to leverage best practices, preview the latest in emerging medication adherence technologies, report on the KP medication adherence technology innovation project and plan next steps.
In research on telehealth, nursing content was developed for scope of practice, standards of care and legal issues, including security, confidentiality, privacy and informed consent for the KP Telehealth strategy. Several telehealth technologies were evaluated.
Currently, work is under way in many regions at KP on telehealth-related projects. Subsequent research on telehealth nursing was done in collaboration with the American Telemedicine Association Nursing Special Interest Group, in an effort to develop a national telehealth nursing fact sheet.
References for this article can be accessed at www.advance web.com/nurses. Click on Resources, then References.
Michelle Y. Williams is national nursing leader, Innovation and Advanced Technology, Kaiser Permanente, Program Offices, Oakland, CA.