As a nurse who worked at the bedside for more than 20 years and now works to educate on technology in hospitals, the most satisfying part of my job is helping improve nurse and patient safety.
As we all know, the safety of nurses is at risk. A recent article by the Robert Wood Johnson Foundation put the situation bluntly: Workplace violence against nurses is at epidemic levels.1 According to a 2014 survey published by the American Nurses Association 21% of nurses reported being physically assaulted. More than 50% reported verbal abuse.2
Multiple organizations, from OSHA to nurse's unions have called for higher focus on workplace violence in healthcare as well as additional regulation.3,4 As hospitals develop policies to meet state regulations and The Joint Commission standards, most are unaware that their existing nurse call system can play a large part in violence prevention and mitigation. 5
Leveraging Existing Technology
Regardless of manufacturer, many nurse calls systems today include real-time locating system (RTLS) technology. 6-8 In these integrated systems, nurses wear locating badges that automate the communication of nurse presence in patient rooms.
In the majority of hospitals I visit, this RTLS technology is vastly underutilized. These badges can do so much more than control dome lights. Among many other uses, most of these badges allow nurses to easily summon help to their exact location.
If the RTLS badge has a button, hospitals can add functionality that sends a needs assistance message to nearby nurses or security, indicating who needs help and where they need help, at the push of a button. Alerts appear on computer monitors and can also be sent to wireless phones or pagers. Certainly nurses have "big brother" concerns with this technology. Yet when implemented correctly, as a way to assist nurses, it can have powerful impacts on safety.
Consider this scenario: A patient lunges at a nurse or grabs her from their bed. Does the nurse have the ability to reach a wall station to press a button? Does she have time to dial a number on her wireless phone? Are there people nearby to come running if she shouts for help? In most cases, no . but on the badge she's already wearing, she can easily press the button and silently send a message for immediate assistance.
Trinitas Regional Medical Center in Elizabeth, New Jersey, went so far as to implement RTLS technology purely as a security measure. More than 300 physicians, RNs, LPNs, and technicians wear the RTLS badges. At the suggestion of The Joint Commission, the hospital conducted a review of assault data, comparing data from the year before they implemented RTLS to the year after.
Although Trinitas saw a 39% increase in violent incidents, they documented a 93.5% decrease in days lost from work, and an 89% decrease in the cost of lost wages. These results are published in The Joint Commission's Leading Practice Library, in a report titled "Workforce Violence in Healthcare Not Always Preventable: A Plan for Mitigation." 9
Benefits for Patients
The button functionality on the badge can also be used to improve patient safety. At a hospital in the Washington, D.C., area, the RTLS was already in place as part of the nurse calls system. When the nurses were presented the opportunity to use the badges for nurse and patient safety, they agreed to a two-week pilot in a Med-Surg unit. The RTLS was set up so that if a nurse pressed her badge button, her name and location would be sent to the wireless phones of other nurses on the unit.
In this case, the staff assist functionality allowed nurses to call for help not only if they felt threatened, but also when they need assistance with a patient. As bedside nurses, we've all been in the situation - you're helping a patient stand up, and the patient loses balance. Or you enter the room to find the patient stumbling toward the bathroom. You immediately prop your patient up, but you can't hold them for long. You can't reach the assistance button on the wall. But you can press the button the badge you're wearing.
In the first week alone, the ability to call for help with the RTLS badges prevented two patient falls. The union supported hospital-wide adoption of the technology, and now nurses wear the badge - and they feel better supported for it.
Last year Ronda McKay, DNP, CNS, RN, chief nursing officer and vice president of patient care services at Community Hospital, Munster, Ind. wrote for Advance about RTLS.10 Her advice is spot-on. Community Hospital clearly spelled out the expectations and intended purpose for using RTLS before implementing the system - improving nurse workflow and safety. Then, most importantly, the hospital used the RTLS for its expressed purpose. McKay advises never using RTLS punitively.
"When RTLS is implemented to accomplish specific goals," she wrote, "and then is only used for this express purpose, concerns about the technology being used to covertly keep tabs on workers quickly dissipate."
It's been my experience again and again that nurses will embrace the technology when it's used to benefit and support the important work we do. And, staff assist is only the tip of the iceberg for this technology. Nurses can also use it to improve patient flow, quickly find equipment like IV pumps, trace the spread of infection, ensure proper hand hygiene, and more.
Learn more about the many uses of RTLS - a technology that is likely already part of your nurse call system - in an educational white paper available at versustech.com/operations.
1. "Nurses Face Epidemic Levels of Violence at Work." Robert Wood Johnson Foundation. July 16, 2015. http://www.rwjf.org/en/library/articles-and-news
2. "American Nurses Association Health Risk Appraisal Preliminary Findings October 2013-October 2014." American Nurses Association."
3. "Workplace Violence in Healthcare." Occupational Safety and Health Administration. December 2015. https://www.osha.gov/Publications/OSHA3826.pdf
4. National Nurses United Petitions Federal OSHA for Workplace Violence Prevention Standard. [news release] National Nurses United. July 7, 2016. http://www.nationalnursesunited.org/press/entry/national-nurses-united-petitions-federal-osha/
5. "Workplace Violence." American Nurses Association. May2016. http://www.nursingworld.org/workplaceviolence
6. Integration Modules for Telligence.http://www.ascom.us/us-en/index-us/products-solutions/our-solutions/product/integration_module
7. Responder 5 RTLS Integration Improves Patient Satisfaction http://www.rauland.com/Staff_Locating_System.cfm
8. Real Time Locating. http://www.jeron.com/about-us/integration-partners/real-time-locating
9. Lending Practice Library. The Joint Commission. July 20, 2016. http://www.jointcommission.org/leading_practice_library
10. McKay, Ronda. "Leveraging Technology for the Greater Good." ADVANCE Perspective: Nursing. June 3, 2015. http://community.advanceweb.com/blogs/nurses3/archive/2015/06/03/all-s-good-when-leveraging-technology-for-the-greater-good.aspx
Kimberly Barnhardt is director of clinical consulting & education for Versus Technology. The former ICU nurse and Patient Safety officer leads the company's workflow optimization and consulting programs, with focus on implementing RTLS technology to improve both nurse and patient experiences.