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Snoopy Ingram, RN, loved using an iTouch at work so much she bought one for herself. It's not to use at home, but to use on other floors when she's floating. Ingram is a nurse on the med/surg floor at Kaiser Permanente's Sacramento Medical Center where the iTouch is being piloted as an alarm tool to remind nurses of upcoming tasks. Ingram has become a true believer in what the technology can do.

"It's awesome for multipurpose work," Ingram said. "I was kind of hesitant at first - I thought it would be just another beep - but it really works."

Kaiser Sacramento nurses are using the iTouch to set alarms for pain meds, to check Foley catheters, to move patients - anything a nurse would have to remember to do in a shift can be tracked on the iTouch. Ingram said she's often already in motion before the reminder beep comes from her pocket. The alarm has changed how she practices.

Chris Patty, MSN, RN, uses the iPad to prepare data files for transmission to CalNOC at Kaweah Delta Hospital. (courtesy Kaweah Delta Hospital)

"The patients all know we're using [the devices] and they're much more involved with their care," she said. "They feel reassured to know they'll get their meds on time. They're ringing the call light less often and actually find they're using the pain meds less when we go in, but they still want to know they're going to get them on time."

Time Saver

Kaiser Sacramento is among a growing number of hospitals looking at technology to give nurses more time at patient bedsides.

"High tech is great, but not at the expense of patient care," said senior consultant/innovation advisor Christine Richter, MBA. "We want to leverage the technology to give nurses more time at the bedside. We have to look at what we can do to support and cherish that time. The iTouch pilot is part of a large project, Destination Bedside, which has increased time at the bedside by 20 percent.

"Nurses are spending more than half their time with patients," she continued. "These results show technology can have a very positive effect on patient care and the time at the bedside is high-quality time."

Kaiser Sacramento also piloted a mobile clinical assistant tablet device at the bedside.

"The pad led to more patient interaction and more charting at the bedside," Richter said. "This cut charting time in half. The goal is to have the pad in place by fall. All we need is an application that can do barcoding to handle medication administration. The device can already accommodate HealthConnect [Kaiser's proprietary electronic medical records], which automatically sets a timer when meds are administered. The iTouch can work with up to 12 different alarms."

Richter said a culture of change at Kaiser Sacramento allows the pilot programs to work.

"We're piloting the iTouch on two floors and the nurses on the other floors keep asking when they can have them," she said. "Actions are bigger than words, as you saw by Snoopy buying her own iTouch to use when she's floating. She's not the only one who's done that."

Kaiser Sacramento COO Patricia Rodriguez, MPH, RN, is big on innovation, technological and otherwise.

"I want to try everything," she said. "I think we're poised to do a lot of innovative things. The question is how to make it real for all staff that this is all about the patient. We have to create a sense of ownership and pride. It's about changing the culture, the conversation, from what we used to do to what we can do."

"We require nurses to keep so much in their heads," Richter added. "My main goal is to get that information out of their heads in such a way so they can focus on the patient, to be able to be present with that patient when they are at the patient's bedside."

Phoning It In

That was the thought behind a 9-month iPhone pilot at Huntington Hospital in Pasadena, said Ron Rutherford, BA, RN, informatics director. As both a nurse and an IT professional, Rutherford is able to "translate" the lingo and needs of both for the betterment of patient care and nursing satisfaction.

Rutherford piloted the iPhone on a 32-bed med/surg unit. Nurses replaced a number of connection devices (pagers and wireless phones) with iPhones that allow them to call, text and receive alarms. A proprietary application was loaded from Voalte, a communications software company. The system allows unified communication through voice, text and alarms on one device. Phone calls come through the hospital's PBX system while text messages are routed through a user directory. Alarms from cardiac monitoring systems can be received by the user as sent from patient monitoring systems. The combination optimized workflow and improved patient and staff satisfaction.

Wound care and treatment nurse Andrea Gregory BSN, RN WCC, who coordinates prevalence studies, gets some data bedside using the iPad at Kaweah Delta Hospital. (courtesy Kaweah Delta Hospital)

"Sometimes nurses don't embrace technological change, but it became infectious when staff found they could use the iPhone for voice, text and alarms," Rutherford said. "Nurses found it was less disruptive for patients than when they were paged overhead and communications on the floor improved measurably. Nurses on other floors were anxious to give the iPhones a try."

During the pilot, nurses sent and received an average of 150 text messages, received more than 1,000 alarms and received and made 375 voice over Internet protocol (VoIP) phone calls per day. In addition to their own texts, the system allows text messages sent frequently to be "canned," increasing efficiency.

"Every nurse has their own profile, so they can individualize the system," Rutherford said. "It's stored in the hospital's system, not in each individual iPhone, so it doesn't matter which phone they use during a shift. They also can choose to be available or not, depending on what they're doing. So if they're with a patient, for example, they can opt out of receiving messages or phone calls during that time.

Now that the pilot has ended, Rutherford is looking forward to rolling the iPhones out house-wide.

"Our nurses have said they feel better being able to be in touch," he said. "We're moving forward with other applications as well, including teletracking, clinical documentation and another proprietary nurse call system. We're trying to find solutions to accommodate every need with the best return on investment. This is an exciting time."

Bedside Convenience

At Kaweah Delta Health Care District in Visalia, iPads are being piloted as laptop replacements to keep physicians and staff connected. In addition, iPhones and iPad Touches are being piloted, and all nurses use a Cisco VoIP wireless phone to connect with each other and their patients.

The district uses Citrix, which allows them to run native Windows applications across platforms.

Nick Volosin, director of information systems services, said the pilots are anticipated to "keep nurses off paper, keep them at the bedside and enhance communications between physicians and nurses."

"Nurses use the phones for medication administration," he continued. "They scan their badge, log in, scan the medications, scan the patient's wrist band, then give the medication. With barcoding on the phone, the nurse knows the right patient is getting the right medication at the right dose at the right time."

A local medical group is subsidizing a portion of the cost of iPads for 300 physicians, who will pay the difference themselves. Kaweah Delta is picking up the tab to pilot iPads for other staff. Volosin expects to have nurses, case managers, dietary personnel, pharmacy and home health and hospice connected. The iPad battery life is much superior to that of a laptop, it's smaller and easier to use and, Volosin pointed out, far less costly.

Chris Patty, MSN, RN, quality and patient safety specialist, piloted the iPad to collect survey data to submit to the Collaborative Alliance for Nursing Outcomes (CALNOC). Collecting the data required Patty to go to every eligible patient (typically about 300 per quarter), ask questions, and fill out a paper form, one per patient. Each patient accounted for approximately 45 data elements. The forms were then copied and sent to CALNOC for them to input the data into their database. The process was cumbersome and time-consuming.

Enter the iPad.

"I had thought about submitting the data electronically for some time, as CALNOC prefers it and supplies the special Excel files," Patty said. "A laptop computer would be difficult to use because of the weight and battery life, since the surveys take 2 full days to complete. I would need to plug the laptop in about every other unit to keep the battery charged.

I found the iPad is really the ideal platform for bedside data collection," he continued. "It is light and easily portable, the battery life is fantastic. Entering all that data was a little slow at first, but after about two patients I became an expert."

That confirmed what Volosin expected.

"I want to get us away from paper processes to electronic," he said. "We're not bleeding edge, but we do pilot often and early, then study how to implement these devices long term.

"It takes an army to get this done," he explained. "Our staff has all bought in on virtualization and its long-term advantages. If we can shave 10 percent off the time nurses have to charting or some other function, that's more time they can spend with their patients."

Candy Goulette is regional editor at ADVANCE.


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