As relief night charge nurse on a medical unit at Sarasota Memorial Hospital, Sarasota, FL, Jackie Baxter, RN-BC, often was frustrated by communication glitches that negatively impacted patient care.
"We were having problems because patients were waiting too long to see a nurse, but the nurses weren't always getting the messages about their patients' needs," she said. Her graduate studies in nursing informatics made her aware of potential solutions, so she was pleased to be invited to participate in a discussion about smartphone solutions.
Entrepreneur Trey Lauderdale came to Sarasota to discuss healthcare-focused communications solutions software with nurses and information technology (IT) staff.
"There are so many systems in the hospital setting that produce critical information, notifications and alarms," he explained. "There are nurse call systems, infusion pumps, smart beds, monitors, alarms and other sources. That's a lot of information to convey. If your end device is a pager, the nurse won't get all that rich information. Nurses were getting frustrated with the lack of innovation in end-user devices."
Lauderdale brought along smartphones preprogrammed with software that integrates some of that vital data. "The nurse walks in, picks up a smartphone from a charger and logs in," he explained. "The system automatically routes all messages and notifications to the correct end user."
The synergy between clinicians and IT experts at that meeting gave rise to a long-term working relationship.
"We didn't want to build a solution in an ivory tower and push it upon nurses," Lauderdale emphasized. "We did know some things - like nurses don't have the time to push four buttons to get a message - but agreed to form a development partnership with Sarasota Memorial Hospital to give us real-life input."
While the initial input was helpful, Lauderdale knew the technology needed to be tested in clinical situations.
"The nurses gave us great feedback about design and flow, but sometimes end users don't really know what they want and what works until they try it out," he explained. "So when we launched the pilot in June 2009, we included a button right on the phone for them to send us feedback and requests. We got more than 90 feedback messages in 2 months."
The design team took the feedback to heart, redesigning workflow and smartphone features to address the nurses' concerns.
"For example, we would get a message one day saying the font was too small and then one the next day saying the font was too big and the nurse wanted to see all the information on one screen," Lauderdale said. "We talked with our engineers, and they set up the smartphones for variable font size with the ability to zoom in."
While the smartphone software gives nurses the capability for voice communications, alarms and text messaging, Lauderdale and his team learned a valuable lesson about how nurses convey information.
"We initially thought the majority of communications would be voice, but we soon learned voice communications are very inefficient for healthcare workers because they require both parties to be available for a discussion," he noted. "Nurses don't have time for a voice conversation on every topic, so the majority of communications are small snippets of information: 'I need ice in room 300' or 'Come to the nurses station.'"
Nurses were quick to let the designers know they weren't interested in wasting time by entering the same messages repeatedly.
"We found out what the most common messages were and then provided a quick-pick list for each end user," Lauderdale said. "Today when a nurse logs in on a smartphone, all of her preferences are downloaded and ready to go. That includes the font size and customized quick messages that she's selected."
Baxter finds her colleagues tend to pick similar quick messages. "These are little phrases like, 'Lab is on the phone with a question, 'Patient in room X is complaining of pain' or 'Can you help me in room X?'" she said. "I get the message I need without leaving the patient's bedside, and can respond with a quick message, 'I'll be right there' or 'I'm tied up; can you ask someone else?' We can share the information we need for patient care without interrupting our workflow."
Better & Quieter
The smartphone solutions have been a big win all around at Sarasota.
"It really has helped communication on our busy 48-bed unit," Baxter said. "We each have six patients on nights and, if I'm in a room with the door shut caring for a patient, I can't hear outside pages. When I'm in charge of the unit, I can locate the nurses I need right away or they can text me when they need help."
The unit clerk used to walk around the unit on nights if she really needed to find a particular nurse.
"But now she just texts us and we answer her," Baxter said. "She can let me know a doctor is on the phone, for example, and I can text back that I'll need to call him back, or that I'll be right out. The patients appreciate the reduced noise level now that we don't have so many overhead pages."
Lauderdale has since brought the smartphone solutions to Huntington Hospital, Pasadena, CA.
"We began a pilot in mid-October 2009 on our telemetry unit, because we wanted to prove the alarm feature of the smartphones worked well with the telemetry monitors on that unit," said Ron Rutherford, BA, RN, director of informatics. "We've implemented the alarm feature and the text messaging component, and will be integrating voice-enabled communications shortly."
Huntington nurses were quick to master the time-saving features developed at Sarasota Memorial.
"The nurses make good use of the canned messages such as 'Where are you?', 'I need help in room such and such', and 'Leads off in room so and so'," Rutherford said. "The alarm sounds are prioritized so the urgent ones sound different from more routine alarms. The nurses would like to get the actual tracings on their smartphones as well, so we'll be talking with the company about that."
Rutherford and his colleagues will soon be adding more nursing applications like the Merck Manual, as well as information from the hospital's bed tracking and nurse call systems.
"We're working right now on a plan to roll the smartphones out to the rest of our nursing units, and it's getting pretty competitive," he noted. "We can't do everyone at once, but it's refreshing to hear nurses say, 'Bring it to our unit,' because they've heard such great word-of-mouth feedback from the telemetry nurses."
Sandy Keefe is a frequent contributor to ADVANCE.