By Kristin Rothwell, NurseZone feature writer
"Technology is adopted by society in
stages. Initially, technology does work that was previously done by people. That
is, technology simply replaces a manual method of doing some activity. As
technology allows work to be accomplished that previously was not possible, true
innovation occurs. Finally, adoption becomes so complete that all dimensions of
society itself are transformed by the technology."
– C. Delaney, Computer Technology,
"Current Issues in Nursing" (1989)
Technology is booming in all sectors of the
workforce and the field of nursing is no exception. Nurses today are discovering
that they have access to advanced devices and software, thereby making their
jobs easier and faster. The result is increased efficiency with day-to-day tasks
and in how nurses provide patient care.
NurseZone
looks at one of the most popular devices on the market today used by nurses –the
personal digital assistants (PDAs).
Instead of carrying manuals with procedures or
references or index cards with patient information in their pockets, with the
use of PDAs nurses can immediately enter patient information at the bedside and
later upload it into a personal computer. Many believe this will not only
increase efficiency, but will also help to reduce medication errors and reduce
costs.
New Tools of the Trade
Although handheld PDA devices are in an early
phase of integration, making it difficult to know how they will significantly
change the way health care is provided, many nurses are using the technology to
write prescriptions, to perform charge capture, vital capture, order entry,
dictation and to look up reference materials.
Peter Geerlofs, chief medical officer at Allscripts,
an e-healthcare solutions company, said, "Clinical information is growing
at a rate where it is impossible for any clinician to keep up. Information
systems are becoming ever more essential to practicing quality medicine. PDAs
make it possible to take that information with you wherever you go. That’s
transformative."
Allscripts positions itself as the leading provider of point-of-care decision support solutions for health care professionals, and markets the Allscripts Pocket Library™, a clinical resource available for PDA devices, in both a stand-alone format and as part of its overall clinical solution, TouchWorks™, a suite of tools including e-prescribing, dictation and charge, all running on the Microsoft Pocket PC operating system.
Geerlofs also said that nurses have most likely been slow
to adopt clinical information systems in the past because of the relative expense and complexity of the technology.
"I believe that physicians and nurses are not necessarily technology phobic as a group--but busy professionals typically adopt new tools only when they meet perceived needs," he said. He also added that, with the advent of newer, more affordable
PDA-based tools, that health care professionals are quckly adapting to using the devices. Today, most PDAs sell between
$400 and $500 each.
Some of the PDAs available to nurses include
those made by Palm, Compaq, Hewlitt Packard and Casio.
Reducing Medical Errors
One PDA user, Christy
Flory, RN, BSN, MS, who is an adult nurse practitioner in dermatology at Beth
Israel Deaconess Medical Center in Boston, Massachusetts, said that the device and the software (qRx and QID) developed by ePocrates, another software solutions company, "has kept my blood pressure down," she said. "I can pull the PalmPilot out
of my pocket, tap a few things and get an answer. It’s much easier than
sitting down at a computer and looking things up."
T.J. Haymans-Benedict, RN, BSN, who works in
critical care, med-surg and the emergency room at Memorial Health System in
Savannah, Georgia, agreed.
"I use the Palm [Pilot] daily to keep up
with medications and interactions," she said.
In fact, the Institute of Medicine’s November
1999 report found that the use of PDAs can reduce medication errors by 50
percent, cutting the number of errors caused by illegible handwriting,
unreadable carbon copies and order sheets stamped with the wrong patient’s
name.
Build It and They Will Come
While much of the software and the operating systems that run the application software on the hand-held devices is being created by large corporations such as Allscripts, 3Com
(makers of PalmPilot), Microsoft and others, nurses are using their critical thinking
skills and computer savvy to create software built "for nurses by
nurses" to specifically meet the on-the-job needs of nurses.
Lynette Jones, RN, Ph.D., chairwoman of the
board of Point of CareWare in Bellevue, Washington, develops software programs for use on hand-held computers and PCs.
After working in health care for more than 20 years, including insurance
companies, government agencies and clinical venues such as intensive care units
and post-acute care, Jones found that all of these places had common
technological needs.
"I went into the Ph.D. program [at the
University of Washington] with intent to start building the ultimate technology
to meet the problems that were lacking in the places where I was employed,"
she said.
Combining epidemiology and bio-statistics with
her doctorate health services research, Jones formulated a system that would
assist clinicians, agencies, consumers and families. In 1996, two years after
earning her advanced degree, Jones turned the project into Point of CareWare, a
company focused on nurses, providing business solutions via an Internet browser—specifically
targeted to skilled nursing facilities, intermediate care, rehabilitation,
assisted living and community retirement facilities.
Jones isn’t the only nurse jumping on this
ever-evolving technology bandwagon.
Jeneane A. Brian, RN, BSN, MBA, president and
corporate executive officer for VNA Home Health
Services (VNAHHS) in Santa Ana, California, wanted to find a way to retain
nurses—especially with the growing nursing shortage.
Looking back over her own nursing experience,
she thought about what nurses liked the least about their jobs. "Certainly
the usual suspects came up: pay and hours," she said, "but it looked
like I could play a big part in keeping people in [nursing] by cutting paperwork—especially
nurses in the home care industry."
According to Brian, for every hour of nursing
care given, there’s 30 minutes of paperwork in a hospital setting, whereas in
home health care for every one hour of nursing there’s 48 minutes of
paperwork, which can amount to three hours of paperwork, not including calls and
travel time—most of which is done on nurses’ personal time.
Pulling together a team of volunteers,
including nurses, Brian set out to create a custom Palm OS software solution for
homecare. Starting with the forms used by nurses in the high-risk infant program
at VNAHHS—because the forms were simpler than those for Medi-Care patients—the
forms were immediately adopted by the nurses in the unit.
"The paper forms are gone and the nurses
won’t go back to paper," said Brian, who noted that paperwork has been
reduced by 50 percent at VNAHHS.
"[The handheld device] has made an
enormous improvement in morale," said Brian. "Though they can’t
replace the computer and they can’t fix management problems, they give [home
care] nurses back their personal lives."
Implementing PDAs in the Workplace
While
certain software could be the answer nurses are looking for, it must also be
user-friendly and necessary.
"Create software nurses want to use, but
don’t punish them with it," Brian said. "It will fail and it’s the
wrong agenda, which is a waste of time and money. It must be an improvement in a
nurse’s day."
While she makes building and implementing
software look easy, that is not always the case as many health care facilities
face budgeting issues and other concerns.
Leah Curtain, RN, ScD(h), FAAN, editor-in-chief
of "Curtain Calls," for Health Management Technology magazine,
advises nurses interested in participating in the information technology
decision-making or with other issues should "understand the full impact of
all modifications to all systems—administrative and financial systems as well
as nursing/clinical systems. Financial and administrative system changes often
have significant impact on nursing, a fact often overlooked by those who are not
involved in the day-to-day use/implementation of IT changes."
PDAs in Nursing Schools
While many nurses are taking advantage of PDAs,
there are still those nurses who can’t seem to put their fears and phobias of
technology aside. Jones pointed out that much of these fears will need to be put
to rest by nursing schools.
"Nursing education needs to accommodate,
accept and embrace technology, while nurses need to learn critical thinking and
technical skills to analyze data," she said. "There are not enough
nurses to continue to provide one-on-one care, which nursing has focused on for
so long. Nursing needs to embrace the tools and the benefits of information
technology otherwise nurses are not going to meet the care demand."
The University of Virginia School of Nursing
recently became the first school of nursing to require students to use hand-held
devices. Introduced by Arlene Keeling, RN, Ph.D., Audrey Snyder, RN, MSN, ACNP,
and Suzanne Burns, RN, MSN, they wanted to bring nursing education into the 21st
century. Recognizing that the paperbound books used by nursing students would
soon be outdated and obsolete, they looked to PDAs as a tool of the future that
would provide students the necessary skills and information technology to
compete in today’s ever-changing health care environment.
"Nurses must have the tools to provide
more efficient care," said Jones. "This is particularly important with
the nursing shortage."
What Does the Future Hold?
The growth in use of hand-held devices by
nurses and other clinicians is expected to rise, especially as the PDAs increase
in memory capacity, gain the ability to add attachments such as digital cameras
and scanning devices, and offer add-ons and multifunctional devices allowing the
PDA user to toggle between different software programs and appliances.
"PDAs will evolve just as PCs have,"
said Brian, who uses her Palm as a computer, a phone and for connecting to the
Internet. "And as they grow, caring for patients will become easier in a
mobile environment."
According to Geerlofs, Allscripts believes that
increasingly sophisticated decision support and knowledge-coupling will become
an indispensable part of the nursing practice.
"This means clinical information systems
[would] understand the context of the problem being addressed for a particular
patient, and [then deliver] any information necessary to make consistent,
evidence-based decisions," he said. "Our next generation of ambulatory
care tools include all of the ordering functions as well—so that the
burdensome and time-consuming administrative aspects of care can be greatly
reduced."