By Debra Wood, RN, contributor
June 23, 2011 - Long a physician favorite, iPhones are making their mark as helpful nursing tools as well.
Nurses are embracing the iPhone and its ability to improve communication and access to clinical reference materials. Photo credit: Apple.
“Having a handheld device in your pocket all day is fabulous,” said Karen Macauley, DNP, APRN, director of the Simulation and Standardized Patient Nursing Laboratory and clinical associate professor at the University of San Diego’s Hahn School of Nursing and Health Science in California.
Macauley references drug and lab manuals and treatment guidelines in her internal medicine practice and shows patients diagrams or photographs to help them understand their disease process or recommended therapies. She appreciates that the information contained is updated regularly and does not become outdated like printed books.
Emergency department nurse practitioner Andrew Bowman, MSN, ACNP-BC, at Witham Health Services in Lebanon, Ind., relies on Epocrates to look up medications taken by presenting patients, to confirm dosing when prescribing, to check for drug interactions, and to review infrequently seen medical conditions.
Andrew Bowman, MSN, ACNP-BC, a nurse practitioner working in the ED, says his iPhone, loaded with Epocrates, improves patient care. Photo credit: Epocrates.
“I use it several times every shift, and it’s one of the most important applications I have on my iPhone,” Bowman said. “The iPhone and other smartphones are valuable devices for registered nurses or advanced practice nurses, because it gives them the ability to carry a wide variety of information to the bedside. … These devices have the ability to improve safe delivery of care.”
John Berry, RN, charge nurse at a 33-bed long-term acute care facility in Beaumont, Texas, also finds an iPhone, loaded with Epocrates, valuable in providing safe care. He uses it for identifying a pill, checking for pharmaceutical interactions, assessing significance of laboratory results, and providing patient information.
“Epocrates has so many pictures and diagrams that you can show the family, instantly, so they can understand the depth of the disease they are dealing with and the curative possibilities, the whole perspective,” Berry said. “You can see the understanding come over them.”
Berry also appreciates the regular updating of information and bulletins with results of scientific studies.
“Evidence-based medicine is in the palm of your hand,” Berry said. “It’s like a ticker-tape of medical information going across your view.”
Northwest Medical Center in Margate, Fla., recently became one of the first hospitals in the country to use AirStrip CARDIOLOGY, which sends electrocardiogram tracings from an ambulance en route to the nurse’s iPhone and from the hospital to a physicians’ iPhone.
“We will call the cardiologist and say the patient is having chest pain or there’s an ST elevation on the EKG, and they log in to look at it,” said Laurie Siggins, RN, director of the cath lab at Northwest. “The cath lab can be activated, or they can intervene with medication right away.”
Nurses no longer explain what the EKG looks like or fax the EKG. Siggins estimates it saves about 15 minutes, which can be a critical time difference with a cardiac patient.
The Epocrates software warns clinicians about drug interactions. Photo credit: Epocrates.
“It makes things more efficient, and you have an answer right away,” Siggins said. “It eliminates questions, because you have the cardiologist right there talking with you and looking at the same thing you are looking at.”
Memorial Healthcare System in Hollywood, Fla., invested in the AirStrip OB application for its three obstetrical units. The program eliminates the need for nurses to call providers with changes in fetal heart rates, because they can send the tracing as well as information about maternal contractions, blood pressure and heart rate to the physician or nurse midwife’s iPhone or iPad.
“It gives a constant, real time ‘what’s happening with the patient,’ without having to pick up the phone, call the nurse, interrupt the nurses’ care,” said Mary Roberts, RN, EdD, director of nursing for the Family Birthplace at Memorial Hospital West.
Hospitals also are installing iPhone Voalte point-of-care communication systems, which allow nurses to send and receive text messages, take and place voice calls and view critical alarms on their specialized iPhones.
“It helps the nurse decide what she needs to act on right away,” said Jacqueline Newton, MSN, RN, assistant director of nursing at Texas Children’s Hospital West Campus Emergency Center in Houston. “It’s a great tool for communicating with other health care team members.”
The Nebraska Medical Center in Omaha recently decided to replace its existing communication system with the Voalte application. A team from nursing and information technology selected it because they expect it will mesh well with nurses’ current workflow, said Lianne Stevens, chief information officer and vice president of information technology at The Nebraska Medical Center.
“The big value was the screen size and the ability to text,” Stevens said. “That will assist the nurse in being able to manage communication and not impact patient care. We think the ability to text will increase patient satisfaction and nurse satisfaction.”
Rather than being interrupted by a phone call while providing patient care, the nurse will receive a text and can check it and continue with her work, if it is not urgent. The system will connect with the hospital’s existing telephone system for incoming and outgoing calls, with professionals from other disciplines, and with the call light and general medical alarm systems. The voice-over-Internet-protocol phones will not work when the nurse leaves the facility.
Karen Macauley, DNP, APRN, associate professor, finds her iPhone invaluable for both clinical practice and instructional purposes. Photo credit: University of San Diego.
The University of San Diego’s Hahn School of Nursing requires students carry a handheld device, either an iPhone, iPad or iTouch, which the school loads with clinical reference tools, class lectures and other materials they can use on campus and in the clinical setting.
“It’s a whole new way of teaching,” Macauley said.
Hospitals require the students deactivate the camera feature when in the facility. The school added that to its handheld device policies, as well as no talking on the phone or texting while in the clinical setting.
When students go to a clinical site, they log their experiences on nTrack, a program Macauley and others at the school developed with Skyscape Medical. It takes just a few minutes to add the information using a drop-down screen format.
“We can look at aggregate data on a cohort of 50 students and see what age groups and diagnoses they saw and how much time they spent with the patient and what they did—start IVs, put in a foley or other procedures,” Macauley said. “And the student has an opportunity to look at their logs to put in their portfolio.”
The portfolios help them show a potential employer the experience the students have gained. Nurse practitioner students can log every patient encounter. Next, Macauley plans to develop a program for clinical nurse specialist students to log experiences.
Students also keep a journal and send messages to their clinical instructor using their iPhones. And instructors can send student evaluations to the student’s iPhone.
“The instructor can get a feel for how the student is moving along with role development as a nurse,” Macauley said. “Clinical faculty love it, because they can keep tabs of what the students are exposed to and how they are dealing with that.”
© 2011. AMN Healthcare, Inc. All Rights Reserved.
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