HIC08 Workshop Presentation Dr Maureen Farrell

CRICOS Provider Number 00103D

The use of wireless technology and hand held computers in the acute

care setting to improve patient safety Dr Maureen FarrellHIC 09

CRICOS Provider Number 00103D27/02/092

Background

Emerging technologies such as wireless networks,

handheld devices and associated applications are

impacting and will further develop in the delivery of

health care in Australia and overseas. The increasing

complexity of the health care system makes information

technology a necessary

work tool for clinicians,

as it provides an effective

system to prevent errors

and adverse events.


Background

The massive amount of nursing and medicalinformation, the rapid growth in newpharmacotherapies and technologies, increasing timeconstraints on clinicians, mounting pressure to reducecosts, and substandard systems for delivery of care,makes it virtually impossible for clinicians to providehigh-quality, error-free care on a consistent basis. Inthe majority of cases most errors and adverse eventsare the result of human failings and faulty systemdesigns, not individual negligence or incompetence. Apossible solution to this problem is the design ofmobile information systems that can assist clinicians inproviding the highest quality of care to their patients.


Background

In the majority of cases most errors and adverse events are theresult of human failings and faulty system designs, not individualnegligence or incompetence. A possible solution to this problemis the design of mobile information systems that can assistclinicians in providing the highest quality of care to theirpatients. Real time point-of-care access (and input) to patientinformation, nursing reference information, and druginformation will be highlighted. The focus will be on registerednurses who will be using the personal digital assistants (PDAa) inthe Oncology ward at the Royal Women’s Hospital and at theAustin Hospital Intensive Care Unit both located in Melbourneas a pilot in an ARC Linkage Grant. It is expected that anoutcome of this grant will be a set of guidelines for managingwireless handheld computers in clinical units, to enhance patientsafety and quality of care.


The Royal Women's Hospital

Gynaecology Oncology Unit

The Royal Women's Hospital:

Is Australia's largest specialist hospital dedicated to improvingthe health of women of all ages and cultures, and newbornbabies.

Provides an integrated inpatient/outpatient oncology servicefor women with benign, pre-malignant and malignantconditions.

Patients of the oncology unit are mostly women withdiagnosed, or suspected, gynaecological or breastcancer who may be treated here at any stage of theirillness.


Oncology-Dysplasia Unit

Cases Treated

JANUARY TO JUNE

2006

Total Number Surgical

Cases - 165

Major Cases - 128

Minor Cases - 37

Malignant Cases -

74/165 (45%)

Benign Cases - 91/165

(55%)

JULY - DECEMBER

2006

Total Number Surgical

Cases - 186

Major Cases - 140

Minor Cases - 46

Malignant Cases - 100

(54%)

Benign Cases - 86

(46%)


Participants at the RWH

Approximately 30 RNS

PDA provided to each RN for a 12 month

period

Training and support provided

Software applications preloaded

MIMS

Care Maps

Handover


Structure of Care Map Form

Type Name Purpose

Label Title Contained title of page

Text Box Contents To contain contents of data

for caring instructions for

pre and post care.

Combo Box 1 Diseases Contains list of

diseases/procedures to

select

Combo Box 2 Day of Care Contains selectable data to

select desired day


Austin Health Ian BaldwinVirtual Tour

Higher bandwidth (broadband) (2Mb

Following slides related to Austin Health are all copyright to Professor Baldwin

http://www.austin.org.au/mod.asp


Staffing ICU – nursing over year 2007

Monthly total admissions 2005 – 07’

The staffing gap….Austin ICU

2084

2344

-ve 260

-3000

-2000

-1000

0

1000

2000

3000

ICU: Monthly Total Patient Admissions

0

50

100

150

200

250

Jul-0

5

Aug

-05

Sep

-05

Oct-0

5

Nov

-05

Dec

-05

Jan-

06

Feb-

06

Mar

-06

Apr

-06

May

-06

Jun-

06

Jul-0

6

Aug

-06

Sep

-06

Oct-0

6

Nov

-06

Dec

-06

Jan-

07

Feb-

07

Mar

-07

Apr

-07

May

-07

Jun-

07

Admissions Moving Average Admission

hrs

2007

Nursing 175 staff, 118 EFT

…..57 Full time

….156 ICU ‘qualified’ or in training


“Now, which

one did they say

not to turn off

?”

But need competent nurses…..

……Post Op Cardiac Surgery..


How do we ensure ‘Competency’ ?


Check - Lists….Protocols

Shift Checklist and Planner Nursing Standards - Summary


2007 Intake Graduate Certificate in Intensive Care Nursing.

Training Programs : Theory and Practical


Traditional Curriculum : Time and

Experience(s)

Set experiences anticipating effective learning

Limited control over specifics

Hurdles – assessments / appraisals

No guarantees

Designed to fit the calendar year, work needs

Achievement determined by summative process – exams

12 month period, 6 monthly exams


Problems with Current Education

Models for Clinical Learning

Based on fixed time

Variable clinical environments to provide development

Potential for individuals to influence learning

Difficulty standardizing clinical learning, ,

New learning styles of the digital world

Need to respond to the ‘Y’ generation


The Y generation (1982 – 2000)

Why ? gen.

NET gen.

Now gen.

24/7 gen.

‘Me’ gen.

Generation mobile


Need to Track Competency

Development

Modulate learning experience(s)

Allows for minimum skills sets

Standardize within groups

Give better feedback

Improve certification standards and

documentation for this


Potential for Personal Computer to Track

Clinical Learning

How to do it .

Which software, program,

Need for speed, real time, simple entry

Individual work space, mobile…wireless


Concept of Competency Logging

Network Server

PDA wireless connection

• Mobile

• Personal, individual Reports TranscriptsAudits

PC – Clinical Teacher

PC – Shift manager

PC – Post grad.


Using Ms Excel: Virtual Basic


Shift Profile 1st


Procedures Done


Validation


Self Selection Score and Send Report


Master Data Sheet from Server


Audit Reports


Microsoft Sharepoint

Microsoft SharePoint browser-based collaboration and document-

management platform.

It can be used to host web sites that access shared workspaces and

documents, as well as specialized applications like wikis and blogs from

a browser.


Austin Health

ICU Procedure Log

PHONE: +61 3 9326 0000

Address: nSynergy

Level 7, 365 Little Collins Street

Melbourne Vic 3000


ICU Procedure Log

Using an Internet

Connection (GPRS

or Wireless

connection) and a

web browser,

navigate to the

ICU Procedure

Log Form.

This address can

be saved in the

favourites.


ICU Procedure Log

Data may be

entered using the

PDA’s Stylus or

Keyboard.

Dropdown boxes

are available for

simplified data

entry.


ICU Procedure Log

Data may be

entered using the

PDA’s Stylus or

Keyboard.

Selection Lists are

available for

simplified data

entry.

Submit options

enable the data to

be transferred

immediately to the

SharePoint Server

for analysis.


ICU Procedure Log

Details are available as a SharePoint List.Each form needs to be approved by the supervisor.Data may be filtered and sorted.


Progress at Austin Health

PDA purchased and configured for 15

postgraduate students participating in study.

Training program completed

Fine tuning of software program for ICU

competencies although copyright issues.

Pilot program commenced February 2009.

Focus Group Discussion undertaken July 2009

Data currently been anlaysed.


Conclusion

• PDAs have the potential to improve patient

safety and this will be investigated in both

studies undertaken in this ARC Linkage Grant.http://midpoint.nsynergy.com/demo/PatientPoint/default.aspx:

http://midpoint.nsynergy.com/demo/PatientPoint/default.aspx

HIC08 Workshop Presentation Dr Maureen Farrell

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