Reclaiming Workflow Productivity With Mobile Computer Carts
By Amanda Burgess, RN, BSN
Clinical documentation at the bedside is gaining ground in healthcare thanks to the adoption of electronic medical records (EMRs) and other clinical systems. The benefits of this advance are well known and understood: Patient safety improves. Access to information is immediate and comprehensive, and consistent processes and data structure enhance accuracy and quality.
Yet one significant misconception about automating workflow at the point of care persists: Hospitals assume that this model will inevitably save time and boost nurse productivity. On the contrary, unless special efforts are made, nurses and other practitioners may require additional time to step through new sequences or routines.
But with the right approach to restructuring clinical workflow and deploying equipment, hospitals and outpatient centers can recover much of the time that may be lost due to the demands of a software-driven process.
For instance, an organization’s choice of equipment for housing mobile computers can have a significant impact. Intelligent workflow redesign—as a part of an EMR, electronic medication administration record (eMAR) system, or similar deployment—can ultimately eliminate steps or repetitive tasks. In addition, a well-designed computer and medication cart will lessen the strain for caregivers, alleviating physician stress through ergonomic functionality.
Moving Facilities and Moving to an EMR System
Cookeville Regional Medical Center, a 247-bed referral center serving middle Tennessee, took a deliberate approach to automating workflow during its recent transition to an EMR.
Cookeville Regional was building a new tower as part of a facility renovation. Before moving into the new wing, the managers wanted to have clinical documentation in place. Familiarity with the new technology would mean that nurses and clinicians had one less change to deal with when the new tower opened.
Cookeville realized that its choice of mobile cart was an important link in the clinical workflow chain. Depending on the equipment selected for each area of the hospital, a nurse’s or patient care assistant’s job could be either more stressful or more streamlined. To achieve the latter, Cookeville leadership dedicated itself to identifying the best computer and medication cart solution.
A Rigorous Selection Process
Research and evaluation of available systems was led by representatives from the IT, biomedical engineering, nursing, pharmacy, infection control, and maintenance departments. Accordingly, Cookeville’s computer and medication cart selection criteria spanned a range of clinical, ergonomic, and operational issues.
Many criteria were related directly or indirectly to the hospital’s ability to successfully leverage the EMR system. Cookeville had specific requirements related to HIPAA compliance and wanted to ensure that the system provided adequate security for patient information and medications. The form factor of the carts was also critical. Reviewers evaluated weight and ease of maneuvering, how well the units fit in patient rooms, stability, and difficulty of adjusting height and position. The carts also would be expected to house medication envelopes from the pharmacy, since Cookeville anticipates deploying an eMAR by the end of the year.
Once the team identified six finalists, Cookeville held sessions for nurses to review vendor products, communicate their preferences, and suggest additional features for consideration. The search committee and nursing staff came to the same conclusion about which cart would best meet the facility’s needs: the Rubbermaid Medical Solutions (RMS) computer cart for its cancer center and patient intake and the RMS medication cart for the remaining units.
Prior to go-live, Cookeville’s 750 nurses had the opportunity to familiarize themselves with the new carts in a classroom setting. Supplemental and continual training is available for new employees or for nurses requesting a refresher course through a DVD provided by RMS. To avoid overwhelming the staff, they were trained on the clinical documentation system separately. In September and October 2008, Cookeville launched its EMR, now supported by about 70 computer and medication carts.
Accuracy, Patient Satisfaction, and a Productive Workflow
With the right technology and equipment in place, nurses were able to smoothly make the move into Cookeville’s new medical tower.
The carts are taken directly into the patient rooms, allowing clinical staff to enter data at the bedside. Cookeville leadership believes this has improved accuracy, since the information is logged immediately, eliminating lag time between care delivery and documentation during which details may be lost. Patients also appreciate the thorough record keeping—and not having to answer the same questions repeatedly.
Nurses pull patient-specific McKesson medication envelopes at the beginning of each shift and store them in one of two large drawers. Secure storage of multiple patients’ medications minimizes trips back and forth to the central medication cart during each shift. This improved workflow creates the opportunity for greater face-to-face time with patients.
The transition both to the new facility and the new technology was eased with Cookeville’s adoption of the advanced computer and medication carts. Nursing staff appreciated that their needs were considered and that they were invited to participate in the selection. When the selected carts proved to enhance efficiency and productivity, nurses’ favorable response rose even higher, which accelerated the smooth and successful conversion from manual to automated clinical documentation processes.
— Amanda Burgess, RN, BSN, is the clinical informatics manager at Cookeville Regional Medical Center in Tennessee. |
