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.
CRICOS Provider Number 00103D27/02/093
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.
CRICOS Provider Number 00103D27/02/094
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.
CRICOS Provider Number 00103D27/02/095
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.
CRICOS Provider Number 00103D27/02/096
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%)
CRICOS Provider Number 00103D27/02/097
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
CRICOS Provider Number 00103D27/02/098
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
CRICOS Provider Number 00103D27/02/0911
Austin Health Ian BaldwinVirtual Tour
Higher bandwidth (broadband) (2Mb
Following slides related to Austin Health are all copyright to Professor Baldwin
CRICOS Provider Number 00103D27/02/0912
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
CRICOS Provider Number 00103D27/02/0913
“Now, which
one did they say
not to turn off
?”
But need competent nurses…..
……Post Op Cardiac Surgery..
CRICOS Provider Number 00103D27/02/0915
Check - Lists….Protocols
Shift Checklist and Planner Nursing Standards - Summary
CRICOS Provider Number 00103D27/02/0916
2007 Intake Graduate Certificate in Intensive Care Nursing.
Training Programs : Theory and Practical
CRICOS Provider Number 00103D27/02/0917
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
CRICOS Provider Number 00103D27/02/0918
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
CRICOS Provider Number 00103D27/02/0919
The Y generation (1982 – 2000)
Why ? gen.
NET gen.
Now gen.
24/7 gen.
‘Me’ gen.
Generation mobile
CRICOS Provider Number 00103D27/02/0920
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
CRICOS Provider Number 00103D27/02/0921
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
CRICOS Provider Number 00103D27/02/0922
Concept of Competency Logging
Network Server
PDA wireless connection
• Mobile
• Personal, individual Reports TranscriptsAudits
PC – Clinical Teacher
PC – Shift manager
PC – Post grad.
CRICOS Provider Number 00103D27/02/0933
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.
CRICOS Provider Number 00103D27/02/0934
Austin Health
ICU Procedure Log
PHONE: +61 3 9326 0000
Address: nSynergy
Level 7, 365 Little Collins Street
Melbourne Vic 3000
CRICOS Provider Number 00103D27/02/0935
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.
CRICOS Provider Number 00103D27/02/0936
ICU Procedure Log
Data may be
entered using the
PDA’s Stylus or
Keyboard.
Dropdown boxes
are available for
simplified data
entry.
CRICOS Provider Number 00103D27/02/0937
ICU Procedure Log
Data may be
entered using the
PDA’s Stylus or
Keyboard.
Dropdown boxes
are available for
simplified data
entry.
CRICOS Provider Number 00103D27/02/0938
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.
CRICOS Provider Number 00103D27/02/0939
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.
CRICOS Provider Number 00103D27/02/0940
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.
CRICOS Provider Number 00103D27/02/0941
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: