meyer staying connected when is mobile technology harmful to patients final rev link

Staying Connected

When is mobile technology harmful to patients?

Conrad Meyer JD MHA FACHE

Health Care Sections

Chehardy Sherman Law Firm

[email protected]

(504) 830-4141

mailto:[email protected]

Staying Connected

When is mobile technology harmful to patients?

• Current Statistics on

Smartphone/Tablets/Cell

• Usage Statistics of Smartphone/Tablets/Cell

for healthcare workers

• Studies regarding distractions and correlation

to connected devices

• Genesis of distraction

• Distracted Nurses

• Distracted Physicians

• Examples of Harm to Patients

• Policies/Solutions

Cell/Smartphone Statistics(1)

As of January 2014:

90% of American adults have a cell phone

58% of American adults have a smartphone

32% of American adults own an e-reader

42% of American adults own a tablet computer

3/30/2015 3Conrad Meyer JD MHA FACHE

http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet

Cell/Smartphone Statistics (2)

As of January 2014:

• 67% of cell owners find themselves checking their phone for

messages, alerts, or calls — even when they don’t notice their

phone ringing or vibrating.

• 44% of cell owners have slept with their phone next to their bed

because they wanted to make sure they didn’t miss any calls, text

messages, or other updates during the night.

• 29% of cell owners describe their cell phone as “something they

can’t imagine living without.”


http://www.pewinternet.org/fact-sheets/mobile-technology-fact-sheet

Cell/Smartphone Activities (As of 2013) (3)


Overall, almost all activities have seen steady upward growth over time. (source linked above)

http://www.pewinternet.org/2013/09/19/cell-phone-activities-2013

Cell/Smartphone Online Use (3)


• 63% of cell phone owners

now use their phone to go

online

• Additionally, one third of

these cell phone users

(34%) mostly use their phone

to access the internet, as

opposed to other devices

like a desktop, laptop, or

tablet computer.

http://www.pewinternet.org/2013/09/16/cell-internet-use-2013

Social Networking Stats(4)


• As of January 2014, 74% of online adults use social networking sites.

Breaking it down by site:

71% of online adults use Facebook

23% of online adults use Twitter

26% use Instagram

28% use Pinterest

28% use LinkedIn

In May 2013, 74% of women were users of social networking sites, compared with 62% of men.

http://www.pewinternet.org/fact-sheets/social-networking-fact-sheet

Social Networking Sites By Category


Social Networking Sites By Top Usage – 2014 Data (Source – Social Media Market Industry Report 2014)


http://www.socialmediaexaminer.com/SocialMediaMarketingIndustryReport2014.pdf

Social Networking Sites By Top Usage – 2015 Data (Source – Pew Internet(5))


http://www.pewinternet.org/2015/01/09/social-media-update-2014

Healthcare and Smartphones – Stats (Usage)

US National Library of Medicine – NIH Study 2014 (See Link)


• Based on Usage (based on >1000 healthcare providers surveyed:

• More than 47% advised use of smartphone more than once per day

• 77% of the more than 1000 healthcare providers surveyed that use their

smartphones more than once per day were Residents.

http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3878932

Healthcare and Smartphones – Stats (Task)

US National Library of Medicine – NIH Study 2014 (See Link)


Task Usage of Smartphones by Healthcare

Providers (over >1000 surveyed):

1. Take Notes 51%

2. Drug Information 73.5%

3. Practice Guidelines 49.8%

4. Point of Care Information 48.9%

5. Clinical Calculations 57.9%

6. Differential Dx 34.6%

7. Search Journal Articles 46.5%

8. Read Journal Articles 50.2%

9. None of the above 10.1%

10. Other uses 10.9%

http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3878932

Nursing and Cell/Smartphone Use


Nurses have been using Smartphones in an

increasing number for the following:

1. Using as a communication tool with

treating physicians

2. Access reference material – e.g. Drug

reference

3. Social Media access

4. Other useful apps created by employers

• Many nurses continue to use voice only phones or multiple pagers

• However, a smartphone revolution is coming to nursing - According to a new

2014 study by Wolters Kluwer Health, 65% of nurses at hospitals say they are

using their smartphones for clinical communications on the job.

• The study also found that 95% of healthcare organizations allow nurses to consult

websites and other online resources for clinical information at work.

Nursing and Cell/Smartphone Use


• The 2014 Wolters Kluwer Health study revealed that 65 percent of nurses are

using mobile devices for professional purposes at work at least 30 minutes per day,

while 20 percent use them for two hours or more.

Nursing and Cell/Smartphone Use Statistics

2014 Wolters Kluwer Health study


• 89% of healthcare organizations allow nurses to use online search engines at work

• 60% of nurses say they use social media to follow healthcare issues at work

• 86% of nurses say they follow healthcare issues on social media outside of work

• 50% of nurses say that their organization blocks access on company networks to

social sites such as Facebook, Twitter, Pinterest and YouTube

• Of the 95% of nurses who say they access health information at work:

• 48% say their healthcare institutions encourage nurses to access online

resources

• 41% of nurses allow for occasional use

• 5% only as a last resort

Physician and Tablet/Smartphone Use Statistics

2013 Epocrates Mobile Trends Study


• 2014 – 9 of 10 healthcare workers will be using smartphones/tablets.

• Of the >1000 providers surveyed breakdown of specialty by use:

• NP – 11.8%

• PA – 11.7%

• Psych – 19%

• Primary Care – 19.4%

• Cardiology – 19.1%

• Oncology – 19%

Physician – Top 7 most used healthcare applications


• Epocrates

• UpToDate

• Doximity

• Read by QxMD

• NEJM This Week

• Isabel

• Figure 1 – Medical Images


What can you miss when you are distracted from listening to the patient?

Nursing and Cell/Smartphone

Distractions???


• Distractions and interruptions include:

• Anything that draws away, disturbs, or diverts attention from the current

desired task;

• Forcing attention on a new task

• Whereby attending to the new task increases the risk of an error with one or

both of the tasks (current and new) because the stress of the distraction or

interruption causes cognitive fatigue, which leads to omissions, mental slips

or lapses, and mistakes.


Distractions???


• How do Distractions Originate?

• Distractions and interruptions impact ones ability to remember to do

something that must be deferred.

• When a person forms an intention (task), their memory establishes a specific

cue to remind them to act.

• If the task is interrupted and the cue is encountered later, a spontaneous

process is supposed to bring the intention to mind. However, individuals are

less likely to remember the intention if they are outside the context in which

the cue was established.

• For example, an interruption that causes a nurse to leave the patient's room

decreases the likelihood that the nurse will remember to come back to finish

the interrupted task.

See Medscape - http://www.medscape.com/viewarticle/778966

http://www.medscape.com/viewarticle/778966


Distractions???


• The genesis of distracted liability:

• Looking at how distractions originate:

• If an individual remembers to go back to the initial task, some of the steps

may be omitted or repeated, or the entire task may be repeated.

• For example, a nurse may re-administer a medication, or a pharmacist may

dispense a second dose of medication, forgetting that she had already done

so.

• When returning to a task (current or new), an individual will need to take

time for the working memory to get back to where it was before the

interruption or distraction.

• If the task is complicated, individuals who feel pressured may not spend the

time it takes for the working memory to catch up, thereby rushing the task

and risking errors.

• See Medscape - http://www.medscape.com/viewarticle/778966



Distractions???


• Distraction is of particular concern to

“prospective memory,” or remembering to

do things in the future.

• This form of memory can be event-based

(i.e., when X happens, do Y) or time-based

(i.e., do Y at a specific time in the future).

• Event-based cues are less likely to be

forgotten, but problems occur when

attention is diverted at the time of the

event.

• Time-based cues require self-initiated

recall and are more likely to be

forgotten without converting them to

events

Nursing and Physician Cell/Smartphone/Tablet

Use Issues - Liability

(What are the issues Risk Managers face?)


1. Increased Liability

• Malpractice

• Physicians

• Hospitals – Respondeat Superior

• HIPAA violations

• State Law Privacy violations

• Potential Defamation – Release of PHI

• Patient data compromised

2. Regulatory Issues

• HIPAA

• TJC compliance

3. Security

4. Ownership of Data – who owns the text

messages or data regarding patient care or

communication with physician/staff?

5. Decreased interpersonal communication

• Nursing and Physician use of smartphones/tablets/cell phones creates a number

of issues including:

Physician/Nurse and Cell/Smartphone

Issues facing Healthcare Facilities


• Device Ownership

• BYOD – bring your own device

• Facility supplied devices –

• Limitations on web surfing etc.

• Doesn’t solve the problem

• Costly

• Policies

• Security

• Data Ownership

• App requirements

• Clinical Communication

• EMR Issues


Distractions???


• How often are nurses distracted during a shift?

• Evidence shows nurses are distracted and interrupted every 2 minutes

• Physicians every 5 minutes in academic setting and every 10 minutes in

community hospital

• Constant need for nurses to multitask when dealing with patients

• With increased demand on nurses – increase of risk of any medication error

increases by 12.7% with each interruption, and the risk of a harmful medication

error is doubled when nurses are interrupted 4 times during a single drug

administration and tripled when interrupted 6 times.

• See Medscape - http://www.medscape.com/viewarticle/778966


Can you spot the issues the nurse creates from the distraction?


Physicians Cell/Smartphone/Tablet Distractions???


• Being more connected means potential for being less focused!

• Distracted doctoring

• Constant need to stay plugged in! – field of medicine is now data driven!

• Treatment

• Research

• Patient care/outcomes – reimbursement – Global Payment Initiatives

• 2010 Perfusion Report http://prf.sagepub.com/content/26/5/375.abstract

• Found 55% of technicians, of the 439 surveyed, who monitor bypass

machines talked on cell phones during heart surgery

• Over 50% text message during procedure

• 40% stated talking on phone during procedure is “unsafe”

• 50% stated texting was unsafe

• Younger generation more comfortable being plugged in.

• On data – patients are being treated better – but physically patients are being

left out.

http://prf.sagepub.com/content/26/5/375.abstract

Physicians Cell/Smartphone/Tablet – Social Media in the OR


• Med Mal case in Texas

• 61 year old female – low risk cardiac procedure

• Anesthesiologist – had been using Ipad throughout the operation

• Was unaware that patient’s vitals indicated low O2 levels were low for 15-20

minutes

• Realized patient in danger when she turned blue

• Admitted to texting, accessing websites, and reading ebooks during

procedures

• Unaware that 5 minutes

of lack of focus creates

potential exposure

• Via discovery – attorneys

found out Doc posted on

FB and published a photo

of a patient’s vitals online


Dr. Checklist – Good example of Best Practices


Can Distractions Be Useful?


• Sure:

• Electronic smartphones, tablets or notebooks, or other wireless

communication devices, electronic references, and notification systems can

be used for timely notification of patient or drug information that is needed

to provide optimal patient care.

• In this case, the interruption or distraction may be useful.

• That is the issue facing healthcare professionals: they may use these devices

for quick access to data, drug information, clinical alerts, and other patient

information; but the unintended consequence is that these same

professionals can be glued to the screen and not focused on the patient, even

during moments of critical care.


Where is the harm?


• Examples of Patient Harm:

• Failing to order medication because of texting interruption.

• Operating medical treatment equipment while texting or viewing email

• In surgery, could be distracted creating adverse event.

• One example: In 2011, a resident failing to complete a medication order change

when interrupted by a text from a friend inviting the resident to a party. The

resident RSVP'd to the party via text and then didn't go back to complete the order

change to a patient's anticoagulant medication. The patient, required open-heart

surgery and three weeks in the unnamed hospital as a result of the distraction.


Where is the harm?


• Examples of Patient Harm:

• Neurosurgeon was using wireless headset

during surgery to make personal calls

• During a surgery – he was distracted and

ended up paralyzing patient

• Plaintiff counsel subpoenaed physicians

phone records

In 2012, Smartphones made the list of the

“Top 10 Health Technology Hazards.” The

list is an annual compilation of the top

hazards caused by technology used in health

care, based on the prevalence and severity of

incidents reported to the ECRI Institute, a

non-profit patient safety organization.

Australian Study – Distracted Nurses (2010)


• Background: An Australian research team observed 98 nurses in six different wards at

two Australian hospitals. Over the course of 505 hours, the nurses prepared and

administered more than 4,000 medications for 720 patients.

• Process: Errors in procedure (such as failing to read a medicine's label) and in clinical

care (such as the dosage or the drug administered) were recorded, as were any

interruptions.

• Findings:

• For each interruption, there was a 12 percent increase in procedural errors and a

12.7 percent increase in clinical errors. Nurses were interrupted at least once

during more than half of all drug administrations. A startling 74 percent of all

administrations were marred by at least one procedural slip-up.

• The most common error in procedure was not double-checking patients' names

against their medical chart, with more experienced nurses more likely to make

the mistake.

• Clinical mistakes occurred in 25 percent of the observed cases. But that

percentage shot to nearly 40 percent when a nurse experienced three or more

interruptions during the procedure.

• Of all the errors, 80 percent were categorized by the researchers as minor; only

2.7 percent were deemed "major" slip-ups.

• See http://archinte.jamanetwork.com/article.aspx?articleid=415843

http://archinte.jamanetwork.com/article.aspx?articleid=415843


Possible Solutions for minimizing liability


• How best should an organization deal with Distractions: The Institute for Safe

Medication Practices recently put out the following list of suggested guidelines.

1. Establishing No Interruption Zone (NIZ).

2. Do Not Disturb. For nurses, the Institute of Medicine recommends wearing a

visual signal during medication administration, such as colored vests, sashes, or

aprons, to signify that they should not be interrupted.

3. Staff Education.

4. Best Times for Necessary Interruptions.

5. Checklists. A checklist of important points during lengthy critical tasks can be

affixed to work areas for reference when leaving one task and returning to

complete it to aid in remembering where the person left off.

6. Preparation.

7. System Improvements to Minimize Distractions.

8. Mobile Device Management Strategy.

9. Alerts, Alarms, and Noise – reduction of distractions.




• A recent article from the Pennsylvania Safety Authority regarding distracted healthcare

providers provided the following suggestions for reducing risk:

1. Educate clinicians about distractions.

2. Raise awareness of the potential for distraction – examples of bad outcomes

3. Teach clinical staff interruption-handling strategies

4. Consider offering a course in mindfulness meditation

5. Avoid communication of irrelevant information whenever possible

6. Designate routinely encountered tasks that are not to be interrupted, and

develop a system to communicate when staff are engaged in these tasks

Minimize interruptions during performance of any tasks that place high

demands on working memory

7. Practice tasks, particularly those that are complicated or known to be distraction-

prone




• A recent article from the Pennsylvania Safety Authority regarding distracted healthcare

providers provided the following suggestions for reducing risk cont.:

8. Develop and utilize checklists for complex tasks

9. Implement communication strategies that do not involve oral communication

10. Use written reminders as event-based cues to complete future tasks.

11. Batch communications to minimize distraction to the recipient

12. Do not batch tasks for multiple patients concurrently

13. Provide environmental cues to assist in recovery from distraction in order to

complete the primary task

See, http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2013/Mar;10(1)/Pages/01.aspx

http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2013/Mar;10(1)/Pages/01.aspx

Physician Cell/Smartphone



• Implement security protections for mobile devices that enable work-related and consumer

functions to be isolated from each other.

• Review Smartphone/Tablet/Cell policies with IT

• Allow only employer-supplied mobile devices to be used in patient care – minimizing risks

• Creation of patient portal to allow text message on hospital devices to input directly into

patient EMR

• Build reminders into computerized order entry systems via best practices

• Implement rules or guidelines for optimal safe use of mobile devices.

• Ensure that routine personal interruptions do not affect the delivery of quality care by

silencing or minimizing nonclinical communications.

Example of a Smartphone Policy


Smartphone Policy

Phone Zones

Safe Usage –including Hygienic

Uses

Data Security and

Access

Legal Compliance

Patient Focused

Privacy Management

How does this nurse manage distractions?



Good Takeaway


• The clinician who is mindful of the negative impact of interruptions and

distractions may react with increased attention, focus, and concentration on his

or her work environment. Being present consists of putting aside external

worries, distractions, and interruptions and centering one's concentration on a

particular work task.


Questions please contact:

CONRAD MEYER JD MHA FACHE

Health Care Section - Chehardy Sherman

One Galleria Blvd Suite 1100

Metairie, La. 70001

(504) 830-4141

[email protected]

mailto:[email protected]

meyer staying connected when is mobile technology harmful to patients final rev link

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