Hi - I trying to gain some understanding on the different types of mobile devices being used at the patients beside to document Vital Signs.
I have a ‘tablet’ (Zebra - older generation) and a WOW - I can access the patients’ electronic medical record to manually enter these recordings for an Early Warning Score etc. BUT the tablet is heavy and clunky, and the WOW trolley is ‘big’ - plus I have the equipment to wheel to the patient.
Any tips to make life better for the nurses would be much appreciated.
Ideally, I would say observation device which can sent observations to the electronic medical records. The device normally should have an option to add some parameters like temperature, pain, oxygen used manually, calculate score to show to the nurse/advice what should be done and then send information to EMR. All depend how possible/easy to interface device with EMR.
What would make life much easier is to automate the transfer of the digital vital signs into the EHR. You could add calculations, EWS, and decision support to the EHR using those metrics. There are devices that patients on monitoring machines can wear as bracelets when they move around the ward, e.g., to go to the toilet, and (correct me if I’m wrong) update the EHR/monitor with the data collected while the patient was moving.
I totally agree - the issue is that many of the current devices which interface directly with patients (e.g. non-invasive BP, pulse oximeters, etc) do not share data effectively with an EPR.
What we need is to eliminate the (tedious) human step in the process, and let computers do what they do well - diligently record and store information. We just need to empower them to do so, in a way that is useful for all the humans involved.
A good example is most anaesthesia EPRs (such as SaferSleep or GETZ); the key to their success and acceptability to users is that they reduce the painful/annoying need to record 5 minutely vital signs. They also offer useful templates for repetitive episodes of care and improve legibility, but the vital signs recording is generally the highest value ‘on the ground’ - particularly when done well.
Good points Nathan. Upon reflection, I note that when we automate part of a process, e.g., documenting vital signs, something changes and we need to be mindful of that change, however nuanced it might be. For example, if manual documentation (transcription) makes a nurse review the data carefully, then automation takes that review opportunity away. Review needs to be done differently, e.g., on a tablet that the nurse is carrying to the next patient - the mode is different (reviewing while transcribing becomes reviewing while walking) and the outcome should be aimed at improved review and follow up action. If the device used by the nurse isn’t fit for purpose (e.g., doesn’t fit in a pocket, is old, doesn’t connect to the ‘live’ clinical record, doesn’t enable contextualised review) then we’ve lost an important action in nursing care.
In a hospital ward or daystay setting for observations and progress notes, it has to be a pocketable device or else the ‘paper towel’ trick will continue leading to potential clinical risk. A pocketable device is not a mini iPad/ tablet - too bulky
In a consult room setting, a desktop suffices.
WOWs and tablets work for set workflow eg admission in a patient room.
Thanks everyone for your great feedback. (and Hello)
The reality of ‘I need to look to streamline workflows and useability - with what we have to work with’. I also need to future proof for further deployments as we keep removing ‘paper’ entry (yes, this old nugget); for example, next I will be introducing Fluid Balance! Making sure nurses are fully support with an appropriate mobile device is important. I have added more context below. If you see any flaws/concerning, please I am open.
clinical reality, technology limits, and human behaviour
The application (Early Warning Score with / without Modifications) does integrate with devices and automatically updates Vital Signs. We use Drager (plugged into the wall and does not score) - this is only available in PACU/ICU/HDU/CTU. We do not have Drager in any other area - that we are deploying the use of Vital Signs - EWS, e.g. Admissions, DayStay, and Inpatient Wards.
The nurse will use existing Blood Pressure / Puls Ox devices (some with wifi capabilities and others do not). We are expecting nurses to take BP machines and table/WOWs into the rooms and then access the EMR and enter Vital Signs. Nurses use tablets and WOWs to add medication administrations / notes etc, BUT they usually return to the ‘nurses’ workstations’ - rarely enter any data at the bedside.
I will be undertaking a ‘shadow’ charting exercise - time and motion - across various shifts to ‘realise’ the impact IF we do nothing - starting with the devices we have! I see a fundamental practice shift which will be accentuated - as we have limited number of shared tablets / WOWs - for measuring → entering → confirming → adding actions → escalating all at the bedside.
I like “Review needs to be done differently, e.g., on a tablet that the nurse is carrying to the next patient - the mode is different (reviewing while transcribing becomes reviewing while walking) and the outcome should be aimed at improved review and follow up action.”
Just like any clinical application - EWS will not replace clinical judgement, override instincts and or their critical thinking skills - but surface visual cues to the ‘triggers’ - and Escalation Plan - they will need to add Action(s) Taken - as per guidelines. Patient First.