Friday April 26th 2019

Texas hospital approaches technology with eye toward patient safety, nursing practice

RNs Benjamin Price and Kelly Dahlen work with the Rapid Communications System on their new smartphones. Photo by A Kramer

Technology — when done right — can help RNs deliver the quality and safe care they want and patients need, particularly given the complexities of health care today.

With that in mind, Texas Children’s Hospital administrators and staff are constantly on the lookout for cutting-edge technology that will benefit patients who come through their doors. Their efforts have paid off: Texas Children’s Hospital recently received the “Most Wired Innovator” award for its new mobile communications system from Hospitals and Healthcare Networks, the flagship publication of the American Hospital Association. It also received the “Most Wired” designation, which is given to hospitals that lead the way in technological integration at all levels.

The recognition is based on an annual benchmark survey, now in its 15th year, of hospital and health care systems around the country.

Implementing technology that enhances and improves patient care is part of the strategic plan at the Houston-based, Magnet®-designated hospital. It also is a personal  goal of Lori Armstrong, MSN, RN, NEA-BC, when she became the chief nursing officer at Texas Children’s 1 1/2 years ago.

“Looking at the complexity of medication administration alone, nurses have to be at the top of their game,” said Armstrong, an American Nurses Association member. “My role is to make it easier for them, and that means securing appropriate technology that supports improving patient outcomes.”

Both Armstrong and Helen Currier, BSN, RN, CNN, CENP, director of nursing for the Renal Division and Vascular Access Team, have seen the use of technology greatly expand and improve during their careers. And they see it as a benefit.

“Our ability to use technology almost always leads to safer care,” said Currier, a Texas Nurses Association member.

Quicker, more direct communication

When she first arrived, Armstrong developed a survey asking the 2,300 nurses who are part of the Texas Children’s system about what was working and what was not. She also asked nurses — if they had a magic wand — what was the one thing they would do to improve patient outcomes. More than half reported a desire for technology to augment care delivery.

That desire helped fuel the creation and implementation of the Rapid Communication System, which allows nurses and other health care professionals to text, talk, access resources and receive alarm queues with priority status via smartphones with specialized apps. This consolidated system also helps determine staff availability, as well as provides them with quick access to the entire health system directory, among other functions.

“For example, this [smartphone] system allows a nurse instant access to resources and tools such as ‘ACLS Advisor’ and internal protocols that can guide care decisions at the bedside,” Armstrong said.

Currier added that the system allows nurses to communicate more directly with physicians and other staff instead of having calls passed through the nurses’ station. This direct communication saves nurses time, as well as aids in safer patient hand-offs.

Armstrong notes that research indicates roughly 85 percent of untoward events that occur in health care nationwide are the result of gaps in communication. This technology has the ability to assist in error prevention.

Other features of the mobile device involve alerts. For example, nurses can pre-set alarms on their phone, so they can return to the patient’s bedside at a specific time to provide pain management or other time-sensitive interventions, according to Currier. Additionally, nurses can receive an alert if, for example, their patients’ vital signs are outside of expected parameters.

Seeing, implementing technological advancements

Currier noted that one major and welcomed piece of technology within her division is a blood volume monitoring device with which nurses can precisely measure patients’ blood volume change for an optimal hemodialysis treatment.

“That technology has really advanced the care we can give to our patients,” she said. And ultrasound technology to place peripheral IV (PIV), as opposed to sight and touch, has also made a positive difference in care. Studies show that ultrasound-guided PIV catheter placement results in higher overall and first-pass success rates.

In terms of other technology, Currier reported that Texas Children’s electronic health record (EHR) system has recently been enhanced — with strong input from nurses.

Further, bar coding and positive patient identification technology is being implemented throughout the system — not only for medications, but also for blood products, and in the NICU and other infant units, for breast milk. Again, Armstrong believes these changes will improve the accuracy of medication administration by giving nurses, who often must contend with many distractions, another tool.

RN Martha Bryant holds milk to deliver to a new mother. Photo by A Kramer

Looking at a completely different type of technology, Texas Children’s is launching the GetWellNetwork®, which is a television-based interactive patient care system that includes education and entertainment. The network offers movies and video games to help distract patients, many of whom are coping with serious illnesses.

It is also used to supplement patients’ educational needs, according to Armstrong. For example, patients admitted with an asthma diagnosis and their families can watch a video to learn about the condition and appropriate care, and then take a video test to determine if the information was understood.

The GetWellNetwork® also allows caregivers an opportunity to utilize evidence-based pathways to guide care and engage patients as full partners in their plan of care.

Nurses help drive technology

When it comes to technology, Texas Children’s ensures that nurses are part of the equation.

“Nurses are vital to the delivery of health care, and their involvement in the selection, implementation and evaluation of technology is an inherent part of the process,” Armstrong said. “I also work closely with the chief information officer, who understands that it is an absolute necessity to have clinical involvement in determining what and how technology is used.”

Additionally, the hospital created a new innovation team, which is comprised largely of nurses examining ways to leverage technology — by selection and enhancement — to achieve the best patient outcomes.

Nurses also play a pivotal role in the ongoing enhancements of our EHR through reviewing, rating and prioritizing EHR optimization requests that impact nursing workflows.

Texas Children’s tries to be very deliberate in managing the introduction of new equipment and processes.

“Technology integration is a slow process, so I am strategic about its implementation,” Armstrong said. “Leadership is the key ingredient.  It is critical to provide nurses with the training and education necessary to guide that innovation’s development.

“We have four generations represented in our workforce, including new grads and nurses who have been here for 30-plus years. Some respond better in traditional classroom settings, while others prefer online education.”

Finally, beyond all the talk of technology, Armstrong and Currier know the importance of the human side of patient care. Said Currier, “With few exceptions, technology remains dependent on nurses’ assessment and knowledge. If there is not a nurse interpreting a cardiac rhythm, for example, there is little value in having a patient connected to an EKG [monitor].”

— Susan Trossman is the senior reporter for The American Nurse.

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