Enhancing nursing productivity through mobile computing solutions

Jeffrey
Chochinov

The simplest concepts often make the biggest differences in patient care. Nursing workflow is a prime example. Requiring nurses to walk back and forth to a nursing station, supply room or medication room dozens of times every shift does not improve nursing productivity or enhance patient care; enabling nurses to spend more time at a patient's bedside, however, does both.

Mobile computing and medication delivery workstations can greatly simplify nursing workflows, lending greater efficiency to patient care processes by bringing powerful information technologies — including electronic health and medication administration records (EHR and eMAR) — as well as secure medication storage to the bedside. Studies have shown that making full use of these mobile solutions significantly improves patient care and patient safety.

For example, a mobile medication cabinet linked to a bar-code point-of-care medication administration system piloted at Spartanburg Regional Medical Center in South Carolina increased nurses' time for face-to-face patient interaction, documentation and other productive patient care activities by 28 percent. This was achieved largely by loading most medications needed at the beginning of each shift into a secure mobile cabinet, thus eliminating the need for nurses to queue at the medication room. It also greatly reduced the incidence of late medication administration, which was a particular problem at the beginning of shifts.

More recently, researchers at Brigham and Women's Hospital in Boston found that a bar-code medication administration system reduced medication errors by half — and virtually eliminated medication documentation errors (Poon E et al. N Engl J Med. 2010 May 6; 362(18): 1698-707). Similarly, documentation of vital signs and other clinical observations and processes at the bedside has been shown to increase the accuracy and timeliness of care notes (Wager K et al. Comput Inform Nurs. 2010 Jul-Aug; 28(4): 205-12).

Our own analysis suggests that for nurses caring for six patients, trips for charting and medication retrieval can be reduced by 90 percent or more using mobile systems instead of fixed, centralized stations. Not only do mobile systems optimize nursing workflow, they also keep medication secure all the way to the patient, and when coupled with bar-code eMAR and EHR, enable automated documentation and charge capture at the point of care.

The bottom line is that mobile computing and medication solutions allow more time at the patient bedside. They go beyond point-of-care information access and become a mobile desk, supply room and medication room all in one. They are a personal workspace able to travel with each nurse through a busy shift, resulting in a safer and more satisfying care experience for both patients and nurses, with better clinical outcomes, better care documentation, lower costs and fewer lost charges. 

For maximum efficiency and effectiveness, mobile computing solutions should not only provide nurses with the ability to document when and where they choose, they should also have a convenient footprint that further allows customization to individual needs and workflow preferences. This can be accomplished through:

• Keyboards and monitors adjustable to any sitting or standing height.
• Storage for supplies (syringes, bandages, alcohol wipes, etc.).
• Spaces for personalized “cheat sheets” and reference tools, or clear document covers under which nurses slip needed information.
• Secure drawers that allow medication administration to multiple patients before returning to the medication room.

Mobile systems also must be flexible enough to evolve over time as nursing workflow continues to incorporate new documentation methods and bedside technologies. Innovative processes will be needed to permit nurses to both effectively interact with patients and preserve contact with physicians and other clinical team members in decentralized workforce environments — all while using computerized systems.

Mobile computing solutions generally are evaluated in conjunction with broader information technology goals. As information technology develops, it is important not to lose sight of opportunities, but to improve long-established workflow patterns. Mobile, point-of-care computing solutions provide a way to effectively leverage information technology to advance both nursing productivity and patient
care quality.

Jeffrey Chochinov is director of global business development for Rubbermaid Medical Solutions.
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