POC solutions to improve workflow, reduce errors and enhance patient experiences

John Pierson, Vice President of Sales and Marketing, Carstens

Time. It is the one thing we can’t make more of and the one thing that costs us the most. This is especially true in a healthcare environment where clinicians are stretched to their limits – expected to do as much as possible in a finite amount of time with minimal errors.

To put this in perspective, one only needs to observe a facility nurse’s daily workload. For example, a nurse in a pediatric unit will perform as many as 2,061 tasks to provide critical and vital treatment and documentation for their patients. That means they perform some function, on average, every one to 1-1/2 minutes for their entire workday … every day. After analyzing the types of tasks and time required to complete those tasks, we find that the time nurses spend with their patients for treatment and assessment may be only 18 percent. The surrounding time is spent walking from the patients’ rooms to nurse and storage stations to retrieve and deliver medications and supplies as well as enter documentation and patient records. This equates to almost 82 percent of a nurse’s time throughout their workday spent away from the point of care. In a healthcare environment that is quickly moving to a pay-for-performance model where patient outcomes and experiences are actually driving the bottom line, it is clear that better delivery of care is needed (see pie graph).

Traditional, centralized nurse stations can impact time spent away from the point of care, affecting and interrupting the clinician’s workflow (see heat map graphic). This heat map, created by Florida Hospital Celebration Health to measure workflow efficiencies, illustrates foot-traffic patterns for a typical nursing staff’s shift. It illustrates how repeated visits to one location cause congested high-traffic areas. Solutions are needed to improve these workflow inefficiencies caused by the use of centralized points away from the patient’s point of care.

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In addition to the costs associated with inefficient use of time within the clinical workflow, medication and documentation errors have massive, negative implications to both patients and facilities. A single error in medication can cost a facility hundreds of thousands of dollars and is considered by the Centers for Medicare and Medicaid Services (CMS) as a never event. Mistakes in electronic medical record (EMR) documentation can cost thousands of dollars in billing errors and, in turn, can lead to disastrous concerns for patient treatment. However, it’s been proven that point-of-care storage directly reduces medication errors, inaccurate documentation, theft and loss while increasing accuracy at the point of care.

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In a 2006 study of six U.S. hospitals, researchers collected data following the minute-by-minute activities of 11 nurse work processes to assess the frequency of work-system failures. They also conducted interviews with six of these nurses and their nurse managers to determine the compared metrics between nurses, managers and the independent observers (see failure table). The results indicated that the five most frequent failure types involved medications, orders, supplies, staffing and equipment – equating to one work-system failure per hour.

Compounding the issue is the fact that workflow inefficiency within the clinical environment impacts multiple facets of clinicians’ ability to provide quality care. These inefficiencies are partially driven by the design and layout of commonly used areas and items. Distractions and disruptions reduce the time the clinical staff has to perform critical tasks, and they create an environment prone to errors.

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While no silver bullet exists to improve clinical efficiencies, one demonstrated method is to move commonly used items to the point of care. Mobile and wall-mounted workstations for EMR documentation and medication distribution are a proven way to do just that. In fact, one of the leading trends in healthcare design today is the implementation of bedside or room-side cabinets to house medication and frequently used supplies needed for the patient as well as a laptop or tablet for the clinician’s EMR documentation. In many progressive hospital environments, these smaller and more localized units are replacing centralized nurse servers and nurse stations, thus reducing the amount of steps and time it takes for a nurse to get from point A to point B.

Ideally, this type of solution can house an EMR input device including a bar-code scanner along with medications and supplies for the patient’s care together – accessible at the point of care inside patient rooms or in the hall adjacent to them.

In the past, one of the challenges with point-of-care storage was security. Boxes could be locked by traditional keys, but keys were often lost and laborious to replace. As a result, workstations were left unlocked or unused in many cases.

Thanks to advances in access control technology, wall-mounted workstations can now be secured. Secure workstations can be mounted in public areas as well as in patient rooms, reducing the opportunity for interruptions and allowing clinicians to respond to patients quickly and with fewer errors. By integrating the most current access control systems within wall cabinets, these workstations secure medications, supplies and computers. These systems can be easily managed at a departmental level, employing the same radio-frequency identification (RFID) cards already used in most facilities. Additionally, new technology allows for implementation without intensive electrical installations with the convenience of Power over Ethernet (PoE) hardware. Wall cabinets essentially become part of the facility’s existing network, making installation and credential management straightforward.

With this new level of security, the challenges associated with keeping medications and supplies at the point of care are greatly reduced. The advantages are enormous. This one simple change to workflow within a nursing unit can improve inefficiencies, reduce errors and enhance patient experiences by keeping clinicians where they should be: at the point of care.