Nine ways to use handheld computers

When a 40-year-old man came to the ED at Tallahassee (FL) Memorial Healthcare in ventricular tachycardia, he was stabilized with anti-arrhythmics. "His wife told me he was on a chemotherapy drug for colon cancer," recalls Terry Schneider, RN, BSN, CEN, the ED nurse who cared for the patient. Immediately, he looked the drug up on a handheld computer and discovered that the drug was associated with cases of sudden death. "We, of course, discontinued that medication, and in a day or so, he was ready to go home," he says. "The patient’s oncologist didn’t even know that the drug he prescribed could cause ventricular tachycardia. I’d call that one a save."

Handheld computers will be to emergency medicine what cellular phones have been to the telephone, predicts Todd B. Taylor, MD, FACEP, an ED physician at Good Samaritan and Phoenix Children’s Hospitals. "For years, we have all been slaves to the computer monitor and keyboard," he says. Now, handheld computers can give you mobility while you access information, says Taylor. "It is only a matter of time before we will all use them," he adds. "Their essential use in the ED is just around the corner."

Many ED clinical staff members are amazed at what handheld computers can do. "I keep my Handspring Visor [manufactured by Handspring of Mountain View, CA] in my scrub pocket at all times," says Schneider. "The bottom line is that this has saved lives. That’s what emergency medicine is all about."

Here are nine ways to use handheld computers in the ED:

1. Use as portable reference texts.

There are a variety of programs available for both the Palm (manufactured by Palm in Santa Clara, CA) and Handheld PC2000 (manufactured by Microsoft in Redmond, WA) operating systems that replace reference texts and provide tools to calculate pregnancy, anion gap, A-a gradient, and osmolar gap, says Taylor. (For information on two programs, see "Resources" at the end of this article.)

Schneider’s handheld computer contains the complete advanced cardiac life support protocols and an ED database called PEPID RN (manufactured by Pepid in Evanstown, IL). "I also use trauma and toxicology data from other sources," he says. (These products can be found at healthypalmpilot.com, handheldmed.com, and palmrn.com.)

2. Have rapid access to contact information.

Handheld computers can give you instant access to contact information for colleagues and community organizations, says Schneider. "On my handheld, I have access to phone numbers for all the doctors, nursing homes, transport agencies, law enforcement agencies, universities, and hospital departments," he reports. Speedy access to this information can be a lifesaver, he adds. "Mostly, I remember those moments when the ED is filled with multicasualties, I’m stuck in the trauma room without enough help — and the main desk doesn’t answer the call light to call anesthesia for me," he says.

In this hectic scenario when seconds count, the handheld computer enables Schneider to make the call himself. New devices are now available that combine cellular phones and personal digital assistants, says Taylor. "These will help you order tests at the bedside, retrieve labs and reports, and also keep you from missing important phone calls," he says.

3. Perform calculations.

Schneider uses software on her handheld to calculate arterial blood gas data, drug infusion rates, pediatric drug doses, Glasgow coma scale, fluid replacement for burn victims, and obstetrical calculations. "I don’t have to search for the IV drug book to calculate a drip. I can look up the drug, make the calculation, set the pump, and read the patient a story from The New York Times without ever leaving the room," she says.

Schneider uses an RSI, a rapid sequence intubation program developed by Spiros Konstas, available at www.rnpalm.com, to calculate drug dosages in a hurry. "Can you imagine anything more life-saving than rapid sequence intubation in a combative, crashing patient?" he asks. "Every drug that I look up on my handheld, every contraindication found, is a potential lifesaver."

4. Know the actual cost of drugs.

Schneider uses a drug reference called ePocrates (manufactured by San Carlos, CA-based ePocrates, available at www.epocrates.com) to obtain information about how much medications cost. "It includes current retail cost of medicines, which doctors never seem to know about," he says. He gives the example of Inderal 20 mg and 40 mg costing nearly the same for 30 pills. "So a patient taking Inderal 20 mg twice a day could get the 40 mg instead, cut them in half, and save half the cost," he suggests.

5. Communicate with non-English-speaking patients.

Translate shareware (manufactured by DDH Software in Lake Worth, FL) enables Schneider to easily communicate with Spanish-speaking patients. "With this software you type in a word or phrase in English and hit the Spanish button, and it converts your word into Spanish," he says. American Sign Language for Palm (manufactured by Singapore-based ZOOS Software) facilitates communication with hearing-impaired individuals.

6. Provide care from remote locations.

The EKGCard (manufactured by QRS Diagnostics, based in Plymouth, MN) can actually do a 12-lead electrocardiogram, says Schneider. He gives the example of a person in a restaurant having an acute myocardial infarction. "You could even fax it to the ED so they can mix the Retavase [Centocor in Malvern, PA] and do a 10-minute door-to-drug’ thrombolytic procedure," he says.

7. Have easy access to digital images.

Schneider suggests having a database of color photos of various dermatological conditions downloaded from the Internet. You can store digital photos of anything using the Eyemodule camera, manufactured by Palo Alto, CA-based Blocks Products, which attaches to a Handspring Visor, he adds.

8. Share information with colleagues.

Schneider uses infrared technology to share data between doctors, nurses, and drug representatives. "I often download emergency nursing articles from the Internet onto my Visor and beam’ them to fellow ED nurses if I find it useful," he says.

9. Post the staffing schedule.

An ED manager might keep the current schedule on a web server to be viewed at home or downloaded to handhelds, suggests Schneider. "This would enable staff to be aware of short shifts and fill in for some extra cash," he says.

Sources

For more information about handheld computers, contact:

Terry Schneider, RN, BSN, CEN, Tallahassee Memorial Healthcare, 1300 Miccosukee Road, Tallahassee, FL 32308. Telephone: (850) 431-5411. E-mail: schneid@supernet.net.

Todd B. Taylor, MD, FACEP, 1323 E. El Parqué Drive, Tempe, AZ 85282-2649. Telephone: (480) 731-4665. E-mail: tbt@compuserve.com.

Resources

Mobile Micromedex is drug, toxicology, alternative medicine, and acute care information for handheld devices. Micromedex Healthcare Series subscribers can download the system at no charge. For more information, contact: Micromedex, 6200 S. Syracuse Way, Suite 300, Greenwood Village, CO 80111-4740. Telephone: (800) 525-9083 or (303) 486-6400. Fax: (303) 486-6464. E-mail: info@mdx.com. Web: www.micromedex.com/products/mobilemicromedex/.

The Mobile PDR is a concise version of the Physician’s Desk Reference designed for use on a handheld computing device. It includes concise drug information, updated daily as new information becomes available, interaction checks between two or more drugs, and alerts about important changes in the drug information. Free download is available to U.S.-based physicians, nurse practitioners, and physician’s assistants in full-time patient practice. For more information, contact: Medical Economics Customer Service at (888) 632-9998, Monday through Thursday, 8:30 am to 8 p.m., and Friday from 9:30 a.m. to 8 p.m., Eastern time. Web: www.pdr.net.