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Devices previously used only by physicians
A groundbreaking pilot program that equips nurses with personal data assistants (PDAs) has saved nursing staff at Moses Cone Health System in Greensboro, NC, almost two hours a day while helping to identify diabetes patients in greatest need of quick intervention.
The diabetes treatment program at Moses Cone treats about 7,000 diabetes discharges a year, says Diane G. Newby, BSN, RN, program director.
"The key clinical issue for us, since we don’t have tons of clinical nurse specialists, is how to decide which patients need to be seen first and how many patients we have in the hospital whose sugars are out of control," she notes, explaining the rationale for the PDAs.
In some ways, it is not surprising that Moses Cone is moving in this direction. After all, it was recently added to Hospitals and Health Network’s list of "Most Wired Hospitals and Health Systems in the Country." However, the PDAs originally were part of a "doctors-only" program.
In early 2002, however, Newby saw some physicians in a hospital hallway using MData software from Durham, NC-based MercuryMD on Palm PDAs. "It incorporates a software application in the Palm that can pull data from several different hospitals — like medical records, labs, and so on," she explains.
The physicians were using it for their patients, which was the original purpose of the software — being able to access X-rays, lab work, medication information, consults with other physicians, and patient histories and physicals.
"So basically, they have most of the medical information they need in the Palm device," Newby notes. "They don’t have to find the chart to look up what they want — they just click on the icon with their stylus."
It occurred to Newby that this might be a great device for her nurses. "There were some conversations with MercuryMD, and they told us the Palms had never been used before by nurses," Newby recalls. "I proposed using them with our clinical nurse specialists, and MercuryMD agreed it would be a good idea to do a pilot program." Since there was no money in Newby’s budget for the Palms, MercuryMD let her borrow some for the pilot.
Clear goals in mind
Both MercuryMD and Newby knew exactly what they were hoping to get out of the pilot program. "What they were looking for was, is it really helpful for nurses? What I wanted to use it for was to stratify the population to focus on specific groups of patients at risk, and to see if it would save nurses time and thus help combat the nursing shortage," she says. "I wanted to find a way to help my clinicians see more patients more appropriately."
The pilot program began around nine months ago, with Palms being used by four nurse clinicians, one dietitian, and one coordinator. "Right now, we use 17 different insulins and 17 different oral agents," Newby notes. "One of our charges is to help physicians keep track of these meds and make sure that any potential interaction is identified early on. What’s more, we were absolutely looking at efficacy."
When logged on to the Internet, the Palm devices also can download information from E-pocrates, which provides advice in medication prescribing modes, contraindications, and so on.
A typical day in the program goes something like this: The operations coordinator takes all the Palms to the sinking (docking) station and downloads all the necessary patient data for all nurses. "The software has been written so that any time a patient has a hemoglobin A1c [higher than] 8 or a blood sugar [more than] 200, that patient’s information is automatically downloaded into the palm," Newby notes. "So, we know right away where the patients are with high sugar." The list is configured so that this information appears when the Palm is turned on.
The operations coordinator then takes the Palms and gives them to the nurses, each of whom has a different unit or campus for which they are responsible. "They review the information on their patients, including what has been ordered by their physicians, and review any recommendations that should be made back to the patients. Then, they go about seeing patients and/or their health care professionals," Newby explains.
"It’s really cool that when they go to see the patients they can say — without leaving the room — You are on medication X,’ so there are certain things you can’t do; Here are the possible side effects,’ and so on. They have all the medical records they need for the patient’s plan of care," says Newby.
So far, Newby is encouraged with the pilot program. "We’ve found it saves nurses 1½ to two hours a day they would normally spend just ferreting out information," she says.
"If they see a physician in the hallway, they can pull up all the patient information they need and discuss the case without having to call their office and leave a message. If there are any clinical issues, they can identify them right away. They can get all kinds of very rapid feedback, like [Physician’s Desk Reference] recommendations, contraindications, and so on," Newby adds.
"With that many meds, there’s no way to keep it all in your head!" she says.
What has impressed Newby most of all is that the nurses have been able to spend more of their time with the patients, taking better care of them, instead of spending time looking up charts.
"It’s much better to identify right up front who the patients are who need help and take care of them," she notes.
"Floating right to the top [of the hand-held display] are things like steroid-induced hyperglycemia, or patients who are on hyperalimentation, which can make your sugar go up," Newby adds.
The next step in the process, Newby says, "is to put Palms in our budget," noting just how valuable they are.
"They can show us the all-patient data that tell us which patients are at risk for long-term stays," she says. "We can tweak the software so we can look at cost and quality at the same time."
It might not be long before other nurses at Moses Cone are using the MercuryMD Palms as well. "Clinical nurse specialists here who look at all diseases are looking at it," she reports. "And the next generation could be the bedside nurse."
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