Suzi Birz, principal, HiQ Analytics, LLC
Imagine being able to complete your documentation while you’re inserting an IV line, just with the sound of your voice.
It’s already happening—thanks in part to some enterprising nurses at Butler Memorial Hospital in Butler, Pennsylvania. They helped pilot a new technology and process to improve the workflow and patient safety during the installation of intravenous (IV) lines.
Their work also earned the top 2009 Nursing IT Innovation Award, which was presented in April and sponsored by Health Data Management.
“Working with the vendor, Vocollect’s AccuNurse®, a voice-activated, hands-free documentation and communication system designed for long-term care, was changed to be appropriate for IV nurses,” said Cindy Esser, BSN, MHA, MBA, the director of emerging technology for Butler.
The Nursing IV team involved in the pilot program to test the AccuNurse®. (l-r) Pam Borcz, PACU, Deb Lewis, PACU, Lynn Oswald, PACU, Nancy Rimer, OPS6, Donna Haid, Clinical Informatics, Dr. Thomas McGill, Administration, and Cindy Esser, Information Technology.
Previously, the physician would write an order for an IV, the unit secretary would call the hospital switchboard, and then the operator would page the IV nurse. The IV nurse would enter into a series of calls with the unit to ensure accurate understanding of the order. The IV nurse would write the documentation following each task.
Now, the physician still writes the order, but the unit secretary enters the order into the database. The database is set up with required fields to ensure transfer of accurate information to the IV nurse. The system prioritizes the tasks and notifies the IV nurse. The nurses traded in a clipboard and pager for a small, wireless computer and headset.
“By speaking into the headset, the IV nurse activates the system and requests the next task,” explained Esser. “The system then provides the details of the location and order for the next patient to treat.”
“During or following the insertion of the IV, the nurse speaks into the headset and dictates the details of the completed work,” said Esser. “The system repeats back what the nurse said and the nurse confirms it.”
The notes are interfaced to the clinical information system.
“The patients are reassured by hearing the nurse dictating,” added Esser.
The effect of the system on patient safety and nurse efficiency is notable. “The system ensures that correct information is provided to the nurse the first time, the tasks are prioritized appropriately and no tasks are missed,” said Esser.
“Once completing the documentation for one patient, the nurse requests the next task,” noted Esser. “At the end of the shift, the nurse can request verification that all tasks are complete.”
“The reliance on a set vocabulary was one of the more challenging aspects,” noted Esser. “We created an ‘IV’ vocabulary containing words used when documenting an IV start or change and then trained the nurses to use this ‘IV-speak’ ensuring the dictation will be understood by the voice recognition system.”
“Dictating the documentation at the bedside while completing the task promotes effective use of IV nurse resources,” added Esser. “With accurate order information entered into the database and administrative documentation tasks eliminated, nurses can spend more time treating patients.”
Encouraged by the success of the pilot, Butler expects to expand the use of the technology to other areas in which therapists perform repetitive tasks.
Butler plans to determine if the system has an impact on IV complications and infection control. “We have an idea that with IV nurses touching fewer objects—
pagers, phones, computers—we might reduce infections,” said Esser.
In closing, Esser encourages nurses to remember that ideas coming from nurses about improvements are valuable. “When the idea is made a reality it becomes powerful not only for the clinician but for the patient.”
For more information:
Butler Health System
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