(This article first published on Advance for Nurses, where “millions of nursing, rehab and allied health professionals” turn to for “a trustworthy source of industry news and information”.)
The current hospital-patient care environment does not allow nurses to spend their time where they are needed most, at the patients’ bedside. A time and motion study of 767 medical-surgical nurses in 36 hospitals found that only 7.2% of their time (31 minutes during a typical 10 hour shift) is spent with the patient performing tasks, such as assessing the patient and reading vital signs. During a 10 hour shift, the study found that nurses’ time was spent in numerous activities, as shown in the chart below:
At a recent healthcare conference, the Patient Safety, Science & Technology Summit, three nursing leaders discussed this important issue about how nurses spend their time and the impact on patient safety:
- Lillee Gelinas, RN, MSN, FAAN (vice-president and chief nursing officer, VHA Inc.)
- Linda Groah, RN, MSN, CNOR, CNAA, FAAN (CEO, executive director, Association of periOperative Registered Nurses (AORN))
- Julianna Morath, RN, MS (chief quality & safety officer, Vanderbilt University Medical Center)
I asked them post-conference to elaborate on how a focus on the conference themes could improve patient care — in short, how science and technology could improve patient safety. Here are their recommendations to keep in mind about the importance of linking technology, patient safety, and nurses.
1. Use Monitoring Technology As A Patient Safety Net
Ideally, a nurse should be at every patient’s bedside watching, observing, and caring for that patient on a continual basis. However, the reality of the current work environment is that a frenetic pace, high workload and numerous administrative demands reduce nursing time with patients.
As Ms. Gelinas says, “Too much of nurses’ time is spent in activities other than in actual patient care. The majority of nurses’ time is spent in ‘hunting’ and ‘gathering’ – types of activities, like finding the right supplies. In addition, they are documenting, coordinating care, and administering medications. Not enough time is actually being spent at the patient’s bedside, assessing, teaching and ‘caring’.”
So, to deal with the demands of the work environment and the needs of multiple patients, technology should be seen as an adjunct to safe care, and used by nurses as a ‘technological safety net’ to support their practice in providing optimal patient outcomes.
An average ICU, for example, has 15 different pieces of technology in the patient’s room, none of which talk to each other, so the nurse is the neural network. Instead, the right technology should help “connect the dots”.
As Ms. Morath explains “Human vigilance is required but insufficient, continuous electronic monitoring needs to be there to support and back up nurses, and allow them to visit a patient while monitors are continuously assessing other patients for various physiological parameters (such as, oxygenation with pulse oximeter or adequacy of ventilation with capnography).”
2. Use Monitoring Technology That Incorporates Multiple Parameters
The more monitors that are used, the more alarms that can go off in a patient’s room, and this barrage of alarms can get in the way of delivering better care and ensuring patient safety. According to ECRI Institute, an independent, nonprofit organization that researches the best approaches to improving the safety, quality, and cost-effectiveness of patient care, alarm hazards are the number-one health technology hazard for 2013.
False alarms can get in the way of nurses and their patients. Ms. Groah explains, “It is the nurse who is usually the first to see the signs and symptoms of a patient’s deteriorating condition. However, false alarms interfere with nurses’ tasks and waste valuable nurses’ time. It is therefore critical that alarms be actionable.”
Studies have shown that the number of alarms that sound can be drastically reduced.
Moreover, as Ms. Gelinas says, “Monitoring systems that incorporate multiple parameters (such as, etCO2, SpO2, respiratory rate, and pulse rate) into a single integrated system is going to be better than managing each four of those physiological indicators separately. Better for the nurse, and better for the patient”
3. Ensure that Technology is “Nurse-Friendly”
Nurses must voice their concerns and make sure their concerns are heard. “Nurses, and all members of the patient’s caregiver team, need to be empowered by leadership to speak up about any concerns regarding patient safety,” says Ms. Groah. “It needs to be communicated from the board room to the front line of patient care, that everyone is responsible and accountable for achieving optimal outcomes for every patient – every time. For example, we can’t have a situation where a nurse can’t easily assess the patient’s situation. Nurses need to insist that technology provide an uncomplicated, inclusive assessment of the patient.”
“The stakes are just too high,” explains Ms. Morath. “We have a life in our hands – someone’s family member or loved one. If we want nurses to use technology, they need to be part of the decision to use it and buy it. They need to receive adequate training and continuing support. Doing this appropriately engages nurses as accountable and active partners and members of the problem solving team in patient safety.”
Technology can assist better nursing care, by continuously electronically monitoring patients to support nursing rounds. This technological vigilance may provide nurses the piece of mind to care for patients, without jeopardizing patient safety. However, for monitoring technology to be of benefit, two issues must be addressed
- Decreasing alarm fatigue: using “smart” alarm management technology can increase the number of actionable alarms and decrease false alarms.
- Easily assessing patients’ status: using algorithms can help nurses easily assess a patient’s condition through the incorporation of multiple psychological parameters (such as, etCO2, SpO2, respiratory rate, and pulse rate) that have been combined into an uncomplicated single assessment.
Above all, nurses must be made an integral part of the process (e.g. in buying and using all forms of technology). Their professional vigilance, along with the aid of continuous electronic monitoring, are critical elements to assuring patient safety and to advancing the goal of eliminating preventable hospital adverse events and death.
What do you think? Please post your comments below or at Advance for Nurses.