Nurse Communication Technology Improves Patient Care and Efficiency

Communicating in the modern nursing work environment is difficult.  In order to provide the best level of patient care, nurses need to be constantly accessible by several sources.  At any given time nurses need to be aware of patient and family requests, while maintaining ongoing communication with physicians.  In addition, nurses must also keep track of patient conditions that are communicated through mechanical devices such as patient monitors.

Juggling information from these sources is already complex, yet the majority of US hospitals add to the problem by lacking effective communication technology.  A study by Forrester Research showed that the inefficient communication methods most nurses are forced to rely on cause major drains on productivity.

A few examples from the study:

“The majority of nurses stated they would save somewhere between 30 minutes to one hour per day with instant access to experts.”

“A sizable percentage of nurses — 65% — said they spent from 20 minutes to more than one hour per day trying to reach other medical staff. This includes 26% that spend more than one hour per day and another 39% that spend from 20 minutes to one hour.”

Regarding elimination of physician-nurse missed communications and phone tag, “estimates of up to one hour per day would be saved by 54% of nurses, and another 26% indicated it would save them from 16 to 30 minutes per day.”

It is no secret that the largest item on the average hospitals expense sheet is employee compensation.  Accordingly, this collective drain on nurse productivity adds a big cost for hospitals.  What isn’t as obvious is the negative impact poor nurse communications has on patient care.

Aside from time wasted on poor communications that could be spent with patients, inferior communication platforms also lead to more troubling outcomes.  Take for example, the fall risk patient who needs to use the restroom and caregivers are too slow to respond to their nurse call request—and arrive only in time to see the patient has fallen while trying to use the restroom by themselves.

Wireless Nurse Communication as a Solution

Current nurse communication problems stem from the fact that most nurses, 78% according to the Forrester Research study, use telephones as their main communication vehicle.  Yet the majority of US hospitals rely on wired telephones, even though nurses are highly mobile.  As a result, communication breakdown is inevitable.

New nurse communication technology such as Dalcon Alert! provide a wireless solution for the modern hospital.  Dalcon Alert!, in tandem with wireless phones, allows nurses to stay in constant contact with patients, staff, and physicians while staying on the move. The Forrester Research study showed that 74% of nurse respondents could save a significant amount of time each day with wireless phones.

In addition to improved productivity, Dalcon Alert! improves patient care by allowing nurses to receive patient care alerts directly on their wireless device.  For example, caregivers receive nurse calls, iv-pump alerts, fall alerts and more on their phones.

Caregiver Alert Fatigue

A subtle problem has been growing inside the modern hospital environment.  The trend towards increased usage of alert/alarm generating patient monitors seems like a logical step towards better patient care.  It certainly makes sense that the more caregivers can know about patients’ conditions the better they can react should an emergency arise.  However, there have been multiple incidents that suggest that this is simply not the case.

The most high profile incident occurred in January when a patient at Massachusetts General Hospital (MGH) died of a cardiac arrest.  As it turned out, the patient’s cardiac arrest monitor had been in alarm mode for over 20 minutes before the patient died, yet nurses failed to notice the scrolling tickertape notices in the hallway or the beeps in the central nursing station.  In addition, an unknown person had completely turned off the separate audible alarm on the physical bedside monitor the night before.

So what exactly causes this disconnect between caregivers and monitoring technology? Alert fatigue.  As more monitoring devices are added into the hospital environment, each additional alert adds weight until nurses feel overwhelmed.  As a result, caregivers experience alert fatigue. Alert fatigue is the condition where caregivers begin to give up trying to manage the onslaught of alerts, and start to ignore them instead.  In extreme cases, such as the situation at MGH, caregivers begin turning down the volume of audible alerts or even turning off alerts completely.

Preventing Alert Fatigue

Stopping alert fatigue isn’t simple.  Obviously, eliminating alerts/alarms isn’t an acceptable solution, since that would defeat the purpose of patient monitoring devices.  Yet something must be done or the problem will only continue to develop as the hospital environment gets more complex.

The solution lies not in eliminating alerts, but in more efficient management of them.  Without an automatic and organized approach to managing alerts, caregivers are forced to juggle them manually.  Manual management of alerts can be effective, as long as the number of alerts stays at a reasonable level.  However, as more alerts are added to the environment, an alert management system becomes more necessary.

Developing an Effective Alert Management System

Today, new technologies such as Dalcon Alert! include an Alert Management System designed to help caregivers organize alerts.  Dalcon Alert!’s Alert Management System automatically tracks all active alerts.  Active alerts are displayed on a large screen monitor at the nursing station and are automatically updated in realtime with alert type, location, and length of duration.  The alert queue is designed to allow caregivers to quickly prioritize active alerts, and canceled alerts are automatically removed from the queue.

Reducing Unnecessary Alerts

In addition, Dalcon Alert! allows nurses to receive alerts via text message to wireless phones.  A successful Alert Management System involves quality design.  As a result, caregivers should only be receiving relevant alerts.

For example, caregivers should only receive non-critical alerts from their assigned patients, not from each patient on an entire floor.  Because Dalcon Alert! utilizes wireless phones assigned to each caregiver, relevant alerts can be tailored to the individual caregiver.

Because all alerts are managed by the Alert Management System, non-critical monitoring devices can have their audible alerts turned down in order to reduce hospital ambient noise.  Any reduction in hospital ambient noise has been shown to increase the quality of patient care significantly.

Implementing Hourly Nurse Rounding

The benefits of hourly rounding can be very encouraging for hospitals considering implementing the program.  However, according to the Studer Group, the hospital consulting organization credited with first documenting the benefits of hourly nurse rounding, hospitals should not attempt to execute the program halfheartedly.  Having the nurses merely get “face-time” in with the patients each hour is not enough.  In order for hospitals to see real results, the Studer Group advocates that nurses follow the following eight-step rounding procedure each time they enter a room during their hourly round:

1. Use opening Key Words.
2. Accomplish scheduled tasks.
3. Address the “Three Ps”—pain, potty, position.
4. Address additional comfort needs.
5. Conduct environmental assessment.
6. Ask, “Is there anything else I can do for you? I have time.”
7. Tell each patient when you will be back.
8. Document the round.

The most critical component, according to the Studer Group, for a successful hourly rounding implementation is maintenance.  Nurse Managers must be committed to the program, and must continually validate the program or it quickly falls apart.  Validation consists of not only making sure that nurses are consistently making hourly rounds, but also that they are faithfully following rounding procedure.

Trust but Verify

The Studer Group suggests that nurse managers execute a “trust but verify” policy.  It is important that nurses do not perceive that they are being “checked up on” by their managers because they are untrustworthy.  Instead, managers need to communicate that they are simply double checking to make sure activities do not “fall through the cracks”  and that bad habits are not formed.

Hourly Nurse Rounding Validation through Technology

Dalcon provides a solution to help hospitals implement nurse rounding as a part of its Dalcon Alert! Remote Patient Monitoring system.

Dalcon Alert! captures patient monitoring device alerts and sends them to wireless phones carried by hospital staff via text message.  In addition to monitoring patient device alerts, Dalcon Alert! also sends periodical bed turn alerts to staff as well as rounding reminder alerts.  Nurses cancel their rounding reminder alert via Dalcon Alert!’s Remote Alarm Monitor at the patient bedside.  As a result, hourly rounding is assured.  However, it is still the responsibility of the nurse managers to confirm that nurses are following rounding procedure accurately and diligently.

The Benefits of Hourly Nurse Rounding

Hourly nurse rounding seems counter-intuitive.  At first glance, adding a major task to an already demanding job in order to decrease workload doesn’t make sense.

Yet researchers have found that adding an hourly nurse rounding program in hospitals makes a dramatic impact in two important areas:

1. Significantly increased staff productivity and satisfaction.
2. Significantly increased quality of patient care and patient satisfaction.

The fact that hourly nurse rounding actually decreases staff workload comes as a surprise to many.  Yet consideration of the impact of hourly rounding on the work environment quickly explains this phenomenon.

In a traditional acute care setting, nurses typically are conditioned to react to patient problems and requests instead of focusing on preventing them.  This strategy of inconsistency creates a high stress environment.  Because nurses are not proactively resolving patient needs, patients learn to rely heavily on their nurse call buttons to get assistance.  Due to the interrupting and distracting nature of nurse calls, as nurse calls increase, staff productivity usually goes down.

Reducing these resource-consuming nurse calls is the first area hourly rounding pays off.  As patients learn to expect nurses at specific times throughout the day, they begin to rely less on the nurse call system, using it for urgent needs only.

The effects are dramatic.  A recent study across 27 nursing units in 14 hospitals by the Studer Group, a hospital consulting organization, showed that hourly rounding decreased nurse calls by almost 40%.  In addition, patient falls were reduced by 50%. According to Christine Meade, PhD and chief researcher of the study, “It’s essentially like adding the time of one full-time RN to complement the staff for a week because of the hours not used answering call lights — and the patients love it.”

A secondary benefit of hourly rounding is the increase in the quality of patient care.  Patients feel like their needs are better cared for when patient care is provided proactively instead of as a reaction.  Also, Because hourly rounding takes care of all non-urgent patient needs, the nurse call system can regain its sense of urgency.  As a result, nurse call response times are drastically reduced.

Implementing Hourly Rounding with New Technology

Dalcon Alert!, Dalcon’s Remote Patient Monitoring and Alert Management solution, has hourly rounding alerts built into the system.  Dalcon Alert! captures patient monitoring device alerts and sends them via text message to wireless phones carried by facility staff.  In addition to these monitoring device alerts, Dalcon Alert! also sends periodic bed turn reminder alerts and nurse rounding alerts.

Because Dalcon Alert! hourly rounding alerts can only be canceled via the Remote Alarm Monitor (RAM) at the patient’s bedside, accidental staff negligence of rounding is eliminated.

Hospital Noise Pollution a Growing Problem

One of the largest complaints of hospital patients and staff nationwide is the abundance of noise in the hospital. Uncomfortable and unsafe noise levels inhibit the healing process of patients that need it most.

In fact a recent study at Johns Hopkins University Hospital has shown that loud hospital environments can have a major negative impact on patients including:

• Elevated blood pressure levels.
• Sleep disruption.
• Decreased oxygen saturation.
• Decreased rates of wound healing.

The consequences of a loud environment on staff include emotional exhaustion and burnout as well as a raised risk of medical errors due to miscommunication. Recently, a patient at Massachusetts General Hospital died because his heart monitor had been turned off by a staff member. The investigators cited “alarm fatigue” as a cause of the problem. Alarm fatigue occurs when nurses become overwhelmed by the number and variety of alarms in the healthcare environment. As a result, nurses begin ignoring or even turning off alarms.

A Mayo Clinic study performed several years ago showed peak noise levels at night in one facility rising to 113 decibels, equivalent to a chainsaw or jackhammer.

Major sources of noise include hospital ventilation systems as well as overuse of the hospital paging system and an abundance of alarms. The Johns Hopkins study noted that though audible alarms were significantly quieter than other sources of noise, patients ranked them as being more irritating than more intense sources.

New Technology as a Solution to Hospital Noise Pollution

Dalcon provides solutions that, as a secondary benefit, help eliminate hospital noise pollution.

Dalcon Alert! for Remote Patient Monitoring connects with various patient monitoring devices such as heart monitors, IV pumps, ventilators, pulse oximeters, and more. When a patient monitoring device triggers an alarm connected to Dalcon Alert!, the system sends a text message to wireless phones (or pagers) held by hospital staff.

Because Dalcon Alert! allows hospital staff to more efficiently manage hospital alarms, alarm fatigue is significantly reduced. Also, since Dalcon Alert! incorporates wireless phones or pagers to be carried by hospital staff, use of the overhead pager can be dramatically decreased as well.

MGH Patient Death Raises Concerns about Patient Monitoring Device Alarm Effectiveness

A male patient at Massachusetts General Hospital died last January after the crisis alarm on his heart monitor was accidentally switched off and left off. The patient was not discovered to be in crisis until a nurse came by during a routine check. The hospital has not said how long the man had been in crisis before the nurse came by.

The patient’s death highlights a growing problem for hospitals nationwide. Failure by staff to acknowledge and respond to alarms is one of the most frequent and serious problems facing hospitals today. The ECRI Institute, an independent nonprofit organization that researches ways to improve patient care, recently released its list of “Top Ten Health Technology Hazards” for 2010. “Alarm Hazards” ranked in at No. 2, passing other high-ranking health risks such as “High Radiation Dose from Computed Tomography” and “Retained Devices and Un-retrieved Fragments Left in Patients.”

A Nationwide Problem

Across the nation, hospitals are taking extra time to examine the effectiveness of alarms on patient monitoring devices. Every year, deaths are reported because alarms either malfunction or are turned off, unheard, or ignored. Kathryn Pelczarski, director of ECRI’s applied solutions group, says that there were 237 alarm-related deaths between 2002 and 2004, and alarms made up 12 percent of the 2,200 medical device problems reported to ECRI between 2000 and 2006.

“Alarm Fatigue” a leading Cause of the Problem

As hospital technology has expanded both in terms of application and complexity, the number and types of alarms have also expanded. As a result, nurses and other caregivers often find themselves overwhelmed to the point that alarms lose their urgency. Pelczarski, calls this problem “alarm fatigue.” When alarm fatigue occurs, nurses begin ignoring and even turning off alarms. Additionally, since nurses are busy responding to a vast array of alarms, it can become difficult for them to hear and recognize each individual alarm.

New Remote Patient Monitoring Technology as a Solution

Today, new technologies and tools are emerging to help hospitals overcome this obstacle in providing quality patient care.

Dalcon Alert! is one such tool that provides caregivers with an efficient way to acknowledge and respond to multiple alarms. Dalcon Alert! is a Remote Patient Monitoring system that simultaneously connects with various patient monitoring devices such as heart monitors, IV pumps, ventilators, pulse oximeters, and more. When a patient monitoring device triggers an alarm connected to Dalcon Alert!, the system sends a text message to wireless phones (or pagers) held by hospital staff.

The system is highly customizable.  For example, less critical alarms can be sent only to the nurses who are responsible for the patient whose device generated the alarm.  Highly critical alarms, such as heart monitor alarms, can be sent to the entire nursing staff to assure that such alarms do not go unnoticed.

Dalcon Alert! also routes alarms to a PC display at the nursing station running the system’s Alert Management software, allowing nurses to manage all active alarms. Alarms cannot be removed from the Alert Management queue until dealt with at the point of care.  As a result, accidental staff negligence is eliminated.

Culture Change in Nursing Homes

Culture change in nursing homes refers to the new and revolutionary patient care practices developing in modern long term care. The overarching goal is to transform these facilities from institutions into real homes and communities.

This change is guided by a shift in focus aimed at enhancing the respect and care given to elderly patients. Culture change stresses the importance of patient choice, dignity, autonomy, and purposeful living. One of the goals of this movement is to expand patient care beyond just physical boundaries; the patient’s mental and emotional well-being also becomes a priority. By attending to every aspect of a patient’s needs while maintaining high respect for the patient, more trust is established between patient and caregiver and the patient will be more satisfied with the care that he or she is receiving.

Healthcare facilities and nursing homes that are involved in this culture change will notice that small changes can lead to big results. For example, changing certain aspects about the language used in the workplace will create a community atmosphere where patients and workers are known as “friends.” Referring to patients as “friends” or “neighbors” and nursing homes as “communities” or “life centers” is a subtle way to deinstitutionalize the atmosphere.

Personalized Care is the Most Important

Creating “neighborhoods” within the nursing home, consistently staffed by the same caregivers, helps enhance the relational aspect of the culture change. Personalized one-on-one care is an important part of nursing home culture change. By having the same caregivers care for the same group of patients, the patients become more familiar and friendly with the workers, and healthy relationships are encouraged.

Also, many times nursing homes that are creating these neighborhoods will allow the staff of each area to maintain high levels of self-management, which increases job satisfaction.

Patient choice plays an important role in nursing home culture change. Certain choice options, such as allowing patients to choose what to eat for dinner, what activities to participate in, or when they would like to go to bed can go a long way toward improving the patients’ perceived quality of life. Also, more nursing homes are making efforts to provide each resident with a private room, as this allows the patient to feel more independent.

New Technology Assists in Nursing Home Culture Change

New remote patient monitoring technology, such as Dalcon Alert!, helps nursing homes “deinstitutionalize” and create a homelike environment by eliminating loud alarms and the need to use the overhead pager. The system also greatly improves staff communication and the quality of care.

The culture change in long term care movement is gaining momentum, mostly because of the benefits that it brings to both residents and employees. Nursing homes that adopt the principles of culture change often see improvements throughout the entire organization, such as reduced operational costs, increased staff retention rates, higher occupancy rates, and increases in overall competitive position.

Decentralized Nursing Stations: A Change for the Better

As hospitals move further into the 21st century, decentralized nursing stations are becoming the standard for enhancing the quality and efficiency of nursing care.

In the past, when medical information was stored on paper, centralized nursing stations were necessary to keep all medical data stored in an easy to access place. However, with the advent of new digital information storage and communication technology, centralized nursing stations have become an increasing burden on the quality of patient care.

The Value of Decentralization

The primary benefit of a well-managed system of decentralized nursing stations is the positive impact the system has on patient care. Having multiple nursing stations located throughout a floor instead of one centrally located station puts nurses in closer proximity to the patients. A result of close nurse-patient proximity is improved nurse response time and room observations.

Also, the close nurse to patient proximity helps hospitals with decentralized nurse stations better prevent never events due to patient falls.

Decentralized nursing stations also save nurses thousands of steps each day traveling back and forth from patient rooms to the central station. Less travel fatigue leads to enhanced quality of care. Also, hospitals with successfully implemented decentralized systems experience lower staff turnover due to improved work satisfaction.

When planning the decentralization process, it is important that nurses retain an area where they can gather and collaborate. Nurses, like many workers, enjoy camaraderie and need to have particular areas allocated for their gathering. Effective nursing requires teamwork, and the social aspect of the job must be respected. Thus, a central nursing workroom is an important part of any decentralized system.

Hospitals looking to incorporate decentralized nursing stations should be prepared to expand their supply inventories since there will be more stations. However, the added cost of expansion will be offset by decreased nursing staff turnover and more efficient workspace.

Importance of Nurse Communication

Communication is a key issue when developing a successful decentralization plan. Because the stations are spread out, effective nurse communications become a more important factor in determining quality of patient care. Communications technology to solve this problem is currently available. Dalcon has multiple communication solutions, including Dalcon Alert!, that can effectively bridge this nurse communication gap by placing wireless phones in the hands of caregiving staff.

Dalcon Alert! is a Remote Patient Monitoring system that places fully functional wireless phones in the hands of caregiving staff. When a patient monitoring device triggers an alert connected to Dalcon Alert!, the system sends a text message to caregivers’ wireless phones so they can respond to the patient immediately. Alerts are simultaneously sent to the PC displays of all nursing stations. The alert is tracked in real time so that caregivers at each station can observe which alerts have been canceled and which have not.

Preventing Pressure Ulcers (Bed Sores) Never Events with Technology

In October 2008, the Center for Medicare & Medicaid Services (CMS) began requiring hospitals that receive federal funding from Medicare and Medicaid to begin disclosing “never events.”  CMS has stated that they will no longer reimburse hospitals for any costs associated with never events, and hospitals are prohibited from passing costs onto the patient.

What are Never Events?

Never events are a series of medical errors that are defined by CMS as, “clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility.” Included in the CMS financial year 2009 list of never events that will be denied federal reimbursement are the following medical errors:

How Dalcon Alert! Helps Prevent Pressure Ulcers (Bed Sores)

Obviously, never events can be quite costly for hospitals.  Yet some occur much more frequently than others.  Preventing bed sores can be difficult, but new technology is available to help hospitals prevent bed sores. Dalcon Alert! is a system that contains 3 distinct sections that help nurses treat and prevent pressure ulcers.

1. Remote Patient Monitoring
2. Alert Management Software
3. Pressure Ulcer Management System

Dalcon Alert! Remote Patient Monitoring

Remote Patient Monitoring is achieved by integrating with existing patient monitoring devices in the hospital.  Dalcon Alert! automatically forwards all device alerts—via a text message—to wireless phones carried by the nursing staff.

Although Dalcon Alert! contains the technology for nurses to remotely monitor patients via wireless phones, the pressure ulcer management system does not require their use or purchase.  If desired, hospitals can implement Dalcon Alert!‘s Alert Management software & Pressure Ulcer Management System as a stand alone system, and use it as a tool to create and manage bed turn alerts using current hospital policy.

Dalcon Alert! Alert Management Software

Dalcon Alert!’s Alert Management application helps caregivers actively manage the many patient monitoring alerts that are created in the hospital. The Alert Management software is similar to a web application, but it can only be accessed from the browsers of computers on the hospital network.

The function of the Alert Management software is to display, in real time, all active alerts that are being managed by the Dalcon Alert! system. Combined with Dalcon Alert!’s pressure ulcer management system, Dalcon Alert!‘s Alert Management software makes sure no pressure ulcer treatment is overlooked by staff.

Dalcon Alert! Pressure Ulcer Management System

Dalcon Alert!’s pressure ulcer management system is a unique solution. When this feature is turned on, the system automatically creates a “bed turn” alert that reoccurs after a set period of time (dictated by the hospital).  This “bed turn” alert is treated the same as any other alert that Dalcon Alert! manages; relevant caregivers receive the alert on their wireless phone, and the alert is reported on the system’s alert management software.  Thus, caregivers are continually reminded to attend to and turn at risk patients. Because Dalcon Alert! helps nurses pro-actively prevent pressure ulcer negligence, the occurrence of dangerous pressure ulcers in at risk patients is significantly reduced.

Creating a Homelike Environment in Nursing Homes with New technology

In June 2009, the Centers for Medicare & Medicaid Services (CMS) issued new revolutionary guidelines for long term care facilities (nursing homes) that receive federal funds.  These guidelines called upon nursing homes to create a “Homelike Environment” for residents; creating a call to action to deinstitutionalize these facilities by making changes such as:

• Removing overhead paging and piped in music.
• Removing institutionalized signage and labeling (such as closet and bathroom labels).
• Removing medicine carts and large centralized nursing stations.
• Discontinuing long term use of patient monitoring systems that use audible alarms.
• Eliminating mass-purchased furniture displayed throughout the building.

Dalcon’s unique patient care communications solution, Dalcon Alert!, is designed to help nursing homes make several of these changes.  As a result, facilities using the Dalcon Alert! system will meet numerous new CMS Homelike Environment guidelines, and their quality of patient care will drastically increase.

Dalcon Alert! provides a communications platform that eliminates the need for:

1. Overhead Paging
2. Audible patient monitoring alarms
3. A large centralized nursing station

How Does Dalcon Alert! Eliminate Audible Alarms?

Dalcon Alert! is a patient care communications system that has several features.  The system provides Remote Patient Monitoring and Alarm Management by integrating with patient monitoring devices including but not limited to:

• bed exit pads
• bed fall pads
• IV-Pumps
• Patient Nurse Calls

When an alert is created by any integrated device, Dalcon Alert! routes that alert to a remote nursing station where it can be actively managed on a PC monitor using Dalcon Alert!’s alert management software.  Dalcon Alert! also sends that alert to select staff carrying fully functional wireless phones via text message, so they are immediately made aware of that alert regardless of their location—and without the use of audible alarms.

How Does Dalcon Alert! Reduce the need for Overhead Paging and a Large Centralized Nursing Station?

Equipping vital staff with wireless phones is a central piece of the Dalcon Alert! system.  These phones allow staff to receive important alerts regardless of their location.  Caregivers can be reached remotely by phone, vastly eliminating the need for overhead paging.

A key component of the successful implementation of a decentralized nursing station system is staff communication.  Dalcon Alert! provides staff with an effective decentralized communications platform, built around fully functional wireless phones.  Also, Dalcon Alert!’s alert management software is accessed via a browser, and there is no limit to how many computers can be logged on to it at once.  Thus, each decentralized nursing station can be actively managing alerts at any given time.

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