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.
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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.
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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.
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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.
]]>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:
List of Never Events covered under the FY 2009 provision
- Object left in patient during surgery
- Air embolism
- Blood incompatibility
- Catheter-associated urinary tract infection
- Pressure ulcers
- Vascular-catheter-associated infection
- Surgical site infection (specifically mediastinitis after coronary artery bypass graft surgery)
- Hospital-acquired injury due to external causes (fractures, dislocations, intracranial injury, crushing injury, burns, and other unspecified effects)
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.
- Remote Patient Monitoring
- Alert Management Software
- 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.
]]> • 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:
- Overhead Paging
- Audible patient monitoring alarms
- 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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The Center for Medicare & Medicaid Services (CMS) creates guidelines for long term care facilities (nursing homes) that receive federal funding via Medicaid and Medicare. Licensed state surveyors perform annual checkups on nursing homes to make sure that these facilities are meeting the expectations of CMS—if not, those facilities are ineligible for CMS reimbursement.
In June 2009, CMS updated their guidelines for long term care facilities (nursing homes) in several ways. Out of the many changes made, the new “Homelike Environment” guideline is one of the most revolutionary.
Section §483.15(h) Homelike Environment
The actual CMS guideline reads, “The facility must provide a safe, clean, comfortable and homelike environment, allowing the resident to use his or her personal belongings to the extent possible.” CMS interpretation of this guideline suggests that, “A ‘homelike environment’ is one that de-emphasizes the institutional character of the setting, to the extent possible, and allows the resident to use those personal belongings that support a homelike environment.” What this means for nursing homes across the nation, is that sweeping changes will have to be made gradually to transform and deinstitutionalize these facilities.
Some of the more drastic “homelike environment” changes include:
• Removing overhead paging and piped in music.
• Removing institutionalized signage and labeling (such as closet and bathroom labels).
• Removing medicine carts and centralized nursing stations.
• Discontinuing long term use of patient monitoring systems that use audible alarms.
• Eliminating mass-purchased furniture displayed throughout the building.
Homelike Environment Compliance Expectations
Obviously, many of these CMS homelike environment suggestions represent sweeping changes for many nursing homes throughout the nation. CMS has stated that these guidelines have been effective since June 12, 2009; but in their own words they don’t expect most nursing homes to be able to meet them immediately. However, they are expecting nursing homes to actively pursue the new guidelines—or face the consequences:
“Many facilities cannot immediately make these types of changes, but it should be a goal for all facilities that have not yet made these types of changes to work toward them. A nursing facility is not considered non-compliant if it still has some of these institutional features, but the facility is expected to do all it can within fiscal constraints to provide an environment that enhances quality of life for residents, in accordance with resident preferences.”
Meeting Homelike Environment Expectations
New technologies exist, such as Dalcon’s patient care communications system Dalcon Alert!, that help nursing homes meet numerous “Homelike Environment” expectations. However, CMS has also stated that physical changes alone won’t fit the bill of a “Homelike Environment.” They are expecting serious culture change by nursing home staff; including a shift towards person centered care, and quality staff-to-resident relationship building.
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Patient falls are of great concern for health care facilities; they cause the patient unnecessary physical and emotional pain, and they are expensive. Not only do fall caused injuries cost thousands of dollars each; they also consume valuable time and tarnish the reputations of hospitals.
Many techniques, tools, and technologies have been utilized to reduce fall rates in hospitals, but fall rates are still remain high. The primary reason patient monitors fail to stop falls is because caregivers are unable to receive patient monitor alarms remotely. As a result, caregivers are only able to act upon those alarms they can see and hear in their close vicinity.
Solutions Offered by New Technology
Dalcon Alert! helps hospitals prevent patient falls by managing and remotely communicating patient monitor alarms.
Dalcon Alert! sends patient monitor alarms directly to wireless phones carried by caregivers. Remotely communicating alarms directly to caregivers allows caregivers to react to all changes in patient status, and provide their best possible patient care.
Dalcon Alert! also sends alarms to the nursing station console where they can be viewed in real-time. This up-to-date tracking of all patient monitoring alarms assures that no alarm will be overlooked.
Specifically, Dalcon Alert! connects with up to five common monitoring devices including, but not limited to:
• IV pumps
• bed fall pads
• bed exit pads
• patient monitors
By working with existing patient care devices, Dalcon Alert! can dramatically reduce patient fall rates, thus saving hospitals tens of thousands of dollars annually.
]]>For more information about the severity of patient fall liability, and methods used to prevent falls, see the white paper “An Assessment of Falls in Patients’ Rooms and Methods of Prevention.”
“With hundreds of applications, the judging process was difficult but Dalcon has demonstrated a commitment to quality and the continued development of the IP communications industry and deserves this honor. I look forward to seeing more innovative solutions from them as they continue to contribute to the future of VoIP and IP communications,” stated TMC Editorial Director, Greg Galitzine.
“We’re pleased to be honored by this leading publication in the internet telephony industry. This is another milestone of our continued journey developing VoIP solutions that are accessible and easy to use,” said David Condra, Dalcon’s CEO.
Dalcon has integrated its award winning IP Communications software with other products commonly found in healthcare. Now hospitals can take full advantage of VoIP through the use of a fully-integrated, open-standards-based, communications system.
Utilizing software running on standard PC servers, and standard IP and analog phones, DCM – Healthcare Edition not only supports functions such as Direct Inward Dial Numbers, Interactive Voice Response, and find-me/follow me to cell phones, it also supports powerful, integrated functions including:
- Electronic Faxing – eliminate the phone lines, paper, and toner of fax machines while automatically producing electronic documents for electronic medical records systems.
- Nurse WiFi – these critically important staff members and others can now be reached as easily as if they were sitting at their personal extension phone.
- Patient Nurse Call Integration – Existing nurse call systems can now be integrated with hospital fixed and wireless phone systems to better respond to patient calls.
- Staff Physician communications – Doctors can now communicate.simply by being a part of the hospital system so that, whether they are in their offices or doing rounds, they can reach key nurses and staff, and be reached immediately if needed.
The DCM Healthcare edition was first installed in Trinity Hospital in Erin, Tennessee. “This is a whole new mindset, like changing from an old IBM mainframe to laptops,” says Trinity Hospital’s CEO, Yvette Gillespie. “You don’t realize what you haven’t had until you finally get it! Now that we’re using Dalcon, I wish we could have done this years ago.”
INTERNET TELEPHONY Magazine has been the VoIP Authority since 1998 and offers rich content from solutions-focused editorial content to reviews on products and services from TMC Labs of 225,000 readers.
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About Dalcon Communication Systems, Inc.
Founded in 1979, Dalcon Communication Systems, Inc. has developed software and IT solutions for businesses nationwide. Dalcon, based in the healthcare capital of Nashville, Tennessee, bridges the latest in voice technology and data functionality into one flexible and integrated system. Its DCM 2.0 has won numerous industry awards.
Media Inquiries
David Condra
615.577.9009
dcondra@dalcon.com
www.dalcon.com