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Patient Safety

Ensuring safety through wireless communication

Mayo Regional Hospital implements a state-of-the art wireless communications system.

lthough typically considered a safe place, emer- gency departments (EDs) have seen a startling increase in aggressive behavior toward medical and nursing staff over the past several years. Data from a 2009 study in the Journal of Nursing Admin- istration indicated a large number of nurses are victims of physical violence or verbal abuse every year. In a 2008 study in the Journal of Academic Emergency Medicine, caregivers reported a yearly average of 11 attacks per ED. In addition, the study found ED nurses feel less safe at work than do other healthcare employees, indicating an urgent need for management to create more secure ED environments across the country.

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Mayo Regional Hospital is a critical access hospital located in the Piscataquis county seat of Dover-Fox-

croft, Maine. In the past year and a half, its ED has gained regional recognition for its response to a number of ag- gressive patient situations and its impressive ability to de- escalate aggression and violence directed at ED staff.

Local problem

Mayo credits its high number of aggressive behavior incidents to the prevalence of mental health issues in the community. When mental health patients destabilize, they are often taken to the Mayo ED by law enforcement. Prior to October 2008, ED nurses had been both physically as- saulted and threatened by emotionally unstable patients.

Intended improvement

Much of the danger emergency department caregivers faced was due to delays in call and response time from local law enforcement (the hospital, with only 12,000 ED visits a year, does not have the resources for a full-time security presence in the department). In the case of an aggressive patient or visitor, caregivers needed to quickly notify the rest of the staff of safety risks posed by an upset patient or visitor. If a caregiver felt threatened without a phone nearby, they had few options for accessing immediate assistance. By late 2008, the ED saw an increase in the frequency of patient outbursts and was repeatedly experiencing a delay in the arrival of law enforcement. The time was right

20 March 2011

for Mayo to implement a state-of-the art wireless communications system. Vocera, a Silicon-Valley based company, provides wireless communication badges designed to help staff communicate instantly at the point of care. As the fi rst hospital in Maine to adopt the Vocera communica- tions system, staff based its decision on hospital case studies and references that showed Vocera had streamlined com- munication and enhanced patient and staff safety.

Planning the intervention In October 2008, the Vocera system went live with the ED and supervisors, and training began immediately. The badges are worn around the neck and provide the ability to communicate, hands free, from anywhere at any time. Most importantly, intelligent software allows communi- cation with critical resources with just a simple spoken command. The badges can connect staff with one another or local law enforcement. Mayo partnered with Vocera Professional Services to train staff on how to operate the badge through classes and scenario experience training. Classes focused on functional- ity, voice commands and speech recognition optimization. The department practiced best practice workfl ow for a number of scenarios involving aggressive patients in dif- ferent parts of the ED. Since the Vocera implementation, Mayo has conducted qualitative sampling to measure its impact in the ED through staff feedback. Staff members share that the implementation of the Vocera badge has improved com- munications between members of the ED team, and it has enhanced patient safety by improving communications.

HIT dimensions utilized The Vocera communications system can operate in any 802.11b/g networked building or campus. The system software platform runs on a standard Windows server and contains system intelligence – including call management, call connections and user profi les – as well as Nuance speech recognition and voiceprint verifi cation software.

HEALTH MANAGEMENT TECHNOLOGY www.healthmgttech.com

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