• July 2008 FEATURE ARTICLES •
POC/Mobile Computing: Case History
COWs and WOWs, Oh My!
Focusing on the needs of nurses can help hospital IT departments make the best technology decisions and improve care giving at the bedside.
By Deborah Whittemore and Jodi Moll
Connecting with patients always has been a key
objective of our leaders at All Children’s Hospital (ACH). Since
ACH was founded in 1926, it has grown into a leading pediatric
referral center that is dedicated to advancing treatment,
education, research and advocacy in child health. Our 216-bed
teaching hospital is affiliated with the University of South
Florida College of Medicine, where more than 140 pediatric
specialists provide state-of-the-art medical and surgical care
for children. These specialists work closely with nurses,
therapists, pharmacists and other caring professionals who
understand the medical, social and emotional needs of each stage
of childhood and adolescence.
Through the years, our professionals have
gained this strong understanding of children by spending as much
time as possible at their bedsides. In order to help nurses and
other clinicians spend even more time with our patients, we have
invested in software applications that allow caregivers to chart
next to a patient’s bed, versus leaving the room to go to a
centralized nurses’ station. To facilitate the charting process,
we wanted to run these applications on workstations that nurses
could easily take directly to the bedside for charting and
rounding.
The Trouble With COWs
Four years ago, we implemented computers on
wheels (COWs) with the goal of encouraging our nurses to chart
at the bedside. The problem was, our nurses didn’t readily adopt
the devices. At first, they were enthusiastic about the new
technology, but as time went on, the problems became evident.
The biggest complaints about the carts we were using came from
our aging workforce and were centered on ergonomics, such as
small screen size and a difficulty pushing the heavy
contraptions. Our nurses also expressed frustration with the
carts’ large size and cumbersome design, which prevented them
from easily navigating tight spaces in patient rooms. And,
because nurses never really knew how much battery life remained
in a COW, they would forget to charge them after their shifts.
When other nurses arrived to begin the next shift, they were
hard pressed to find one with a full battery.
After several months, the carts sat abandoned
in an area that soon became known as the "COW corral." It wasn’t
simply an issue with a change in culture — the staff really
tried to adopt the new technology, but with little success.
We learned that happy nurses make our patients happy. Once we addressed our nurses' concerns, they enthusiastically adopted the new technology. As a result,
they spend more time caring for patients and less time worrying about technology.
We considered tablet PCs, but our nurses did
not like their small screen size. The general consensus was that
tablets might be fine down the road for applications, such as
bar coding, but our clinicians preferred a large monitor for
daily general use.
So, it was back to carts. We had already gone
through the cart selection process once before, and it was
easier to choose a workstation the second time around. Simply
put, we knew what we didn’t want. We didn’t want anything heavy,
cumbersome, difficult to navigate or uncomfortable to use. And,
we didn’t want to have to guess how much battery life remained.
Our IT department collaborated with our
nursing staff to assess the current COWs and to determine what
changes needed to be made.
Overwhelmingly, our nurses asked for a
workstation with a smaller footprint, a height-adjustable work
surface, the ability to add or upgrade components as needed, and
the ability to provide on-screen battery-charge status. The
smaller footprint was necessary to navigate in and out of
patient rooms, as well as for easier storage between shifts. The
height-adjustable work surface was requested after numerous
complaints from nurses about feeling uncomfortable when using
our previous COWs. The nurses wanted a workstation that could be
customized for various departments, depending on their needs.
For example, nurses in the ICU might require a chart rack, while
Med Surg might not. Finally, our clinicians communicated that
any method that could alert them when the cart’s battery was
getting low would be a huge plus.
Our project leaders brought in carts from
four different vendors so that our clinicians could conduct a
side-by-side comparison over a several-day period. We placed
surveys for user feedback in the area, and we took all opinions
into consideration. The nurses eliminated a couple of models
right off the bat because they were too hard to push. The two
remaining models were tested in the nurses’ workflow for a few
more days. Overall, the nurses and the IT department preferred
the Flo 1750 mobile clinical workstation.
We considered tablet PCs, but our nurses did not like their small screen size. The general consensus was that tablets might be fine
down the road for applications, such as bar coding, but our clinicians preferred a large monitor for daily general use.
Our nurses chose it for its height-adjustable
work surface, footrest and large monitor. The small footprint
also facilitates bringing the workstation directly to the point
of care. However, the feature that elevated it to number one on
the list was the battery meter. This feature displays the
battery data on the workstation monitor so users can see what
percentage of the battery is left. Our IT leaders preferred the
1750 because it was modular and easily customized, meaning we
would not be required to replace the entire workstation if all
we wanted was a different accessory or a simple computer
upgrade. Flexibility is paramount in a hospital such as ours,
where each department requires a different design. Since August
2007, we’ve deployed nearly 70 new mobile workstations in our
emergency center, neonatal intensive care unit, pediatric
intensive care unit and preoperative areas to rave reviews from
our nursing staff and IT department. The carts feature Wyse thin
clients and 20-inch monitors.
From COWs to WOWs
The biggest testament to our success is the
fact that our nurses are actually using the new mobile
workstations, instead of abandoning them in the old COW corral.
Now, everyone wants a "WOW" (workstation on wheels) including
the physicians, who take them on their rounds. When the IT
department has to borrow a workstation, the nurses complain
because they want to use them throughout their shift. This is an
enormous change from the days when nurses barely noticed if a
cart was missing, or they were actually happy to see the cart
wheeled out the door and into the IT department.
We’ve been amazed at how a simple technology
change can impact our workload for the better. We no longer
receive phone calls about dead batteries, because they always
know how much power is left. Moreover, the workstations’
wireless signals and computers work flawlessly. The need for
nurses to continuously sign on because the battery died, or they
dropped a wireless signal, has been virtually eliminated. In the
past, we had to reboot repeatedly, which was time consuming and
aggravating for our nurses. Now, if we ever do have to reboot,
our system automatically logs the user back in, which is a
win-win for our nurses, as well as our IT department. And, the
thin client technology is much faster, which thrills our
clinicians to no end.
We hope to purchase more mobile workstations
for our cardio intensive care and Med Surg units. Each
workstation will have additional packages based on departmental
needs. We’ve already added chart holders and tilting keyboards,
and are evaluating baskets and hand-sanitizer holders.
We learned that happy nurses make our
patients happy. Once we addressed our nurses’ concerns, they
enthusiastically adopted the new technology. As a result, they
spend more time caring for patients and less time worrying about
technology.
Deborah Whittemore is a client technology
specialist (left) and
Jodi Moll, BSN,
RN-BC is a clinical informatics education specialist at
All Children’s Hospital in St. Petersburg, Fla. Contact them at
WhittemD@allkids.org and
MollJ@allkids.org.