Major Writing Assignment — Nursing Technology
Below is my feature story about how technology has changed the nursing world. Names have been changed, of course, but the dates are accurate:
6 July 2014
Technology in Nursing
My Town, State. — We are inundated with technology. From our personal cell phones to our HD television monitors, we must deal with devices and software designed to increase our convenience. Healthcare is no different. Nursing has dramatically changed in the last 15 years or so because of the increasing availability and demand for technology. How do nurses feel about this technology? Two new nurses responded with a resounding “YES!” “Awesome,” and “I never want to go backwards.” The veteran nurses also feel this has increased patient safety, but temper their enthusiasm by saying it is great when it is used properly.
Is technology a good thing? Are there any drawbacks? Let’s look at one scenario in a typical small-town hospital and find out what the staff members say about it.
R is a floor nurse on the Medical/Surgical floor. She has been a Registered Nurse for a grand total of eight months. The outgoing nurse reported the patient in room 116 has had a slight fever off and on all day, but nothing remarkable. The minute she walks into the room, R can see something is wrong. She has not been a nurse for very long, but she has a bad feeling from the doorway. The patient’s face is flushed, his skin is sweaty and hot. He has difficulty following the questions the nurse asks him. He is drifting in and out of consciousness. She quickly goes to the computer in the room, logs into EPIC, the electronic medical health record system to check on his last vital signs. The aide had just been in the room and had entered a fever and fast heart rate.
In the past, everything was done by hand on paper charts. R, who was an aide for about 20 years before becoming a nurse, relates how the nurse had to chase the aide down to find out the latest vital signs. She also describes when she used glass mercury thermometers “that you had to shake down and leave in the mouth for 10 minutes.” Now, the digital thermometers provide a readout in less than 30 seconds.
W, who has been a CNA for 16.5 years says that the blood pressures and pulses were taken manually, using a cuff and a stethoscope when she started. Now, she puts the cuff on the patient, pushes a button and she gets a readout of blood pressure and pulse. She describes how difficult it was to essentially fight the nurses or the doctors for access to the charts to put the vital signs in. They called the nurse who took all of her charts and kept them at her station a “chart hog.”
R calls for the Administrative Supervisor to verify her suspicions and to clarify the next plan of action. Together, they call for the Respiratory Therapist (RT) to give the patient his breathing treatment early and to get an EKG. They put the patient on a cardiac monitor to keep an eye on his heart and set the machine to take his vital signs every 15 minutes.
Twenty years ago the technology for EKG and defibrillators did exist, but nothing like today. J was a nurse that long ago. Now, he is the Information Technologist for the entire county, so one would expect he is the local expert in all things tech. The EKG machines at that time were not digital, but were analog. The nurse had to print out the information on paper if anything was to go into the chart.
The patient already has one intravenous line (IV) but because he is obviously so very sick, he needs to have another line inserted. While R calls the doctor on her wireless phone to relay the patient’s vital signs as well as her concerns this might be septic. H inserts the second line, drawing out a blood culture and a lactic acid for analysis in the lab. She secures the IV catheter before flushing it with normal saline. The doctor enters the new orders into the computer from his home.
When J started nursing, electronic lab ordering system “was the extent of our EMR.” Now we use several forms of communication, from cell phone, wifi phones and messaging. S is also a new nurse of only eight months. She and R graduated together, were hired together and now work together. She says the paper charting was much slower than today, and was less accurate. Now, with the computerized charting, she has access to the lab work the minute they are resulted.
R checks the orders on the computer and finds the doctor has also ordered some IV fluids as well as medications for pain and nausea, and SoluMedrol which is a steroid to reduce the inflammation which happens during sepsis. She gets them out of the Pyxis in the med room. She uses her badge as a key to swipe into the room in the first place, and uses her fingerprint identification to gain access to the medication dispensing cabinet. She takes the medications back into the room and uses the bedside medication verification (BMV). This is a laser scanner similar to the one at Walmart. She focuses the red light at the bar code or the QR codes on the patient’s armband, then at the barcodes on each medication in turn. This is a safety check to reduce medication errors.
In an earlier interview, J remarked how medication errors dropped dramatically soon after our facility started BMV. Now, he says, the only errors are the result of failure to scan the medications properly.
M, who works in the emergency department as a midlevel provider, feels that nurses need to have more skills when working with more technological equipment. He also notes that the computerized ordering system provides very good warning system whenever a medication is on the patient’s allergy list. M has worked with nurses for about 20 years. At that time, nurses did just about everything, from caring for the patient, to running the lab work. Now, these tasks are divided. J notes that what little computerized tasks were minimal in the everyday workflow.
The results of the chest x-ray and the blood work are in. The patient is indeed septic and it looks like the source is his lungs. He has pneumonia. The doctor reviews the patient’s past medical history by looking through his electronic chart. He can see this patient has had pneumonia before, but never as bad as this. He requests a blood glucose and some cardiac markers to see if he might be having a heart attack. These tests are done at the bedside with results uploaded to the chart very quickly.
Radiologists used film for x-rays until recently. Now, they are taken with digital equipment and are sent to a bigger hospital where a doctor reads them. The results are entered into the computer, and the staff have them right away. If the doctor chooses, he can view the images himself online.
S remembers when it took three days for a doctor’s dictation to get into the chart. Now, she can read this dictation the minute the doctor files it. J points out that our bedside testing just wasn’t available in the recent past.
W notes, “Everything is in the system. Everyone can see the charting right away.” S loves this aspect of the EMR. She says, “I can look up lab results and find out why they are important for this patient.” When she was an aide 15 years ago, she says that it was difficult to see the trends in test results, or in vital signs.
This patient is too ill for this small hospital. He needs to transfer to a larger facility with an Intensive Care Unit. The doctor calls a hospital in Big City to find a room for the patient. The transfer center finds the one available bed left in the big city, and relays that information. Now, he spends a bit of time consulting with a pulmonary specialist to determine the best course of action. Which antibiotic should this patient have? Levaquin? Vancomycin? Has his sputum culture shown any antibiotic resistance that we need to be aware of in the past? After a while, Doctor enters new orders for Zosyn, Levaquin and Vancomycin.
H is now the Administrative Supervisor, but she remembers working as a floor nurse after graduating in 1975. Back then, the only people who had IV pumps were those getting chemotherapy. Instead, the IV tubing was hung and the nurse stood there with her watch in hand, counting how many drips in six seconds and multiplying that by 10 to determine drops per minute. In fact, IV catheters now do not leave the needles in the vein like they used to. Now there is just a tiny flexible tubing.
B is the pharmacist. She stops by the patient’s room to give the Vancomycin she has just mixed up. She had to use the patient’s BMI and his current lab work to determine the best dose and frequency for this antibiotic. The trick is to have enough in the body to kill the bad bugs, but not so much that the patient is harmed in the process. R looks up the last Vancomycin administration in his EMR. While she is in the chart, she looks up specific details about the drug such as how quickly to infuse it, and warning signs to watch for.
J, the Information Services nurse reminds us that technology helps nursing staff by decreasing medication errors. It is easy to see when the last medication was given, and by whom. But in the recent past it wasn’t that easy. S asks, “Did the RN miss giving the medication? Or did she just not chart it? It was impossible to tell.”
R loves having the ability to access information about medications in the room, instead of running out to look it up in the drug book … which was usually outdated. “This is huge!” S agrees, saying, “I can explain it well.”
Veteran Nurse H feels that the trend has been increasing awareness of patient safety. R gives the medications by accessing the needleless access port in the IV line. This technology is fairly recent, but has dramatically reduced needle stick injuries.
The doctor has all the information he needs for the transfer, and asks nurse to launch MedStar. H stays with the patient while R calls report to the receiving nurse. The forms necessary for the transfer are filled out in the chart, printed out through the wireless printer system so the patient can use low-tech pen to sign.
According to S, things now are a lot more thorough, faster and easier to share medical information with other hospitals. She said that it was “a cluster” when transferring patients in the past, even to another department within the same hospital. But, as W puts it, hospitals can see the entire chart. “All of Providence can see medications and treatments.”
As R hangs up the phone she hears the distinctive sound of the MedStar helicopter landing outside. Her heart rejoices at that glorious sound, and she has to struggle to remain professional. Oh, how she wants to do a fist-pump in the air! She and her team have saved this man’s life, and can now hand off responsibility to the highly qualified transport staff. His blood pressure has improved slightly and his temperature is below 100 degrees.
J notes that in his early days as a nurse people died more often simply because “we didn’t have anything to help them.” With each technological advance that worked well was amazing. He says, “We counted every success as a miracle.” Now, he says, people think that they “deserve to live no matter what.” However, he says tremendously increased patient safety in the hospital setting. He feels that CT scans and MRIs could not exist then because technology could not support the concept.
According to H, these diagnostics have changed health care. She feels that physicians have different diagnostic skills than they did then, and they rely on test results much more now.
With all this technology advances now, what does the future hold for healthcare in general and nursing in particular? I asked these men and women for their predictions and got some amazing responses.
J, whose workflow is technology, answered this question via email. He predicts that nurses will use more mobile devices. “Perhaps a BYOD type system were the nurse uses their own mobile phone for communication and documentation.” He thinks that we will use Google Glass to communicate with providers and patients. He finishes his interview by saying that technology affects every aspect of nursing. “Nurses need to leverage technology to enhance their knowledge and become a more valued part of the healthcare team.”
Here is a video showing how some older folks respond to Google Glass:
Surgery while doctors wear Google Glass:
M was a medic in the Army before becoming a Physician’s Assistant 20 years ago. In an unexpected chance to interview him in person, he tended to veer off onto his medic experiences. He ended by predicting more robots in the future. Currently, the stroke robot this facility uses is more of a camera for the neurologist to use to assess the patient, and not a true robot. He says using robots would decrease human error. Then he pauses to think about that for a bit before adding, “But we might see an increase in errors due to bad human programming.”
He also thinks someone will develop something like an ATM machine. The patient would enter his credit or debit card, select through a series of signs and symptoms, stick your finger in for a blood sample and “wait for your prescription to pop out.” He also predicts more Nano-technology, or something like using modified HIV to attack specific leukemia cancer cells.
This video shows some non-medical uses for nanotech:
This one shows how nanotech might be used for targeted cancer treatments:
This video describes the modified T-cells to attack cancer:
S and R get along so well. They have known each other for over 15 years. Their predictions began innocently enough with increasing use for Robot Doctors. This would be for long-distance specialist consultations, which is great for rural patients. Robotic surgeries would increase, as well as more electronic record sharing.
Now they start to get into the spirit of the question. How about, they ask, a scanner chip for medical records? “You know, if you are in an accident and they just scan you to find out what you are allergic to, or something.” They end that sentence by miming a scanning device up and down my person.
They become more animated. Perhaps I made the coffee too strong?
“How about a Jetson’s conveyor belt? You get on at one end and come out the other all shiny and new.” The other one pipes in,
“A Jetson’s Fooderator 5000 in each room so the patient can select his own dinner!”
Now, I am afraid. Very afraid, as they continue:
“How about one of those air screens [she makes motions in the air with her hands], those holographic screens instead of a computer?” The other one gets louder. I can’t write fast enough anymore.
“Hoover shoes! So I can just glide down the hallway!”
They advance towards me and I swear they both said the same thing at exactly the same time.
“I think they will come up with a toilet that will collect stool samples and send them to the lab directly!” I turned around to leave them at this point. But I will never forget their haunting voices echoing down the dark nightshift halls:
“Hey! We have a lot more great ideas! We are just getting started!”
Yeah. That’s what I’m afraid of!