Technology Target Studies: Technology Solutions to Make Patient Care Safer and More Efficient AMERICAN ACADEMY OF NURSING WORKFORCE COMMISSION MONOGRAPH Author Carole Gassert, PhD, RN, FACMI, FAAN Workforce Commission Membership Pamela F. Cipriano, PhD, RN, FAAN - Chair Pamela Mitchell, PhD, RN, FAHA, FAAN - AAN Board Liaison Ida Androwich, PhD, RNC, FAAN Linda Burnes Bolton, DrPH, RN, FAAN Marilyn P. Chow, DNSc, RN, FAAN Brenda Cleary, PhD, RN, FAAN Carole A. Gassert, PhD, RN, FACMI, FAAN Lillee Gelinas, MSN, RN, FAAN Denise H. Geolot, PhD, RN, FAAN Susan Hassmiller, PhD, RN, FAAN Diane J. Mancino, EdD, RN, CAE Margaret L. McClure, EdD, RN, FAAN Patricia Moritz, PhD, RN, FAAN Pamela Austin Thompson, MS, RN, FAAN The Technology Targets work was generously funded by the Robert Wood Johnson Foundation. © 2009 American Academy of Nursing Workforce Commission Table of Contents I. Executive Summary ................................................................................................ 3 II. Introduction to the Problem .................................................................................. 6 III. Phase I, Invitational Conference: .......................................................................... 7 Using Innovative Technology to Enhance Patient Care Delivery .................................................... 7 IV. Phase II, Pilot Study: .......................................................................................... 11 Creating a Technology Enhanced Practice Environment in Acute Care Hospitals .................. 11 V. Phase III, Technology Targets Study .................................................................... 14 A. Planning .............................................................................................................................................. 14 B. Conduct of Study, “A Synthesized Approach for Identifying and Fostering Technological Solutions to Workflow Inefficiencies on Medical/Surgical Units .............. 16 C. Data Analysis and Results .............................................................................................................. 23 D. Interpretation of the Findings ........................................................................................................ 28 E. Dissemination of Findings .............................................................................................................. 28 VI. Synergy with Time & Motion and TCAB ............................................................ 30 VII. Conclusion and Impact of Technology Targets Projects .................................... 31 VIII. Acknowledgements .............................................................................................. 32 IX. Appendices ............................................................................................................ 33 1 2 I. Executive Summary In 2000, the Workforce Commission of the American Conference participants indicated the two priority Academy of Nursing (AAN) was charged with develop - action steps needed to reach the desired states were: ing unique strategies for dealing with existing and future nursing workforce shortages. At that time, a 1. Comprehensive, universally available, integrated patient records. massive nursing shortage had developed — prompted by both a shortage of trained nurses and burgeoning 2. Technology assisted medication use processes. demand for nursing services. Clearly, public health was Based on recommendations from conference partici - threatened. pants and the Workforce Commission, the Academy The Workforce Commission acknowledged that many focused subsequent Workforce Commission efforts on: groups were addressing the issue, and focused its own • Research into the state of technology that impacts efforts on how patient care demands could be managed nursing care, to identify the gaps between existing — particularly through technology — to reduce stresses, and desired capabilities, and physical strains, and inefficiencies of work and work - • Partnering with the technology industry to develop flow for nurses. Technology was seen as a way to create commercially available technologies to enable re - efficiencies that would enable nurses to meet patient designed nursing practices. needs more effectively and efficiently, resulting in safer patient care. Subsequently, the Workforce Commission developed and tested the Technology Drill Down (TD2) process In mid-2002 the Workforce Commission began identi - to identify technologies that would reshape practice envi - fying technologies that could improve the practice envi - ronments. This took place at three sites: University of Vir - ronment. An invitational, multidisciplinary conference ginia Medical Center, Kaiser Permanente Orange County entitled “Using Innovative Technology to Enhance Medical Center and Cedars-Sinai Medical Center. Patient Care Delivery” was held to assess the existing nursing delivery system relative to predicted workforce The two-day TD2 process focused on medical/surgical availability and to envision and describe a future nurs - unit workflow from a systems-wide perspective. The ing care delivery system. The 115 attendees identified process engaged an interdisciplinary group of 20 –30 five preferred scenarios, along with action plans to participants that could include nurses, unit clerks, phar - achieve those goals: macists, materials managers, information technology specialists, social workers and respiratory therapists. 1. Provision of patient specific information which is Participants first identified tasks that might be better- accessible at the site of services. facilitated by technology. Workflow was examined 2. Interactive point of care technologies for care givers with an eye toward improvements that technology and patients. might bring. 3. Technology that improves medication processes. 4. Best practice models immediately available across Many similarities in workflow processes were identified all care settings. at the three TD2 sites. There were also many detailed 5. Efficient inpatient care environment that responds areas specific to each site, where additional study and to issues of trust, responsibility and accountability. workflow process modification could lead to changes in the work environment. At all three sites, the leading The Commission focused on two primary objectives: workflow process concern was in streamlining and enhancing multidisciplinary communications. 1. Gaining better patient and provider interaction which would result in better outcomes, more The second concern at all three sites was improving efficiency and improved patient and employee supply chain functions such as those associated with satisfaction, and materials distribution and medication management. 2. Using technology to provide the right information Each group identified enhancements to improve speed to the right people at the point of care, automating non-direct delivery processes, and re-structuring the and enhance accuracy of medication fulfillment, simpli - care environment. fied access with dispensing machines, electronic chart - ing, inventory control, alerts, and improved safety across the medication cycle. 3 The three interdisciplinary teams generated 400 ideas cies, and 2) accumulate a wealth of data that, coupled for developing and testing technology over the follow - with a findings-dissemination process, would capture ing three to five years. The ideas were categorized into the attention of industry and prompt development of potential technology applications: workflow-enhancing technologies. • Integrated electronic medical record across the Outcomes from the Technology Targets project in - continuum of care. cluded development of functional requirements for new • Electronic medication systems to facilitate ordering, or revised technology products emerging from TD2 and administration, evaluation and medication reconcili - a DVD describing the TD2 process. Major project activ - ation across the continuum of care. ities included: • Staff scheduling system (accessible both at work and at home) to facilitate control over schedules and min - • Implementing a Technology Drill Down or TD2 imize errors, also allowing staff to obtain report re - process within at least 25 acute care settings. motely and participate in patient care planning. • Creating an Advisory Committee/Coalition compris - • Equipment and supplies connected to tracking and ing AAN, AONE, RWJF, industry and other health deployment systems. care organization representatives to decide upon op - • Voice over information systems. timal strategies for ensuring that increasing numbers of hospitals embrace the TD2 and TCAB/PDA mod - • Wireless and voice-activated systems for patient care els and that project findings result in the develop - and documentation. ment of useful technologies. • Technology to support patient activities of daily liv - • Posting, publishing and disseminating a report that ing, nutrition, mobility and hygiene. analyzes and evaluates the TD2 outcomes. • Rooms designed to support care delivery, prevent patient and staff injury, patient and family education TD2s were conducted at the 25 sites nationwide and communication. between March 2006 and May 2007. The majority of • Non-invasive, wireless patient care monitoring systems. hospitals were in urban areas, with 250 or more beds. • Enterprise wide patient scheduling systems. At those facilities 40 percent of nurses, physicians and • Multilingual wireless communication systems