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Identifying Devices for Point of Care Documentation: Experiences from the Field.
Summer Institute in Nursing Informatics
Baltimore, MD
July 16-21, 2007

Jeffrey M. Adams, PhD(c), RN
Principal, The Bogart Group, Inc.
Doctoral Fellow, Massachusetts General Hospital - Yvonne Munn Center for Nursing Research
Research Associate, The Institute for Nursing Healthcare Leadership
Doctoral Student, Boston College Connell School of Nursing

Virginia I. Williams, MSN, RN
Director of Clinical Informatics, Salinas Valley Memorial Healthcare System

Leslie Schirmer, BSN, RN
Director, Nursing Informatics, Alexian Brothers Medical Center

Alicemary Aspell Adams, MBA, BSN, RN
 Principal, The Bogart Group, Inc.

The current state of technology adoption related to patient safety and clinical organizational efficiencies include strategies for Point of Care (POC) documentation, Bedside Medication Verification (BMV) and Electronic Medication Administration Record (eMAR). These solutions have been well studied and have all been identified as key factors in reducing errors (Langowski C 2005; Poissant L 2005). BMV and eMAR in particular are designed to assist with alerts, notifications and documentation related to medication delivery and they are currently being deployed in hospitals throughout the United States.

This manuscript is designed to provide a comprehensive and detailed review of the patient care environments within two US acute care institutions/ systems preparing for POC, BMV and EMAR. The aim of this review is to understand clinical informatics documentation device types (PDA, laptop, tablet PC, stationary PCs and/or Workstations on Wheels) required to provide the safest and most efficient care delivery in organizations embracing POC documentation. The review was completed throughout each care delivery area within each organization. The review included assessment of current device use as well as new device needs anticipated with the adoption of POC, BMV and or EMAR.

Each unit and patient care area was assessed by a survey team to consider workflow and any specific physical space, wireless connectivity and/or power limitations that may dictate the type of computing device type that could be used. Previous budgetary counts of devices and other data were validated or changed, given any new discoveries. Metrics describing each patient unit were captured to understand the care provider environment and provide the team with the ability to analyze similar care units.

The assessment data gathered was placed into a costing tool. Given the somewhat fragile nature of the computing equipment, extended warranties were also included in the financial model, to ensure their availability to the workforce over time. Further, a spare device proposal as well as a policy to maintain infection control was devised based on the experience gained via other client site references. A detailed strategy was also developed to provide infection control measures such as adding devices to the total count, based on the high number of isolation rooms in use at each hospital, and the inclusion of strategically placed ultraviolet lights on timers to adhere infection control needs.

While each organization will be faced with specific nuances, this paper provides a practical and experiential based framework for organizations moving toward POC, EMAR and BMV in the selection of clinical device types.

Langowski C (2005). "The times they are a changing: effects of online nursing documentation systems." Quality management in health care 14(2): 121-5.

Poissant L, Pereira J, Tamblyn R, Kawasumi Y, (2005). "The impact of electronic health records on time efficiency of physicians and nurses: a systematic review." Journal of the American Medical Informatics Association 12(5): 505-16.