Operations and Facility Management

Time. It is the one thing we can’t make more of, and the one thing that costs us the most. This is especially true in a healthcare environment, where clinicians are stretched to their limits—expected to do as much as possible, in a finite amount of time, with minimal errors.

To put this in perspective, one only needs to observe a nurse’s daily workload. For example, a nurse in a pediatric unit will perform as many as 2,061 tasks to provide treatment and clinical documentation for their patients. Nurses perform some function, on average, every 1 to 1 1/2 minutes for their entire workday– every day. After analyzing the tasks and time required to complete their responsibilities, we find the time nurses spend with patients for treatment and assessment may be only 18 percent. The remaining time is spent walking from patients’ rooms to nurse and storage stations to retrieve medications, supplies, and enter documentation into the electronic health record (EHR). This equates to almost 82 percent of a nurse’s time throughout their workday spent away from the point of care. In a healthcare environment that is rapidly transitioning to a pay-for-performance model where patient outcomes and experiences are driving the bottom line, it is clear that better delivery of care is needed.

According to a recent study, nurses may only spend 18% of their time with the patient.

Centralized nurse stations can impact time spent away from the point of care, effecting and interrupting the clinician’s workflow.

Repeat visits to one location create congested areas, causing workflow inefficiencies.

The above heat map, created by Florida Hospital Celebration Health to measure workflow efficiencies, illustrates foot traffic patterns for a typical nurse’s shift. It illustrates how repeat visits to one location create congested high-traffic areas. Solutions are needed to improve these workflow inefficiencies caused by the use of centralized points away from the patient bedside.

In addition to the cost of an inefficient clinical workflow, medication and documentation errors have massive negative implications to both patients and providers. A single error in medication can cost an organization hundreds of thousands of dollars, and is considered by CMS a “never event”. Mistakes in EHR documentation can cost thousands of dollars in billing errors, and in turn can lead to disastrous concerns regarding patient treatment. However, it has been proven that point-of-care storage directly reduces medication errors, inaccurate documentation, theft and loss–all while increasing accuracy at the point of care.

In a 2006 study of six U.S. hospitals, researchers collected data following the minute-by-minute activities of 11 nurse work processes to assess the frequency of work system failures. They also conducted interviews with six of these nurses and their nurse managers, to determine the compared metrics between nurses, managers, and the independent observers. Findings indicated the five most frequent failure types involved: medications, orders, supplies, staffing, and equipment—equating to one work system failure per hour.

Workflow inefficiencies reduce the time needed to perform critical tasks, creating an environment susceptible to errors.

Compounding the issue is the fact that workflow inefficiency within the clinical environment impacts multiple facets of clinicians’ ability to provide quality care. These inefficiencies are partially driven by the design and layout of commonly used areas and items. Distractions and disruptions reduce the time clinical staffs have to perform critical tasks, ultimately creating an environment highly susceptible to errors.

While no silver bullet exists to improve clinical efficiencies, one demonstrated method is to move commonly used items to the point of care. One of the leading trends in modern healthcare design is the implementation of bedside or room-side cabinets to store medication and frequently used supplies for patient care, in addition to a laptop or tablet for EHR documentation. In many progressive hospital environments, these smaller, more localized units are replacing centralized servers and nurse stations, reducing the amount of steps and time for a nurse to get from point A to point B. This type of solution can also house an EHR input device, including a bar code scanner, along with medications and supplies for the patient’s care, together—accessible at the point of care inside patient rooms, or in the hall adjacent to them.

In the past, one challenge of point-of-care storage was security. Boxes could be locked by traditional keys, but keys were often lost and laborious to replace. As a result, workstations were left unlocked or unused in many cases.

Thanks to advances in access control technology, wall-mounted workstations can now be secured. Secure workstations can be mounted in public areas as well as in patient rooms—reducing interruptions and allowing clinicians to respond to patients quickly, and with fewer errors. By integrating the latest access control systems within wall cabinets, these workstations can now compliantly secure medications, supplies, and computers all at the point of care. The workstation security systems are easily managed at a departmental level, employing the same radio-frequency identification (RFID) cards used in most facilities. Additionally, new technology allows for implementation without intensive electrical installations with the convenience of Power over Ethernet (PoE) hardware. Wall cabinet systems essentially become part of the organization’s existing security network, simplifying the installation and credentials management process.

Point-of-care workstations have introduced a new level of security and workflow efficiency.  The HIPAA compliance challenges associated with keeping medications and supplies at the point of care are addressed, while optimizing the clinical workflow. This simple adjustment to workflow within a nursing unit can improve efficiencies, reduce errors, and enhance the patient experience by keeping clinicians where they should be: at the point of care.

About the Author and Carstens

John Pierson is vice president of sales and marketing at Carstens, Inc. in Chicago, Ill. Founded more than 125 years ago, Carstens pioneered putting patient information and medication dispensing at the point of care with customized records systems and workstations.

As the healthcare industry evolves, Carstens continues to expand its line of EHR support products, offering innovative solutions for paper based record keeping as well as the integration of electronic solutions at point-of-patient care. All made in the USA, Carstens’ products are designed to enhance communication and increase interaction between clinicians and patients at the point of care.

Contact: (800) 782-1524 or www.Carstens.com

References:

1 Cornell, P., Riordan, M., Townsend-Gervis, M., & Mobley, R. (2011). Barriers to Critical Thinking: Workflow Interruptions and Task Switching Among Journal of Nursing Administration, 41(10), 407-414.