April 23, 2012

We must keep student access to handhelds in clinical

I just got back from a great trip to speak with folks from the Florida League for Nursing. During our conversations about the use of handheld computers many nursing faculty in attendance relayed stories of being denied use of handheld computers in the clinical settings. The reasons given for such a ban by a hospital are always a little fuzzy but I believe they are based on a few fears. As we know fear usually comes from lack of knowledge. Each of these fears can be easily answered.

Here are some of the fears and how nursing faculty need to respond:
1. A smartphone/handheld computer could be used for a HIPAA violation.
Response: There have always been ways to violate privacy of patients. All nurses and students are expected to act ethically, and there should be consequences if they don't. We just need to make the privacy rules clear, and the consequences for violations clear and consistent.

2. Those devices will cause interference with equipment that will endanger patients.
Response: Hospitals are full of radio interferences from the telemetry devices themselves, security radios, cordless telephones, light dimmers, fax machines, floor buffer motors, elevators, nearby cell towers, and of course visitors' cellular telephones. There is little evidence of interference unless the transmitting device is right next to the receiving device. Some ultrasounds and telemetry devices can be affected but just stepping back a few feet will stop the effect.

3. Patient satisfaction scores will be hurt because patients will think the nurses/nursing students are playing on their phones.
Response: I would first want data to see if there is even merit to this concern. I have had students using handhelds in the clinical setting for over 12 years and found patients like to see nurses looking up information that helps their care. Nurses need to explain and show what they are doing on the handheld, and the hospital needs to engage in some education through signs or orientation brochures explaining this is how nurses and physicians practice now.

We nursing faculty must be assertive in speaking with the hospital administration about the importance of this access. In the 21st Century it is impossible, and not even desirable, for nurses to know all the facts about the drugs, surgeries, procedures, and test results of their patients. There are more facts available every day but our brains stay the same size.

Nurses are users not just recipients of knowledge. Handheld devices help nurses use the facts to make clinical decisions.

And as a final argument, it was pointed out that the administration says nothing about physician use but feels it is OK to single out nurses for these restrictions. If I was at such an institution I would really press the administration for their reasons for such a double standard.

Nursing faculty cannot just let this happen without a fight. We need to be assertive and press our points. It is not only helps nursing education but nursing practice as well.


Florida said...

It will be interesting to see how mobile technology progresses at the Point of Care. As a patient, I prefer to have a provider use an iPad/iPhone instead of the COW that provides more of a physical barrier between myself and the caregiver. Thank you Dr. Thompson for addressing these myopic concerns.

jeangonska said...

I agree with you, that hand held devices in clinical provide us with an immediate reference for medical information and medications. It enhances our efficiency and safety, and ultimately affects quality patient care.

Just a year or two ago, PDAs were considered the ultimate mobile reference, and now in our area, they have become nearly obsolete, replaced with smart phones, ipods, ipads etc. Skyscape is a required application in our nursing program and is invaluable!

sosullivan08 said...

In addition to the questions you posed responses to, I believe the biggest argument for the use of handhelds in clinical is the benefit to the patient and the improved workflow and productivity. They benefit the patient by putting multiple resources by the use of apps or even just by using the search engine to access trusted, reputable websites. An example being if a patient asks about all possible side effects of a new drug on the market. It may not be in a printed drug book yet, but would be in a commercially available application and if not could be accessed by visiting the drug companies website to get the information from the source.
If the student had access to the EHR via their iPad they could answer questions immediately about lab work, imaging results, what the consult doctor said, etc. The main advantage is this is all done at the bedside instead of going back and forth to the nurses station which means more time at the bedside and less time searching around for the information. An iPad or similar is a great patient teaching tool also. Pictures of the signs of wound infections is more memorable than saying redness, pus, drainage, etc. Finally whatever device is used should be wifi only with messaging disabled during clinical time so the device is less phone/communication device and more patient care tool.

Brent Thompson, PhD, RN said...

@sossullivan08 All excellent points. At the heart of healthcare is the collection, processing, and communication of information among patients and providers.

EHRs and handheld computers are designed to facilitate that communication. Healthcare is the only area of business that seems to struggle with embracing technology that would improve their work.

pprin006 said...

I am a Registered Nurse at an intensive care unit in Miami, FL, and my facility has just recently adopted a policy regarding handheld computers and smartphones. The hospital policy states that these items (smart phones, iPads, etc.) should not be in patient care areas and if these items are brought into the hospital they should remain in the employee’s locker. I feel this is a disservice to our patients. I have found myself unable to find information using the programs provided by the hospital. When I have found myself in that situation I have looked up several medications and patient conditions on my iPhone in order to educate myself. It is interesting to me that the explanation offered to me for this new rule is included in your blog. I was told a HIPPA violation could occur and that our patients and their family members would think that we were using these technologies to play games or socialize. I am concerned that I won’t be able to find information for my patient as efficiently as I could with my smartphone, as I would with the resources provided by the hospital. After reading your blog I will definitely be bringing this topic up the chain of command. Thank you!

Brent Thompson, PhD, RN said...

@pprin006: The key argument is that we are professionals who know how to use technology professionally. Your institution is saying they will not let you use a tool that would improve care because they don't trust nurses.

There already are lots of devices on the unit that could violate patient privacy such as the telephone, fax machine, and copier. Not to mention digital cameras, tape recorders, and camcorders that could also be brought to a unit.

Please let me know how your administration responds.

Unknown said...

Just going to play devil's advocate a bit... In my familiar hospital environment all of the same information available via personal electronic devices is available via the internet on computers both at the bedside and at the nurse's station. With an employee log on, the internet is easily accessible to any employee.

The one drawback is no student access.

Brent Thompson, PhD, RN said...

I still argue that just having Internet access via a computer is not the same as having a handheld computer. Students and nurses can put many specialized apps on the device that give quick answers to clinical problems. Clinical calculators and reference apps are not as readily available on a desktop web browser. I don't even want to go through a clinical day without access to my healthcare apps!

Anonymous said...

I am in agreement that denying the use of information-related devices does our patients a disservice. The COW is cumbersome and creates a large physical barrier between the patient and nurse- not to mention trying to push it into the patient's room. As Dr. Thompson has pointed out, we are professionals who can be expected to use technology in a professional manner. I see residents making clinical decisions based upon hand-held device information all the time. As nurses, we should be expected (not denied) to take advantage of every resource available to us. HIPPA and electronic interference are dismissible excuses for the reasons cited here.

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