Portal de Periódicos da CAPES

New uses for wireless technology

2003; Lippincott Williams & Wilkins; Volume: 34; Linguagem: Inglês

10.1097/00006247-200310002-00006

1538-8670

Susan K. Newbold,

Wireless Communication Networks Research

Clinicians stay connected with tools that offer real-time data, including personal digital assistants, patient care robots, network voice communication badges, and telehealth. Protecting patient safety while alleviating the nursing shortage’s impact tops health care leaders’ concerns. Increasingly, nurses turn to creative means such as information technology (IT) to help them provide quality care efficiently. In a 2003 survey by the Healthcare Information and Management Systems Society, all 247 respondents agree that technology can address patient safety issues, and 93% believe that reducing medication errors is the best use of technology. 1 But respondents differ regarding the degree to which specific care elements benefit. More than half of respondents (54%) believe that technology saves excessive time on administrative tasks, but less than half feel that technology positively impacts care quality (42%) and care variability (40%). And, interestingly, only 8% think that technology can address staffing shortages. 2 EVOLVING OPTIONS Wireless technology uses radio signals, not hardwired systems, to transmit data. “Wireless” implies that the system is always connected and that the data are in real time, which is appropriate and necessary for use in health care. Wireless technology enables mobile caregivers, such as nurses and physicians, to have access to data wherever and whenever it’s needed. Personal digital assistants (PDAs), robots, telehealth apparatus, pagers, telephones, tablet computers and subnotebook computers (smaller, lighter portable computers), smart telephones, wireless networks, mobile hardware peripherals, and all related software are pieces of the wireless puzzle. Using this technology, clinicians will soon be able to access the patient’s entire electronic health record without leaving the bedside; functionality also includes integration of point-of-care testing, telemetry, documentation, charting, referencing, and paging. Although the hardware and the software are evolving, many solutions are currently available. Applications for wireless technology in health care enable clinicians to make and access: ♦ interdisciplinary consultations ♦ electronic orders and diagnostic test results ♦ patient histories ♦ progress notes ♦ assessments ♦ nursing and medical reference databases ♦ protocols ♦ prescription generation ♦ insurance information. Personal digital assistants Use of these devices in nursing has increased in recent years. A small, informal survey of informatics nurses—who focus on the use of information management in health care—found that approximately one fourth own personal digital assistants (PDAs) and that the prime use in the clinical environment is for drug referencing. 3 Other PDA uses include prescription writing by physicians and other providers, charge capture, research, patient education, daily schedule access, memo writing, voice dictation, photography, drug calculations, laboratory work orders, and clinical trials. Drug and other popular nursing references are also available in PDA versions. One publisher offers a package of reference materials that allows a user to select a certain drug with the option of then directly connecting to information about the disease in another reference. In addition to granting access to word processed documents, spreadsheets, and presentation materials, PDAs enable nurses to use database software to create health-related applications. A Baltimore nurse uses his PDA to carry data regarding patients on transplant waiting lists, enabling him immediate data access for emergency purposes at any time or location. The Visiting Nurses Association (VNA) Home Health System of Santa Ana, Calif., uses a forms development tool to track patients and to document care. All required data are collected on PDAs and uploaded or downloaded from the nurses’ homes or the VNA office. Charting that once took place after hours is now performed during the nurses’ shifts—a factor that the VNA president and CEO uses to recruit and retain nurses: In the first 6 months of implementation, employment applications increased by 39%. The newest PDAs have numerous features: monochrome or color display, various sizes of internal memory, wireless Internet and e-mail connections, expandable memory, and different operating systems. The devices also offer such accessories as keyboards, travel chargers, carrying cases, and digital cameras. Combination devices exist that function as a PDA, telephone, and a camera. As point-of-care devices, PDAs afford nurses: ♦ rapid chart access ♦ increased time with patients ♦ easier access to computerized provider order entry ♦ improved workflow ♦ cost savings ♦ enhanced productivity and satisfaction. 4,5 Wireless robots In conjunction with Carnegie Mellon University and the University of Michigan, a researcher from the University of Pittsburgh School of Nursing is creating a robotic assistant to aid elderly patients. In other pilot projects in California and Maryland geriatric environments, nurses use a robot to make virtual visits. Specifically, a computer, equipped with a broadband wireless Internet connection, is controlled remotely with a joystick. An image of the nurse’s face appears on the monitor, which is located at the head of the robot. Voice communication Nurses at a leading hospital in Baltimore, Md., use a lightweight wearable badge that enables voice communication instantly over a wireless network. At the touch of a button, a nurse can ask the system to call any staff member who’s within the wireless environment. Telehealth Wireless technology for telehealth applications allows patients greater freedom to send and receive their data from any location at any time, while still enabling nurses and other care providers to effectively monitor medical conditions. With this technology, care providers can send alerts and reminders to patients regarding prescribed medications and maintain personal or family health information regarding health insurance, physician contacts, and past medical conditions. Telehealth also enables users to send emergency information from a cellular telephone to a hospital or emergency care clinic’s facsimile machine. Drug interaction checkers help determine if certain prescribed drugs will interact with the patient’s current medications. Additional functions In addition to medication bar coding, wireless technology allows clinicians to enter and capture vital sign data directly into flowcharts at the bedside or point of care. The information is available immediately to any user with an authenticated device, improving data accuracy and supporting real-time decisions. Other wireless options include a digital paging and messaging device that features constant e-mail and instant messaging, along with standard organizer functions and a small but growing number of software applications for health care users. Tablet and subnotebook computers, which address problems such as diminished screen size, are also gaining favor with health care providers. LEADERSHIP CONSIDERATIONS Carefully consider security, device selection, wireless communication service, applications, and user interface. Prior to implementation, determine: ♦ how your current organization infrastructure will accommodate the wireless traffic ♦ how many devices each staff member will need ♦ who’s responsible for broken or lost equipment ♦ who’ll train for the project ♦ whether you’ll roll out the project in stages ♦ how the new system will interface with the current information system ♦ how users will capture charges ♦ procedures for downtime and workflow impact. Don’t let this list of considerations intimidate you: Technology is a promising solution to patient safety dilemmas—one certainly worth exploring. So, stay informed and get connected.