Mary Viney, RN, MSN, NEA, vice president of Nursing Systems and Network Accreditation at the Austin, Texas-based Seton Family of Hospitals, wanted to improve nursing practices at Seton, and she wanted nurses to lead the way.
"We came up with ideas for change when we were part of Transforming Care at the Bedside," said Viney. "Then, when we heard about Technology Drill Downs, we saw them as an opportunity to explore technology solutions for some of those ideas." Transforming Care at the Bedside is a Robert Wood Johnson Foundation (RWJF) national program.
The Partners. Seton Family of Hospitals is the leading provider of health care in Central Texas, serving 1.8 million people. The Seton network includes five medical centers, two community hospitals, two rural hospitals, an inpatient mental health hospital, three primary care clinics for the uninsured and several rehabilitation facilities.
The Technology Drill Down project, funded by RWJF from 2004 to 2009, focused on finding technology solutions to workflow problems in the adult medical-surgical units of acute-care hospitals. A Drill Down is a process created by the American Academy of Nursing to bring participants together for two days to identify technology solutions to their most frustrating workflow problems.
Two Seton hospitals—Seton Northwest and University Medical Center Brackenridge—conducted a Technology Drill Down in 2006. About 10 nurses from each hospital attended the sessions, which were facilitated by the unit director, also a nurse. After discussing priority areas for change, they focused on documentation; medication administration; and communication, especially communication among caregivers.
Drill Down Prompts New System of Administering Medication at Seton. In hospitals across the country, cumbersome medication administration procedures frustrate physicians, nurses and patients alike, and Seton was no exception.
As a result of ideas generated during its Drill Down, Seton's system of "closed loop medication" is well underway. With closed loop medication, all steps involved in getting medication to a patient are captured and tracked within one electronic system, says Viney.
When a doctor orders medication, the order is automatically and simultaneously recorded in the patient's medical record and sent to the pharmacy. When the pharmacy fills the order, the system automatically updates the record and notifies the nurse. The medication is then delivered to the nurse, often by robots. When the nurse gives the medication to the patient, she scans a medication barcode and a patient barcode, closing the loop from doctor to patient.
Viney says, "We know this is what we want to do and we know it will help. You know everything is accurate because all the steps take place within the same system."
As of March 2010, Seton had implemented the entire closed loop medication system except for the final barcode step in Hays Medical Center, its newest facility. The implementation process also is underway at the Brackenridge facility.
What's Next: Voice Activation Systems? Seton's Drill Down participants also wanted to change the way information was documented so that it was more timely and available to nurses, pharmacists, social workers and others. They proposed a system of voice-activated documentation, in which the caregiver speaks into a machine that converts the information to text and updates the record.
This project is on hold because of a broader move to electronic medical records. "We didn't want to make changes in the paper forms knowing we would be going electronic," said Viney. Although voice activation remains of significant interest among Seton's nurses, Viney believes it is about three years from becoming reality.
If Your Hospital Wants to Try Drill Downs... Viney draws some lessons from doing a Drill Down:
- Be prepared to spend time helping clinicians understand technology and encouraging them to think in new ways about how to solve workflow problems. "Clinicians were not thinking about how technology could help," said Viney.
- As participants embark on Drill Downs, project staff should encourage them to think "more futuristically," and to try new things.
- Drill Downs involve focus and commitment, but they are not hard to do, and materials are available to help with the structure. Viney said, "Drill Downs do not have to be an expensive endeavor."