“Any improvements to minimize the number of interruptions experienced by nurses will improve healthcare quality and will help ensure patient safety.”

American River Medical Commentary – “This data directly correlates to medical cart workstation usage by nursing professionals. It identifies ‘Cumbersome processes’ which the current environment of care requires nurses to monitor, manage, and maintain the power systems on their medical carts and workstations. These ‘Cumbersome processes’ are unnecessary and distract from patient care. Thus, if innovative medical cart workstations reduce nurses’ travel paths and eliminate unnecessary interruptions enhanced patient care will be achieved which positively impacts better patient outcomes.”

“I contend available (geographically proximate and consistent), reliable, and abundantly powered medical cart workstations will enhance nursing work flow, elevate quality of patient care, reduce work place risk injury, and improve work place satisfaction. American River Medical continues to gain momentum and stakeholder buy-in on our project to innovate medical cart workstations that embody such an environment of care, possessing infinite scalability to grow with future increasing power demands on all types of medical carts.”

Tagg Neal, President – American River Medical, LLC

Knowledge Repository – The Knowledge Repository is a free user-friendly library of design resources that continues to grow with the latest research. Thank you to The Center For Health Design for making the KR free and available to all for the advancement of better healthcare. See bottom of this article for more information and a link to the KR.

Interruptions and Geographic Challenges to Nurses’ Cognitive Workload

*2009 Key Point Summary by: Terri Zborowsky

Author(s)

• Redding, D.
• Robinson, S.

Publication Source

Journal of Nursing Care Quality;

From: Knowledge Repository, The Center For Health Design

Issue 3, Pages 194 – 200

Copyright 2015 The Center for Health Design. All Rights Reserved.

Redding,D.,Robinson,S.2009|JournalofNursingCareQualityVolume24,Issue3,Pages194–200

OBJECTIVES This study set out to examine workload interruptions for nurses in medical-surgical hospital units, with the intent to identify methods for reducing interruptions and improving the nurses’ cognitive work efficiency.

Key Concepts / Contex – Inpatient care is fast-paced and requires nurses to constantly shift their attention to make clinical decisions and care for patients in a constantly environment. Nurses integrate complex thinking with psychomotor and affective skills to deliver interventions. This thinking is continually disrupted by interruptions and distractions, which compete for their attention and can lead to errors or omissions and potentially pose a risk to patient safety. Earlier studies estimate that each interruption reflected an operational loss and cost $95. The research methods used in this study replicated a prior study.

Methods – The study was conducted in medical-surgical nursing units at a 562-bed, tertiary care, urban hospital in the Midwest. The units comprised two medical units, two surgical units, and two cardiology units (one medical, one surgical). The units ranged from 30 beds (medical oncology) to 37 beds (cardiology surgical). Three of the units (medical, surgical, and cardiology medical) included intermediate care beds with invasive monitoring capacity.

The descriptive study included quantitative and qualitative observation techniques. Data collection tools included observations by two trained nurse faculty practitioners who tracked nurses’ paths on floor plans as well as kept field notes on the nurses’ actions and communication with others. A convenience sample of 32 staff nurses was observed during the day shift, working in six medical-surgical nursing units.

The study calculated interruption frequencies by type and qualitatively assessed subjects’ travel patterns to identify possible sources of interruptions and cumbersome processes interfering with patient care.

Findings – The study calculated interruption frequencies by type and qualitatively assessed subjects’ travel patterns to identify possible sources of interruptions and cumbersome processes interfering with patient care. Observers recorded 244 interruptions and found six major themes: (1) employees asking questions, (2) distracting peripheral conversations, (3) unavailable supplies that required the nurse to get them, (4) phone calls, (5) family questions, and (6) patient call lights.

Travel patterns also contributed to workflow interruptions. Nurses traveled frequently between patient rooms, medication carts or stations, and centralized equipment and care supplies locations, responding to requests from patients and other caregivers.

Reviewer note: This article discusses many findings relative to nursing unit design than can be represented here. Therefore, review of this article is recommended.

Limitations – This study is limited in that it was conducted at only one hospital where the system of care, operations, equipment, and staffing patterns may be unique to this environment. Further, the observations were all made on the day shift.

The observers did not enter patient rooms to avoid creating yet another distraction; thus, some interruptions may not have been recorded. Finally, it is possible that observers classified observations into different categories, despite their training.

Design Implications – Many interruptions occurred while nurses were in the process of performing intervention activities such as traveling to patient rooms, gathering supplies, preparing or administering medication, and patient teaching, creating a risk for medication error and the potential for unintentional omissions in care. As the authors note, “Any improvements to minimize the number of interruptions experienced by nurses will improve healthcare quality and will help ensure patient safety.”

The data from this study suggest that nurses’ travel paths on a unit create interruptions in their ability to carry out efficient patient care. Designers might consider the results of this study as they work with staff planning for their work flow. The End.

About the Knowledge Repository: The Knowledge Repository is a complete, user-friendly library of healthcare design resources that continues to grow with the latest research. Learn More Here

About The Center For Health Design: The Center for Health Design is a nonprofit 501c(3) organization whose mission is to transform healthcare environments for a healthier, safer world through design research, education and advocacy. Learn More Here

About American River Medical: American River Medical is a innovation, design and service company focused on medical cart and storage systems for healthcare. We embrace project based work, collaboration, and “Outside the box” thinking that offer opportunities to positively impact medical cart system solutions for healthcare. We fuse our experience to apply innovation where inefficiencies exist, and creativity to apply design improvements for medical cart system solutions. American River Medical is a certified Veteran Owned Small Business and a sought after diversified supplier for hundreds of healthcare systems. As a healthcare professional you’ve dedicated yourself to patient care. Our mission is to provide medical cart systems, services, and solutions that make your calling more meaningful, efficient and effective. True Solutions.

Download the Synopsis of the Key Point Summary from the Knowledge Repository here

The Marketing Research class of The W.A. Franke College of Business at Northern Arizona University in Flagstaff, Arizona, has partnered with American River Medical, LLC to conduct a marketing research study. The marketing research students will develop and field a Qualtrics online survey, and present their analysis and recommendations on American River Medical’s project and patent pending invention pertaining to “Medical Cart Mobile Power Systems” for healthcare. The research study is being overseen by Franke College of Business’s Assistant Professor of Practice, Marketing and Executive-in-Residence, Len Hostetter, and being conducted during the spring semester 2019.

Len Hostetter earned a B.S. of Business and Economics from Lehigh University as well as a M.B.A. in Marketing from The Harvard Business School. 

Taggart Neal earned a B.S. from Northern Arizona University, is a second generation Lumberjack, and has an Evidence-Based Design Accreditation and Certification (EDAC) from The Center for Health Design. 

Professor Hostetter shares, “I’m thrilled to help Tagg as an alumnus of Northern Arizona University and American River Medical in marketing research for their visionary and innovative concept for healthcare. Tagg is a recognized subject matter expert of medical carts and workstations for healthcare and we’re proud to continue to be a part of his professional development, as well as work on a project with such immense potential to positively impact healthcare sustainability, workflows, and outcomes”, says Hostetter. 

According to American River Medical President, Tagg Neal, “It is a privilege to partner with fellow Lumberjacks at NAU on one of my company’s project design concepts for healthcare. This is a first step towards understanding the environment of care without a body of data surrounding healthcare medical cart mobile power systems and the negative impact they have on healthcare professionals’ workflow, work place safety, patient outcomes, and hospitals’ sustainability goals and green initiatives. Together we will analyze the data that will either support or refine the hypothesis underlying my patent pending design for the future of medical cart mobile power systems”, shares Neal. 

NAU – The W.A. Franke College of Business – https://nau.edu/franke/

American River Medical – https://www.americanrivermedical.com/

Download the article
About American River Medical: We are Medical Carts. They are our passion, purpose, discipline, and expertise.

Medical Cart – noun, /med-i-kul – ‘kart/; “Mobile systems, solutions, or workstations that optimize the storage, mobilization, and access of healthcare equipment, supplies, medication, and electronic data.” -American River Medical, LLC

American River Medical is a innovation, design and service company focused on medical cart and storage systems for healthcare. We embrace project based work, collaboration, and “Outside the box” thinking that offer opportunities to positively impact medical cart system solutions for healthcare. We fuse our experience to apply innovation where inefficiencies exist, and creativity to apply design improvements for medical cart system solutions. American River Medical is a certified Veteran Owned Small Business and a sought after diversified supplier for hundreds of healthcare systems. As a healthcare professional you’ve dedicated yourself to patient care. Our mission is to provide medical cart systems, services, and solutions that make your calling more meaningful, efficient and effective. True Solutions.

Hospital Property Evidence Locker

Business Challenge

• Maintain the integrity of trauma patient’s property, valuables and evidence.
• Provide clear chain of custody for all property and evidence (forensic, specimen, controlled).
• Reduce the hospital’s liability for improperly handled property, valuables and evidence
• Develop and implement a consistent “Policy and Procedure” protocol for staff and authorities
• Scope and coverage required the inclusion and consideration of any and all evidence such as: bullets, knives, controlled substances, currency, clothing, personal garments, weapons and other evidence that may be associated to the trauma patient and to secure the evidence until the evidence is retrieved by law enforcement.
• Solution would apply to all staff in the Emergency Department, the Peri-Operative Department and Security Services Department

Solution

The hospital selected American River Medical’s  AR-EL-10 Evidence Locker to manage the handling of evidence and property. The goal was to provide an organized and credible way of handling patient property, evidence, and valuables, establish credible hospital trauma staff protocol and procedures, improve patient care by empowering staff with a consistent time saving methodology of inventorying evidence, property, and valuables. American River Medical proposed both hard and soft system solutions for receiving, inventorying, and releasing patients’ personal property, valuables and evidence. The solution had to meet the local and state law enforcement provisions, as well as those of California Occupational Safety and Health Administration’s. American River Medical became critical to this healthcare organization in achieving these goals, and providing a True Solution. American River Medical’s Evidence Locker property storage solution integrates the AR-EL-10 locker with touch-less proximity access and inventory management software, which allows authorized hospital personnel to retrieve accessed audit trails at any time. The software’s capabilities permit law enforcement officials to establish a clear chain of custody and effectively maintain the use of evidence required to seek justice in our criminal and civil proceedings. In addition, American River Medical provided the hospital with a service plan that included multiple staff in service trainings, evidence and property log templates, and in hospital personal representative support to ensure the proper use and integration.

Hospital Property Evidence Locker Benefits

American River Medical’s solution provides complete accountability to the evidence, property, and patient valuable’s that are frequently brought onto location at a trauma credentialed facility with the added benefit of ensuring the security of these items against loss, theft, or compromise of integrity. By implementing the AR-EL-10 hospital property evidence locker solution staff readily follow protocol and procedure to log and inventory items so they can focus their true purpose to our communities; caring for patients.

Today, evidence commonly seen in the trauma setting such as removed bullets are inventoried and logged into our AR-EL-10 solution. Management, staff, and law enforcement agree it is an effective and efficient solution for unique setting that is a trauma emergency department. This secure storage solution accompanied by touch-less proximity access and a consistent log protocol make for a True Solution. By using American River Medical’s experience, the hospital can secure, protect, and account for property, evidence, and valuables to include: a patient’s dentures, controlled narcotics, firearms, large currency, knives and weapons, jewelry and keepsakes, contraband, victim’s clothing and garments, bodily fluids, and cell phones. This perpetual security and accountability adds credibility to the trauma designated facility while reducing its liability to claims for mishandling property, evidence, and patient valuables.

Hospital Property Evidence Locker Outcome

Because of the solution that is now in place, secure access provides information as to who handled the item(s) and which item(s) were handled. Finally, the new solution helps the hospital ensure that the their valued patients receive their personal property at the time of discharge by establishing a clear system for processing.

“The customer service that I experienced from American River Medical was the best . . . Tagg Neal flew to Texas just to check on the manufacturing process of the next evidence/property locker . . . and made sure all the specifications and customer’s needs were met to our satisfaction.”

DEFINITIONS

Belongings/Personal Property: Any property belonging to the patient in which are not limited to, include clothing, jewelry, wallet, cell phone, purse, cash, checks, credit cards.

Chain of Custody: A legal term that refers to the ability to guarantee the identity and integrity of the forensic evidence/specimens with sequential accounting for the handling of evidence to deter the possibility of evidence alteration, substitution or loss. A record of collection, movement and storage location of evidence must be kept from time obtained until the evidence is released into the custody of law enforcement.

Forensic Evidence: Any items taken from a patient that is potentially or actually requested by law enforcement officers for use of legal or criminal proceedings: to include, but not limited to clothing and other personal items, contraband, foreign… “…evidence for the courts…”.

Business Challenge

• Reduce the time spent by nurses to record and track the movement of heart valves.
• Provide traceability for each heart valve.
• Reduce the number of heart valves lost.

Solution

The hospital selected Terso’s TS032 RFID cabinet to store, track, and manage the utilization of high cost heart valves. The goal was to improve workflow by eliminating manual transactions for heart valve inventory, reduce operating costs and improve patient safety. Terso Solutions became critical to this healthcare organization in achieving these goals.

Terso’s RFID storage solution integrates the TS032 RFID cabinet with hosted inventory management software, which allows the hospital to effectively monitor product inventory any time of the day or night. In addition, the cabinet is monitored 24/7 by the Terso support staff to identify issues such as items nearing expiration date or doors left open.

The Benefits

Terso’s solution provides complete visibility to the heart valves that are on location at any time with the added benefit of ensuring patient safety by providing notice of products that are near their expiration date.

Today, an RFID tag is attached to the inventory at time of receipt and stored in the cabinet until removed for surgery. By using RFID, all products are acknowledged without requiring a direct line of sight. This perpetual visibility allows the nurses and doctors to see what is on hand (in the cabinet) at all times so they can be prepared for scheduled cases.

Because of the solution that is now in place, secure access provides information as to who handled the product(s) and which products were handled. Finally, this new system helps ensure patients are properly charged for items consumed.

Business Challenge

• Identify and target a high-use high-value instrument
• Select comparable instrument with > 15% cost savings
• Reduce dollar cost associated with selected instrument over a six month period
• Analyze and compare instrument integrity, quality, and durability

Solution

The hospital selected American River Medical to assist in identifying selected items within the peri-operative department. Together they concluded that an immediate cost savings could be realized with their fiber-optic laryngoscope instruments. The instruments targeted were fiber-optic laryngoscope blades and LED handles. These instruments are used during the procedure/technique of intubating a patient. Patient intubation is done daily and allows the anesthesiologist or nurse anesthetist to secure the patients airway.

The existing inventory of instruments was a potpourri of: brands, sizes, and types. Light component delivery systems were often incompatible and not operating at new or optimum levels. The anesthesia support staff was confident they could standardize to a specific brand and save costs while improving the overall quality of the instruments themselves.

American River Medical proposed the Riester (copyright) ri-Integral fiber optic line of specialty instruments. The handles utilize an LED bulb that has output of over 60,000 lux and a lifetime use of 100,000 hours (15 hr battery life). The blade themselves are forged as opposed to cast and have a smoother surface to reduce long term crevice contamination.

The peri-operative staff were allowed to independently compare product specifications. They concluded that the Riester product line was equivalent or superior to even the best of their existing inventory.

Initial instrument inventory was selected and ordered. The laryngoscope blades were comprised of the “Mactintosh” style such as, the AR-12-233 “MAC-3”. The handles were comprised of the fiber optic style such as, the AR-12-317, 2.5V “C” battery powered “Stubby”. The choice for “C” batteries was chosen as ideal for their cleaning, decontamination and reuse protocols.

1-30 Days

Blades: Upon ordering an immediate cost savings was realized. The cost savings is > 20%.
Handles: Upon ordering an immediate cost savings was realized. The cost savings is > 18% over the previously preferred brand.

30-60 Days

In addition to the cost savings being enjoyed by the department, user satisfaction surged with the feedback of anesthesiologists and certified nurse anesthetists. Users actually “Loved” the fiber optic stubby handle for its ergonomic comfort.

60-90 Days

Instrument cost savings continue averaging 20% and only positive user feedback is being received.

The Benefits

American River Medical’s ability to provide a cost savings solution mattered to this hospital.

“American River Medical stands out among the best with their superior customer service and products. I have enjoyed working with them since their beginning and know we will be doing so for years to come.”

The Riester line of ri-Integral fiber optic specialty instruments enabled this facility to meet revised budget expectations and enjoy an increase in user satisfaction. The ability of the departments staff to provide physicians with a superior product at reduced costs is now an ongoing benefit to the hospital and its leadership.

DEFINITIONS

lux noun or lux·es plural: a unit of illumination equal to the direct illumination on a surface that is everywhere one meter from a uniform point source of one candle intensity or equal to one lumen per square meter—called also meter-candle – first known use 1889.

LED noun: a semiconductor diode that emits light when a voltage is applied to it and that is used especially in electronic devices (as for an indicator light) light-emitting diode – first known use 1968.