At the nurses' station, improving data collection and care.

When a tornado warning went out to the southeastern area of Pennsylvania last summer, the facility Kendal at Longwood in Kennett Square, Pa., was able to quickly communicate to staff that no baths or showers should be conducted until the threat had passed.

Unlike the "old days" when such information was passed along person-to-person or in hushed tones to keep anyone from panicking (and possibly taking several minutes), this time the staff heard it over their headsets, connected to the nurses' station.

Improved communication is one of the benefits the facility received when it agreed to be a beta site for AccuNurse, which its developer, Adherence Technologies, introduced last fall.

Cel Agustin, administrator of Kendal at Longwood, explained that the wireless product enables nurses and nursing assistants to gather information on residents quickly and privately. And the information also goes the other way, updating residents' vitals and care needs by speaking through a headset. The information is received at the nurses' station and recorded into the program.

Though LTC has been notoriously slow to embrace technology in the workplace-and perhaps most noticeably among nursing staffs--with electronic health records on the horizon more facilities have begun to invest in electronic tools. The filing of the MDS (minimum data set) is already required to be electronic.

The first day Beth DeLaHunt, RN, BAN, began her career as a nursing assistant, her facility had just begun using disposable briefs as opposed to cloth products. "Everyone told me how lucky I was not to have to deal with (the older products)," she recalled with a laugh.

Nursing advancements have taken a decidedly more technical approach. A former director of nursing, DeLaHunt now serves as a clinical product marketing manager for Achieve Healthcare Technologies, a Minneapolis company.

DeLaHunt said getting nurses to use new--even seemingly commonplace--technologies has been an uphill battle. "Nurses typically are not major computer users," she said. "Maybe about 25 percent of the nurses I've worked with are actually regular computer users."

Nurses sometimes feel intimidated by technology and a perceived permanence of data. "They wonder how they can delete a mistake or an entry," she said. "They are intimidated by the navigation at first. However, I've talked to several nurses that say since they've started using the technology, they love it and can't imagine going back to paper."

Achieve's Matrix is Web-based and handles a variety of tasks, both clinical and financial. DeLaHunt explained the advantage of the various products out in the marketplace currently is that messages can be sent to nurses without interruption of care. "It allows the nurse to proactively deal with those events and take immediate action," she said, adding that notifying physicians and other necessary providers can be virtually instantaneous.

She added that as nurses get more comfortable using technology, their quality will continue to improve and allow "the nurses to spend more time at the resident's bedside." With improved quality care, the regulatory risk goes down as does the litigation risk.

Agustin of Kendal said that from an administrative perspective, improved technology has helped cut back on overtime and wasted time during staff meetings. "The nursing assistants can go directly to the nursing unit, take up their headset, (and) they know exactly what's happened to the resident." The care plan is available on the system for them to hear.

She added that it hastens treatment before potential problems become an issue. For example, if a CNA notices a red spot on a resident, she can call a nurse through the system rather than make a note that could be forgotten as the day grows busier. Agustin also liked that vital signs and items such as weight have become more accurate as they are documented at the point of care.

The new system took some getting used to and some steps it might not otherwise have needed to take. Agustin explained that the facility communicated with state surveyors to inform them of what they were doing with the new system. "Also we met with the residents," she said. "We didn't want them to think we had converted our skilled nursing facility to a Wendy's with a take-out order."

The system also became a way to empower the staff, as the nurses and assistants offered suggestions about how to improve things, such as the durability of the headsets. "It's used 24 hours a day, so it has to be sturdy," she said.

Evan Newton, information systems director at Walker Methodist, a Minneapolis-based system with several facilities, said the use of newer technology has helped facilities' bottom lines. Record keeping for admissions, medical records, care plans and MDS filings, which are required to be electronic, were all simplified through an implementation project of an InfoSys product in three nursing homes Walker completed in 2002.

Where he saw the most impact for nurses, Newton said, was in reducing the time needed to submit initial MDS reports, which must be completed within 14 days of the resident's admission. "We had a whole department focused on producing the MDSs," he said.

The benefits were evident in allowing nurses to provide accurate information and on a more timely basis. "The accuracy of the bills and the claims that we submit means we get reimbursed much faster," he added. "The timeliness of the submission of the MDS (means) we don't get paid a default rate," allowing the facility to maximize its reimbursements.

Plus, the software simplified operations enough that when one person left the facility, that job didn't need to be re-filled. The money saved there can go toward direct care service, Newton said.

The software upgrade meant other changes needed to be made as well. "It re-engineers other processes and forms around the software," he said. "That's huge in terms of making an impact on the business and making full impact in implementing new systems. I believe very strongly that if you're implementing new software, you need to re-engineer everything that's around that software."

With a price

To be sure, technologic advances come with a price. The approach Walker took was not cheap for the nonprofit organization, Newton acknowledged. "Less than a million dollars," he said, declining to be more specific.

Alan Letzt, who along with his wife developed AccuNurse, said their product is best suited to a facility with more than 40 beds. "When you start getting below 40 beds, the cost may be high relative to the benefits.

Cost variables include the number of staff, construction of the facility, and how it's laid out. Since the system works on wireless technology, "certain buildings require more work getting the system installed than others," Letzt said.

The types of information placed into the system include which ear a hearing aid should be in, whether the resident wears glasses, etc. "This is the type of information that's often passed on from CNA to nurse by word of mouth," Letzt said. But as a day's events develop, "it's not always possible to remember all those details."

DeLaHunt said she believed the advancements help nurses learn and make better assessments. Short of developing a button that instantly creates another nurse's assistant, the advancing technology appears to offer nurses hope for the future.