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More functions, better healthcare: tablet PCs help increase efficiency, accuracy and reduce the risk of healthcare-associated infections (HAIs).

Located in Jefferson Parish, La., East Jefferson General Hospital (EJGH) places great emphasis on the quality and safety of the care it provides. Multi-disciplinary teams of physicians, advanced practice nurses (APNs), pharmacists, therapists and clinical nurses work together as a team to achieve improvements in clinical care and guide the organization toward a culture of quality and patient safety.

As a national leader in the adoption of electronic medical records (EMRs) to improve the accuracy, efficiency and measurability of clinical outcomes, EJGH's uses specific strategies and tools to accomplish clinical excellence, including:

* Development of physician order sets incorporating the current best practices;

* Development of clinical pathways addressing the daily care of the individual patient;

* Dedicated resources for quality management and patient throughput programs; and

* Expansion of the EMR system.

EJGH has successfully incorporated patient safety goals into the daily care provided to the community. In 2002, EJGH became the first hospital in Louisiana to earn the prestigious Magnet Status for nursing excellence from the American Nurses Credentialing Center. In 2006, EJGH was one of only a handful of hospitals able to raise their standards high enough to earn the distinction of being re-designated as a Nurse Magnet Hospital and in 2012, became one out of only 52 hospitals in the U.S. to receive re-designation for the third time.

EJGH tackles o pressure ulcer prevention project

Healthcare-associated infections (HAIs) are infections caused during the course of receiving medical care, and according to the U.S. Centers for Disease Control (CDC), there are an estimated 1.7 million HAIs annually, causing 99,000 deaths. The overall annual direct medical cost of the HAIs to U.S. hospitals is as high as $45 billion, claims the CDC, with an estimated cost of HAI per patient as high as $25,903. In 2008, the Centers for Medicare & Medicaid Services (CMS) began to decrease reimbursement for certain hospital-acquired incidents, such as pressure ulcers.

While EJGH worked diligently to prevent pressure ulcers throughout the care process, documentation did not always begin at the patient's arrival. As a result, if a pressure ulcer was found during a patient's stay, it was categorized as hospital acquired due to the inability to determine when it first occurred.

When patients first arrived at EJGH, the nurses were required to input detailed wound assessments into Cerner electronic power forms via COWs (computers on wheels) or desktop PCs. According to Jody Torres, RN, director of nursing informatics, East Jefferson General Hospital, regardless of how many descriptors the nurses used, it was impossible to know exactly what the wounds looked like.

"A picture is definitely worth a thousand words, and we found that out first hand," Torres says. "We needed photos to accurately capture the patients' skin integrity at arrival. On patients with major wounds, it is necessary to do this periodically throughout the entire stay in order to ensure wounds are improving and to adhere to documentation and compliance protocols."

With its integrated digital and Web cameras, EJGH immediately turned to the Motion C5v Tablet PC and equipped its 20 nursing units with the devices. In addition to wound documentation, the nurses can use the devices to access and input patient data. When not in use, the tablets are docked in docking stations and can be used with a mouse, keyboard and monitor as a desktop replacement. According to Torres, clinicians can undock in the middle of documentation and continue inputting information while mobile.

"From our research, Motion was first to come out with a tablet that's portable and has the integrated features, such as cameras and barcode scanners, that we needed while still being rugged and easily disinfected. This is huge for any healthcare environment where devices are going to be dropped and require disinfection between patient visits," Torres says. "It's also powerful enough to run our entire Cerner EHR in a usable format. The device's digitizer pen helps with clicking the application's small targets, and we can document without having to change our workflows."

Torres also cites the C5v Tablet PC's battery life as a crucial factor. EJGH had problems keeping the COWs charged and running, but battery life is never a factor with the tablets. "When docked, the tablets are charging, and the clinicians never have to worry about losing power."

"The ability to document photos takes the process from words to something more visible," Torres says. "Now, the nurses take one device into the patient's room, snap the photo and immediately upload it to the patient's chart--there's no printing or scanning involved, meaning we save time and costs."

Battling hospital-acquired pressure ulcers

"It's critical that everything be documented appropriately," Torres says. "Currently, we use a risk-assessment scale upon admission to evaluate the potential for pressure ulcers to develop. If a patient is at risk when they first arrive, we take photos of skin areas where breakdowns most often occur and of any wounds that are present."

With the Motion Tablet PC-enabled photo documentation process in place, EJGH has drastically reduced hospital-acquired pressure ulcers, which has a significant financial impact. Additionally, caring for patients with wounds is more efficient for physicians and enterostomal therapy (ET) nurse specialists, as they can view the image of the wound prior to the initial visit in order to decide on treatment options and bring needed supplies. ET nurses also report that the wound images help them prioritize which patients are most in need when they have long lists of patients to see.


"When we started the project, the pilot nursing unit dropped to zero hospital-acquired pressure ulcers within the first month, and that is maintained as long as compliance with taking wound images for at-risk patients is consistent," says Torres.

Most importantly, EJGH's patients benefit from the nurses' ability to catch pressure ulcers sooner and monitor them closely, meaning faster enhanced treatment. The tablets help the hospital deliver on its mission of providing patients with the highest quality care while streamlining workflows.

Looking Forward

In the near future, EJGH plans to reintroduce the C5v Tablet PCs for medication administration. Using the tablet's integrated barcode scanner, nurses can scan a patient's I.D. wristband as well as the barcode on the medication itself to ensure the right patient, medication, dose, route and time for that medication administration. "The use of a small mobile device like the C5v Tablet PC, instead of pushing a COW to the room for single medication administration, such as non-scheduled, 'as-needed' PRN medications, will help increase medication-scanning compliance, therefore improving patient safety," says Torres.

"The Motion Tablet PCs help increase efficiency, accuracy and reduce risk across the board, and it's the patients that benefit the most," Torres says.

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Title Annotation:Mobile Computing Equipment; personal computer
Publication:Health Management Technology
Geographic Code:1USA
Date:May 1, 2012
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