Technology Target Studies: Technology Solutions to Make Patient Care Safer and More Efficient

Presents findings on technologies that could enhance care delivery, including patient records and medication processes; features and functionality nurses require, including tracking, interoperability, and hand-held capability; and best practices

Robotic Assistance in Coordination of Patient Care

We conducted a study to investigate trust in and dependence upon robotic decision support among nurses and doctors on a labor and delivery floor. There is evidence that suggestions provided by embodied agents engender inappropriate degrees of trust and reliance among humans. This concern is a critical barrier that must be addressed before fielding intelligent hospital service robots that take initiative to coordinate patient care. Our experiment was conducted with nurses and physicians, and evaluated the subjects’ levels of trust in and dependence on high- and low-quality recommendations issued by robotic versus computer-based decision support. The support, generated through action-driven learning from expert demonstration, was shown to produce high-quality recommendations that were ac- cepted by nurses and physicians at a compliance rate of 90%. Rates of Type I and Type II errors were comparable between robotic and computer-based decision support. Furthermore, em- bodiment appeared to benefit performance, as indicated by a higher degree of appropriate dependence after the quality of recommendations changed over the course of the experiment. These results support the notion that a robotic assistant may be able to safely and effectively assist in patient care. Finally, we conducted a pilot demonstration in which a robot assisted resource nurses on a labor and delivery floor at a tertiary care center.National Science Foundation (U.S.) (Grant 2388357

Medical Device Alarm Systems: a Multi-Hospital Study of Alarm-Related Events, Caregiver Alarm Response, and Their Contributing Factors

Medical device alarm systems are expected to improve patient care by alerting clinicians about conditions that require attention. However, due to a variety of circumstances, including inadequate training, muting alarms, alarm fatigue, and staffing shortages, the effectiveness of alarm systems may be questionable. This research looked at the appropriateness of time- to-respond (TTR) to alarms, the alarm system configuration, policies and procedures regarding alarms, and the extent of alarm-specific training and education alarms. Using concepts from cognitive systems engineering, organization policy, and organizational learning, a research model was assembled to investigate these relationships. Quantitative data analysis included an online survey conducted in four hospitals, retrospective review of alarm data related to patient harms, review of Nurse Call download data used to compare self-report of alarms to actual numbers of alarms as well as to assist in answering exploratory questions. Qualitative data analysis included the clinician survey comments, review of alarm-related policy and procedure, and staff interviews. Alarm survey data were collected from a total of 107 respondents over a three-month timeframe. Data download of alarms totaled 88,307. Using a logistic regression approach, partial support for the hypotheses was found across contexts of high, medium, and low priority alarms. The overall prediction of appropriateness of alarm response was good, except in the case of medium priority alarms. Examination of the alarm data revealed that clinician response to medium priority alarms was considerably slower than anticipated. The results indicated that alarm configuration, policy, education, and training provided some explanation about alarm response. However, resulting data also indicated that the relationship between the alarm priorities and response times are not fully understood. While high priority and low priority alarms were approached appropriately, medium priority alarms did not elicit the same response. This is of some concern given that they form the bulk of the alarms in some hospitals. While alarm configuration, policy and procedures, education and training provided some explanation about alarm response, other factors may contribute to the disparity in response which were not clarified in this research. As more devices with alarm capabilities are introduced into patient care, it is imperative that the appropriate response is elicited in clinicians

Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace

Focuses on promising strategies and opportunities for retaining experienced nurses, one of many approaches the authors recommend to alleviate the current nurse shortage crisis

Proceedings, MSVSCC 2011

Proceedings of the 5th Annual Modeling, Simulation & Visualization Student Capstone Conference held on April 14, 2011 at VMASC in Suffolk, Virginia. 186 pp

Comparison of the effectiveness of traditional nursing medication administration with the Color Coding Kids system in a sample of undergraduate nursing students

The problem of medication errors in hospitals and the vulnerability of pediatric patients to adverse drug events (ADE) was investigated and well substantiated. The estimated additional cost of inpatient care for ADE’s in the hospital setting alone was conservatively estimated at an annual rate per incident of 400,000 preventable events each incurring an extra cost of approximately $5,857. The purpose of the researcher was to compare the effectiveness of traditional nursing medication administration with the Color Coding Kids (CCK) system (developed by Broselow and Luten for standardizing dosages) to reduce pediatric medication errors. A simulated pediatric rapid response scenario was used in a randomized clinical study to measure the effects of the CCK system to the traditional method of treatment using last semester nursing students. Safe medication administration, workflow turnaround time and hand-off communication were variables studied. A multivariate analysis of variance was used to reveal a significant difference between the groups on safe medication administration. No significant difference between the groups on time and communication was found. The researcher provides substantial evidence that the CCK system of medication administration is a promising technological breakthrough in the prevention of pediatric medication errors

Roundtable Discussion (RTD03) - Is there a downside to using Simulated Patients to teach and assess communication skills?

Background Simulated Patients (SPs) are widely used to facilitate the learning of communication skills enabling students to receive detailed feedback on experiential practice in a safe environment. They are also used in the assessment of students’ communication skills in Objective Structured Clinical Examinations (OSCEs). We have observed that our most experienced SPs are highly conversant with medical jargon and consultation skills and have almost become ‘medical faculty’. Consultations can therefore lack the true patient perspective, with SPs focussing their feedback on process rather than giving a true patient perspective. Roundtable objectives To consider the challenges in ensuring that highly experienced SPs continue to respond from a true patient perspective To critique whether the use of SPs in OSCE stations is a valid way to assess students’ communication skills with real patients To consider whether using consultations with Simulated Patients is useful for students in the later years of an Undergraduate medical course who are learning to integrate the different components of a consultation and reasoning clinically in a real-life clinical context To share best practice with colleagues Roundtable A brief interactive presentation including the authors’ experiences of working with experienced Simulated Patients which will draw on current literature regarding the evidence for using Simulated Patients in the teaching and assessing of communication skills Delegates will have the opportunity to take part in three roundtable discussions • OSCE Stations using SPs assess how good students are at communicating with SPs but not with real patients • Experienced SPs are in danger of responding with a faculty not a patient perspective • By using SPs in teaching we over focus on process and forget the global picture