Outcomes of Communication, Workflow Efficiency, & Patient Care Quality Resulting from a Hands-free, Wireless Communication Device

Purpose: Failures in communication have long been identified as one of the root causes of preventable medical errors. The purpose of this quality improvement project was to assess staff perceptions on the outcomes of communication, workflow efficiency, and patient care quality after the implementation of a hands-free, wireless communication device in a federal acute care setting. Methodology: Replicating the quantitative component of a 2012 study by De Grood et al., a 10-item survey using a 5-point Likert scale was administered within a 4-week period to healthcare team members from two inpatient units composed of monitor technicians, nurses, nursing assistants, and unit clerks. Results: Out of 110 staff sampled, 84 surveys were returned garnering a 76.4% response rate. Frequencies for each of the 10 survey statements within the strongly agree/agree category ranged between 54%-88%. Pearson correlation coefficient generated statistically significant results and yielded strong, positive correlation values between each pair: communication and patient care quality, workflow efficiency and patient care quality, and communication and workflow efficiency. Implications: Healthcare team members positively perceive the use of the hands-free, wireless communication device. Staff believed that as communication improved, their workflow efficiency increased, and the quality of patient care they delivered was enhanced with the technology used. Investments in communication technology can positively influence patient care quality and staff satisfaction

NURSING INTERRUPTION DYNAMICS: THE IMPACT OF WORK SYSTEM FACTORS

Interruptions occur frequently in healthcare work systems. Hands-free Communication Devices (HCDs) were implemented in healthcare work systems to support the interruption process. However, from a sociotechnical systems perspective, HCDs may introduce new complications and unintended consequences to the work system. Research gaps exist in investigating the complexity of HCD interruptions in the real-world context. This dissertation aims to understand HCD interruption dynamics in the nursing work systems, using qualitative research methods. The first study examined the major differences between face-to-face and HCD-mediated interruptions, based on 30 hours of field observations in the acute care setting. Three major differences included: (1) The available cues to understand interruptee’s interruptibility, (2) The delivery of interruption content, and (3) The options to manage interruptions. The results uncovered facilitators and barriers that appeared to influence nursing work in the interruption process. The second study explored HCD interruption dynamics in more depth. It examined which system factors impact the interruption dynamics and how they influence nurses’ decisions and performance regarding the use of HCDs, based on 15 hours of field observations and 15 in-depth interviews with registered nurses in the pediatric intensive care units. This study was framed by the meso-ergonomics paradigm and activity theory. A descriptive model of HCD interruption dynamics was developed, comprising of five proximal system factors, 17 indicator and moderator system factors, and four distal system factors. These system factors interact and create integrated causal chains to impact interruption dynamics and influence the nurses’ decisions and performance regarding the use of HCDs. Specifically, the proximal system factors immediately impact interruption dynamics, the indicator or moderator system factors provide partial inputs and contextual circumstances of the proximal system factors, and the distal system factors are further down the causal chain. The results of the dissertation provided the basis for improving the design of interruption-mediating tools as well as the nursing work system, to better support the HCD-mediated interruption process, which may ultimately enhance the quality and safety of healthcare work systems

Alarm Fatigue on Medical-Surgical Units

Technology use in the medical-surgical acute care setting has increased and leads to alarm, alert, and notification overload, also known as alarm fatigue, which is one of the top 10 health technology hazards leading to patient harm. Alarm fatigue is a new phenomenon within the acute care health care setting and impacts patients, families, staff, leadership, organizations, and the profession of nursing. The purpose of this descriptive, comparative, quantitative study was to examine the difference in the level of alarm fatigue and its impact on performance for nurses who work on a technology-dedicated, inpatient, medical-surgical unit versus a traditional inpatient medical-surgical unit. Howard’s decision theory informed this study as the theoretical framework. Two groups of nurses (N = 141), one group from each unit under study, completed the Alarm Fatigue Questionnaire. Calculated with an independent t test, the results showed no statistical significance regarding the impact of alarm fatigue on nurses’ performance between the technology-dedicated and traditional, inpatient, medical-surgical units. Both unit types were impacted by a moderate level of alarm fatigue. Future research could focus on reducing alarm fatigue across inpatient, medical-surgical units. The findings of this study can effect positive social change by defining how the level of alarm fatigue affects medical-surgical nurses’ performance. Benefits of this research impact health care individuals, patients/families, and health care organizations to concentrate on reducing alarm fatigue which will promote patient safety within the acute care setting

Patient Safety and Quality: An Evidence-Based Handbook for Nurses

Compiles peer-reviewed research and literature reviews on issues regarding patient safety and quality of care, ranging from evidence-based practice, patient-centered care, and nurses' working conditions to critical opportunities and tools for improvement

Comunicações Móveis Celulares e Sem Fios Aplicadas a e-Saúde em Ambientes Hospitalares

As comunicações móveis celulares e sem fios, tem sido um grande avanço nas telecomunicações, possibilitando o surgimento de várias tecnologias que mudaram a nossa forma de comunicar. Graças ao avanço da comunicação sem fios na área de saúde, surgiram as redes sem fio de área corporal (WBAN), graças a esta tecnologia, é possível monitorizar um paciente a longa distância. Uma WBAN é constituída por um conjunto de dispositivos que são colocados ao redor ou dentro do corpo humano. Estes dispositivos nós sensores, atuadores e controladores que coletam e enviam dados específicos para dispositivos médicos. O processo de envio de dados coletados por dispositivos médicos é composto por três camadas diferentes: a comunicação IntraWBAN, Comunicação Inter-WBAN e Comunicação Além-WBAN. A camada física (PHY) e a subcamada MAC da rede WBAN foram especificada pela norma IEEE 802.15.6. Podem ser utilizadas em várias tecnologias nas redes WBAN como, por exemplo ZigBee, Wi-Fi, Bluetooth/BLE. Na tecnologia 5G NR, em quase todos os pontos da medição, identificou-se as operadoras MEO e NOS, sendo o ponto inicial a exceção. Já na tecnologia LTE, embora tendo MEO e NOS quase presentes em todas as zonas, a melhor qualidade de sinal pertence a operadora NOS. Com base nestes resultados, para as tecnologias analisadas LTE, UMTS, 5G NR, e NB-IoT, as zonas que precisam da melhoria de cobertura, são nos pontos 17, 19, 21 e no primeiro ponto de medição (porta de entrada das consultas externas). Um dos maiores problemas com que as redes WBANs se deparam, é a vida útil dos nós, uma limitação causada pelo consumo energético. Por isso, nas comunicações fora do corpo humano, como no caso de rastreio e localização dos ativos num hospital, e não só, a implementação da tecnologia Bluetooth Low Energy (BLE), pode ser uma solução energética eficiente o rastreio de ativos (dispositivos e pessoas) para dispositivos BLE que um oferece o serviço de rastreio e localização dos ativos. As tags depois de serem configurados com os APs que possuem a tecnologia, são capazes de fornecer trajeto e localização dos ativos. A plataforma Meridian Editor da Aruba, permite não só localizar os ativos, mas também permite ao usuário introduzir o mapa de um lugar específico, estabelecer limites para ativos no mapa, e receber notificações quando estes perímetros forem violados.Cellular and wireless mobile communications have been a major advance in telecommunications, enabling the emergence of various technologies that have changed the way we communicate. Thanks to the advancement of wireless communication in healthcare, wireless body area networks (WBAN) have emerged, thanks to this technology, it is possible to monitor a patient over long distance. A WBAN is made up of a set of devices that are placed around or inside the human body. These devices are sensors, actuators and controllers that collect and send specific data to medical devices. The process of sending data collected by medical devices comprises three different layers: Intra-WBAN communication, Inter-WBAN communication and Beyond-WBAN communication. The physical layer (PHY) and MAC sublayer of the WBAN network were specified by the IEEE 802.15.6 standard. They can be used in various technologies on WBAN networks such as ZigBee, Wi-Fi, Bluetooth/BLE. In 5G NR technology, at almost all measurement points, MEO and NOS operators were identified, with the initial point being the exception. As for LTE technology, despite having MEO and NOS almost present in all areas, the best signal quality belongs to the NOS operator. Based on these results, for the analyzed technologies LTE, UMTS, 5G NR, and NB-IoT, the areas that need coverage improvement are at points 17, 19, 21 and at the first measurement point (entry port for queries external). One of the biggest problems that WBAN networks face is the useful life of the nodes, a limitation caused by energy consumption. Therefore, in communications outside the human body, as in the case of tracking and locating assets in a hospital, and not only, the implementation of Bluetooth Low Energy (BLE) technology, tracking assets (devices and people) for BLE devices that one offers the asset tracking and location service. The tags, after being configured with the APs that have the technology, are able to provide the path and location of the assets. Aruba's Meridian Editor platform not only allows locating assets, but also allows the user to enter the map of a specific place, set boundaries for assets on the map, and receive notifications when these perimeters are breached

Accessibility of Health Data Representations for Older Adults: Challenges and Opportunities for Design

Health data of consumer off-the-shelf wearable devices is often conveyed to users through visual data representations and analyses. However, this is not always accessible to people with disabilities or older people due to low vision, cognitive impairments or literacy issues. Due to trade-offs between aesthetics predominance or information overload, real-time user feedback may not be conveyed easily from sensor devices through visual cues like graphs and texts. These difficulties may hinder critical data understanding. Additional auditory and tactile feedback can also provide immediate and accessible cues from these wearable devices, but it is necessary to understand existing data representation limitations initially. To avoid higher cognitive and visual overload, auditory and haptic cues can be designed to complement, replace or reinforce visual cues. In this paper, we outline the challenges in existing data representation and the necessary evidence to enhance the accessibility of health information from personal sensing devices used to monitor health parameters such as blood pressure, sleep, activity, heart rate and more. By creating innovative and inclusive user feedback, users will likely want to engage and interact with new devices and their own data