A Mobile Cart Balancing Act

Compiled by Jennifer Dennard

While experimenting with tablets, smartphones, and other medical devices, this regional hospital believes mobile carts are still crucial to its mobility initiatives. The key is ensuring that each tool provides value to clinicians and patients.

Montrose Memorial Hospital is a not-forprofit, 75-bed, regional medical center that has served the community of Montrose, CO for 64 years. Its staff of 573 provides care at its main facility as well as at San Juan Cancer Center, Cardiology Clinic, and Basin Clinic in nearby Naturita. Like many providers today, Montrose’s staff members are juggling multiple IT initiatives and looking to implement technologies that speed projects along in the most efficient and secure way possible. Mobile devices are slowly entering the picture but aren’t necessarily providing the immediate panacea many mobile health advocates so eagerly tout. A balancing act between tried-and-true mobile carts and upstart tablets and smartphones is being played out, and Montrose’s ecosystem of healthcare IT is evolving in the process. Carlos Lovera, IT director, and Dawn Currier, RN, Meditech application analyst, weigh in on this evolution and share their take on why mobile carts will remain the backbone of Montrose’s mobile ecosystem for some time to come.

Q: What mobile devices are currently in play in your healthcare ecosystem?

Currier: We first adopted mobile carts from Stinger Medical in 2011. Our nurses currently use 18 of its mobile carts throughout our med/surg unit as well as in our joint replacement unit and acute rehabilitation unit. They are used to look up lab results, for medication administration, clinical and administrative documentation, and bar code scanning.

We have one tablet that our respiratory therapists have been using since last fall. The tablet works well for them because they typically have to get to patients quickly, and mobile carts can be hard to maneuver, even in an elevator, when going from floor to floor in a hurry. We also utilize iPads in nonclinical departments such as in IT, foodservices, and the executive offices.

Q: How do you foresee Montrose’s mobility demands growing in the next few years?

Lovera: We’re looking into purchasing a Fuji PACS app for physicians’ personal iPads sometime this year so they can have mobile access to digital x-rays and CTs. We’ll look even more intensely at integrating smart devices like tablets and phones as more apps come out that better interface with our systems.

The hard part for us, at this point, is controlling them. I just got a mobile device management product called MaaS360 that enables me to remotely wipe a Montrose-issued app and any patient health information from a physician’s personal iPad. That’s something we just started doing.

As for mobile carts, we’ll likely add more sometime next year as our facility becomes more Wi-Fi-enabled in preparation for implementing in-patient computerized physician order entry (CPOE) through our Meditech system in June. We’ll be adding additional access points to our wireless network to make it more widespread throughout our facility. There are some places where wireless is currently a little weak, so we’re going to fill those holes. The hardware has been ordered, and we’re looking forward to bumping up our access points from 50 to 80.

The ultimate goal is to be 100% paperless, but I’m not sure that we’ll ever get there. We have to move forward, though. Providers have to facilitate the utilization of mobile carts and mobile smart devices, otherwise you’re going to end up shooting yourself in the foot.

Reliable wireless access is important, not just from a clinical standpoint, but from a customer service standpoint as well. We’re becoming more and more like a hotel. Wireless provides better service for our patients, not only because they can surf the Internet, but also because it enables our nurses to do real-time charting and documentation at the bedside. Instead of seeing a patient, documenting the encounter on paper, and then logging the data at the nursing station later, they are now able to do everything at the bedside. They’re able to give patients better, more efficient customer service.

Q: What benefits do mobile carts bring to your patient care?

Currier: Safer medication administration is definitely number one. The mobile carts enable us to quickly ensure that we are administering the right medication in the right dosage to the right patient, all at the bedside. Real-time documentation is a close second and has increased our workflow efficiencies. It helps prevent the need for double, potentially inaccurate, documentation later on. The ability to look up lab results at the bedside and to see what other care directives the patient has received from other Montrose providers has also been a big benefit.

We’re working on meeting the Stage 2 deadline for Meaningful Use by Oct. 1 of this year, which will include implementing a patient portal. I’m confident the mobile carts will really help our nurses educate our patients on how to sign up for and use the portal while they’re still in the facility. Having a computer on a mobile cart at the bedside will definitely expedite that process.

Q: What best-practice advice would you give to other facilities rolling out mobile carts in the midst of other IT projects?

Currier: The big thing to keep in mind is that the mobile cart is a tool for clinicians, a resource that should enable them to provide care more efficiently. As you introduce mobile carts into your clinical environment, you have to keep their benefits patient-centered.

It’s also a good idea to make sure the clinicians play around and get comfortable with the carts, or other mobile devices for that matter, before they start using them in patient encounters. That level of comfort before going live will enable them to focus on the patient, rather than the device or cart.

On the flip-side of my first point, while it’s a good idea to educate clinicians on the benefits mobile carts and devices bring to patient care, we’ve found it’s also a good idea to educate our patients on the role these pieces of equipment play in their care. When we introduced mobile carts into our inpatient rehab unit, some patients thought we were playing games on the cart’s computer. So now we’ve developed some canned phrases about the benefits of mobile carts and how they enable both patient safety and more efficient documentation. It’s really all about the attitude of the clinicians. They have the power to effectively convey the benefits of mobile carts to the patient.