Mobile Carts Improve Workflow, Patient Safety

By Katie Wike, Contributing Writer

MaineGeneral Medical Center equips every patient room with a workstation on wheels, facilitating communication between hospital staff and preventing the spread of infection.

When MaineGeneral Medical Center set out to build a new $312 million, 192-bed hospital to replace services at three aging facilities 20 miles apart, it was a once-in-a-lifetime opportunity to design a building and its systems from the ground up. The goal was to create a welcoming, warm, soothing, and healing environment. To accomplish that, it engaged more than 250 employees, physicians, patients, and their families throughout the design and construction process to ensure the new hospital was equipped to fully meet patients’ needs. The facility opened to patients Nov. 9, 2013.

“We challenged ourselves to ask — how can we do things better than we do them now? From the largest architectural elements to the smallest details, the new hospital, the Alfond Center for Health (ACH), is designed with patients in mind,” says Chuck Hays, MaineGeneral Health president and CEO.

In order to provide the best care, MaineGeneral needed to update not just the architecture, but the technology as well. Accessing EHRs anywhere in the hospital has its benefits, but according to a study published in Family Practice News, charting patient information into an EHR takes as much as 16 minutes longer than filling out paper charts. To overcome this obstacle, MaineGeneral needed to find a tool to speed up the process. Ergotron’s workstations on wheels (WOWs) were the answer.

Retrofitted Laptops Not The Answer
One of the things that needed to change in the new medical center was bedside charting. Although the old facilities were retrofitted with laptops in wall-mounted cabinets to accomplish that task, the system was awkward, unreliable, inefficient, and expensive. MaineGeneral needed a better solution.

“The cabinets were located at the footwall, which meant nurses had to turn their backs on patients in order to chart,” recalls Mark St. John, administrative director of technology services. “Because they didn’t want to do that, they undocked the laptops and took them to the bedside, but then didn’t have a place to set them down. We ran into problems with battery life and the wireless connection not working consistently. Another factor was there were often two patients in a room. And having to run cable and power into the wall cabinets was extremely expensive. As a result of these problems, bedside charting was not adopted consistently. We needed a better solution and had the budget and the luxury of choosing something with no existing physical barriers.”

Finding A One-Size-Fits-All Solution
Initially, MaineGeneral explored the possibility of a wall mount for computers. After testing this option by placing wall mounts in mockup patient rooms, staff still couldn’t find a position within the “staff zone” that would work well.

“We knew it would be more expensive, but decided to look at a solution that would allow nurses to move the unit throughout the room. That way, nurses could position it on either side, depending on whether they were right- or left-handed. That was the beauty of the room mockups; everything could be tested for physical fit while still in the design phase,” says St. John.

Eventually, dedicated WOWs were chosen for every room. Despite the carts’ mobility, sharing between rooms was not an option because the staff wanted to make sure the units were always readily available. Also, eliminating sharing reduces the risk of spreading infection that can come from running carts from room to room. One final consideration was that WOWs in every private room can be charged like laptops. Rather than running cable and power into the walls of every room, the workstations can be plugged directly into an outlet.

To select the particular WOW, MaineGeneral invited representatives from three cart manufacturers to pitch their products to a group of nurses and nurse managers and give the staff a chance to “test drive” them. The group selected the Ergotron StyleView Medical Cart. According to St. John, the StyleView allowed nurses to raise and lower the cart easily when having to adjust it to different heights. This ergonomic feature won the nurses over.

Customized Workstations Please Staff
St. John and his team customized the carts to the hospital’s specific needs. For example, they selected large-screen, high-resolution monitors that can swivel 180 degrees and feature a light so that nurses don’t have to turn on the overhead lights to chart at night. Additionally, the cart design helps promote optimal battery life and health. The WOWs are programmed to send an alert to information technology personnel when the batteries are running low so they can let the nurses know they should be charged. A clamp on the back of the unit was also added so the power cord can be easily stored. In addition to meeting the needs of nurses, physicians also can use the carts to call up X-rays through the Picture Archiving Communication System (PACS) to show to patients at bedside.

“Because we knew we were going to start bar coding for medication safety, we added a holder for a bar code scanner to each cart,” explains St. John. Wristbands on inpatients have special bar codes to ensure they get the right medication every time. The clinician, who is logged into the patient record, scans the bar code on the patient’s wrist and the bar code on the medication. The system compares the information and indicates whether it is safe to administer the medication. If there is a discrepancy, it alerts the clinician immediately.

“The WOWs have been a big success,” says Sherri Woodward, senior vice president and chief nursing officer. “Now, nurses can sit down and be at eye level with their patients and not have their backs to them,”

Elizabeth Nutting, RN, who uses the WOW throughout her shift, agrees. “It’s fantastic — a huge improvement over what we had. Because it’s always on, we don’t have to wait for it to boot up. It’s ergonomically correct; we can easily raise and lower it. And we can roll it anywhere around the room. If we want to show a patient or family member something, we can take it beside. It’s really nice to have.”

Selecting and buying the WOWs was really part of an IT dream job to provide all the technology for the new hospital, St. John says. “We had the time, we had the money, and with no facility barriers, we could really do it the right way. Now, with the WOWs, bedside charting has gone from inconsistent to 100 percent since the ACH opened in November 2013.”