Mobile Computing

HP Nursing Project

Where did the idea come from?

RMIT University was one of seven universities in the Asia-Pacific region to be presented with $136,000, for a Hewlett-Packards (HP) Mobile Technology for Teaching Grant Initiative where Tablet PCs and iPAQ handheld devices were supplied, and an additional $14,000 in funds to support the project. We were asked to participate in the project to trail the mobile technology as I have had an interest in this area for some time. In 2000/2001 I was the Learning Technology Mentor within RMIT Nursing and Midwifery and was instrumental in all courses going online for undergraduate students. Also received some money from the Department (now Division of Nursing and Midwifery) to conduct minor research that examined the use of hand held computers by clinical teachers in the clinical setting for student nurse record keeping and evaluation. The results showed that it was a useful tool however the Excel documents with the data information needed further refinement. Was recently granted an ARC Linkage that will investigate the use of PDAs in three acute care units located at Southern Health and the Royal Womens Hospital. Nurses will use the PDAs in real time to access information and decision support for patient care. The research team will determine the impact of the use of the PDAs in improving patient outcomes and will ascertain how nurses have embraced using the new devices and the difficulties they may have encountered. Outcomes from the project will include a set of guidelines for introducing and managing wireless PDAs in the acute care clinical setting. (See description of the ARC Linkage Grant at end of this document)

Will this be ongoing that is giving the nursing students the devices for all rounds?

Due to the success of the recent trial the ongoing utilisation of PDAs in the medical surgical course will be continued for Semester 2 and the devices will be once again in the medical surgical nursing clinical nursing area by students on clinical practicum or field experience. We envisage the use of the devices will be successful in Semester 2 and are planning to introduce this technology for all Year 2 students in 2006 to use on campus and in the clinical area. Options on how to fund such an initiative are currently being investigated. To our knowledge RMIT Nursing and Midwifery would be the first university in Australia to introduce such innovative mobile technologies in the undergraduate-nursing program.

What are some of the features of the devices?

Hewlett Packard has provided the 50 PDAs (HP iPAQ Pocket PC h5500) and the specifications are listed below.

Integrated wireless LAN (802.11b) and Bluetooth (v1.1)
Biometric fingerprint reader
3.8" transflective TFT display with 64k colours
48MB Flash ROM, 128MB RAM
Integrated secure digital slot - supports SDIO technology
Lithium ion polymer removable/rechargeable battery
HP iPAQ expansion pack system support
400MHz Intel XScale technology based processor

The software programs downloaded on the PDAs included MIMS for PDAs, a drug reference guide for Australia and New Zealand health care professionals and this was given free for the clinical trial. The device is powered by Windows Mobile 2003 for Pocket PC including a calculator that the student nurses used for drug calculations in the clinical area. We also loaded the devices with two Excel documents- student appraisal and a medical surgical nursing skills checklist that the students used for their own self appraisal and a checklist for the skills they did in the clinical area. The devices were not wirelessed, as the clinical areas did not have the capacity to support such mobile technologies. In the future(2006) the devices will be wirelessed which means that students can access the Internet and use the device as a mobile phone.

How will these devices aid nurses?

There are many benefits for using mobile information technology in the delivery of health care. There is substantial evidence to show that PDAs can improve the safety, quality and efficiency of health care provided by nurses. These devices have the potential to reduce medication errors, including errors that can cause patients harm; increase appropriate and safe prescribing decisions by providing information about suggested drug dosages and frequency of doses; improve the quality of medical ad nursing care by providing clinicians with ever-changing management guidelines and care standards; contribute to patient education, practice audit and clinical outcome analysis by providing the opportunity to use data to review clinical practice patterns, for medication and tests ordered for specific patient groups; Reduce nursing time spent on administrative tasks thereby improving efficiency of care to the patient; reduce costs mainly related to less expensive tests and drugs, and fewer medication errors and adverse drug events (Electronic Decision Support for Australia's Health Sector Report, 2002). What we are doing is preparing student nurses in the use of this technology in the health care area as it is currently being embraced and will most certainly be embraced in some form in the future.

How new is the technology?

This technology evolved in the late 1980s when Mark Weiser began writing and discussing the potentials of ubiquitous computing - computing in which computers are no longer seen and resides in the periphery of our daily lives. The hand held computers or PDAs have evolved over the past 25 years from earlier electronic devices. Programmed scientific calculators were used in the basic science and engineering world. For the first time in history, handheld calculators could be used to solve extensive equations. Simultaneously in the business community, pocket-sized data organisers replaced the Rolodex(text based files and cards) and allowed people freedom from their office and administrative assistants. These organisers became known as personal digital assistants or PDAs. This acronym has continued to generically describe handheld devices even as their functions become more diverse. Another important technical development was the evolution from desktop to laptop computers. Software applications for word processing, spreadsheets, and computerised reference material became available anywhere, not just at the office. We are currently seeing rapid proliferation in the use of e-mail, the Internet, and mobile telephones. All of these electronic devices have created the niche for PDAs that are currently being used in this project.

Is it being used in any other Australian hospitals?

PDAs are being used mainly by physicians in Australia hospitals setting on an informal basis, that is they purchase their own The benefits of mobile computing for physicians are now being realised and are being published in the literature. In Australia, there are no published studies about the use of mobile technology systems in health care settings yet it has been embraced in some areas. For example the Royal Nursing District Service (RDNS) in Melbourne provide tablet computers for nursing staff to collect information relating to clients and service provision so that there is minimal reliance on paper based processes. A field trial of 80 tablet computers was conducted during 1997/98 and due to its success all field nursing now use mobile computer devices for patient care. Pirani (2003) reported on a nursing trial, where nurses in aged care facilities in Victoria, Tasmania and New South Wales, are using handheld computers in the care of their older clients. This project is still being trialled, yet initial results have shown substantial reduced errors and improved quality of care.

This project to our knowledge is the first of its kind in Australia to enhance student learning for clinical practice to provide quality patient care.

Are the nursing students using the devices every time they do a hospital stint?

Year 2 student nurses used the devices for a three-week time period in the medical surgical nursing area, April Semester 1 2005. Due to the large numbers we could only provide 44 students with the devices. Another 6 devices were given to the clinical teachers who were supervising them in the clinical area. We will be giving another 44 students in Semester 2 2005, the devices to take in their three-week clinical practicum in the same area as above. They are trained to use the devices and keep them for the entire three-week period. They can download the information they have gathered on the devices to their personal computers at home after each shift if they wish.

How much was the grant, and how much are the devices worth?

The grant was approximately $62, 000 and the devices are worth $1,000 each.

What are the advantages and disadvantages of the device?

Many of the advantages have been covered in question on how they will aid the nurses and the questions below outline the disadvantages.

What sort of feedback from students did you get?

Dr Farrell conducted a formative evaluation of the use of the PDAs during the three-week clinical placement. An hour session with the student groups and the clinical teachers was undertaken on the clinical site at the end of the 2nd week. The students were asked to evaluate general usage, the advantages and disadvantage of using the PDAs and suggestions for improvement. Summary of the student responses are listed below:

Usage

Most students utilised the PDAs at work in real time with their patients
At work used mainly for drug information (MIMS pharmacological data base) and calculator for drug calculations.
Most students used the PDA at home after work to seek more information on drugs and to stream line word documents, such as daily journal and pharmacological log.
Medical surgical clinical skills log used daily by most students

Advantages

MIMS pharmacological database enhanced drug knowledge and it was an advantage to have this information on hand in real time with patients.
Portability of the PDA
Access to clinical skills and student appraisal list
Access to calculator for drug calculations
Assisted motivation in clinical area

Disadvantages

Mims doesn't cover everything eg. It doesn't state what category all drugs are in
Screen is too small for writing in Excel
Keyboard not big enough
Time consuming to enter things on the PDA

Technical Issues

Screen froze a couple of times on some of the students not allowing access to end the program
Was slow opening up the programs some of the time
For one student MIMS time had expired and asked for validation so the internal date had to be
changed on the PDA to allow access for the whole clinical
Transcriber was not accurate in written communication
Battery needed recharging for one student

Suggestions for Improvement

Excel skills log and student appraisal needs improving- hard to read
Provide IV administration guidelines, what to draw up the drug with time to administer over
Provide Internet connection- to keep contact with the clinical teacher change set out of main menu
Be able to tell it what to write
Provide a medical or nursing dictionary to look up unfamiliar terms in real time with patients.

Overall the feedback from students was positive and most saw it as an excellent tool for accessing educational resources, rather than a tool for assessments and reports. The structure of the Excel documents contributed to the latter and will need to be reformatted for future use.

Focus group discussions were also conducted with the students (by an independent person) who used the PDAs, will send the data and the questions asked, I have not had time to do an analysis however would appreciate confidentially of the data.

What was the feedback from the hospitals/other staff?

Hospital nursing and medical staff embraced the technology and were quite jealous of our student nurses. Saw the huge potential of these devices in relation to drug errors and preparing students for practice in the clinical area.

Dr MJ Farrell; Mr I McGrath; Prof MD Wilson; Ms M D'Arcy
Title: Improving patient health outcomes in acute care hospital settings using mobile wireless technology and handheld computers
2005 : $35,500
2006 : $54,000
2007 : $37,000
2008 : $18,500
Category: 3211 - NURSING
Partner Organisation(s)
Southern Health
Royal Women's Hospital
Administering Institution: RMIT University

Summary: This project will investigate the use of wireless handheld computers, in three acute care clinical units located at Southern Health and the Royal Women's Hospital, to determine the impact on patient safety and quality of care. There is a need for real time point-of-care access (and input) to patient information, nursing reference information, and drug information for nurses in Australian hospitals. This project aims to address this need by providing nurses with wireless handheld access to such resources. This project is extremely significant, as the outcomes will provide nurses, in Australia and overseas, a set of guidelines for managing wireless handheld computers in clinical units, to enhance patient safety and quality of care.