Using a personal digital assistant to streamline the OR workload

AORN Journal,  Dec, 2003  by Lisa McCord

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Handheld computers, called personal digital assistants (PDAs), are changing the face of health care. These tiny computers, which can be used for referencing, documentation, research, and calculation, can track addresses and store text documents and spreadsheets. They even can download, store, and transfer photographs, audiotapes, and videotapes. A PDA can do many things a desktop computer can do--on a smaller scale. Using a modem, a portable keyboard, and a docking cradle, users can store data and access it later. Prices, options, and accessories for these devices change frequently as the technology rapidly advances.

Physicians have incorporated PDAs into their practice settings for some time. The use of PDAs in nursing is in its infancy, but the nursing community finally has recognized their potential uses. Instead of consulting textbooks or reference materials stored far from patients, nurses can access treatment and medication databases at patients' bedsides by touching a PDA screen. Nursing documentation can be accelerated and streamlined with the use of PDAs. Accessible, accurate, organized surgical preference cards, a complete database of physician requests, and reference materials are just a few kinds of data nurses can store on PDAs tucked into their pockets.

THE SCENARIO

During the past 20 years, many aspects of perioperative nursing have changed. For example, computer data management has become almost as important a part of a circulating nurse's job as direct patient care. User friendliness in computer systems directly influences the effectiveness of circulating nurses as productive members of surgical teams, and a PDA has features that can help improve that effectiveness. From managing computer data to determining treatment options and dispensing medications at patients' bedsides, a PDA can make nurses' lives much easier.

A particularly thorny problem area is computer preparation of physician preference cards, which is the responsibility of circulating nurses when they prepare ORs for scheduled procedures. At one central Tennessee hospital, surgical procedures are physician-specific, not standard, so each surgeon's surgical preferences have to be listed. Retrieving additional preferences from the OR computer and printing out the day's preference cards can consume a significant amount of time; this task can take longer than preparing the surgical suite and providing patient care.

Determining how to reduce the amount of time spent on this task required analyzing the process of preference-card retrieval. Upon arriving at the OR suite on a given day, nurses enter all the intraoperative information about each scheduled patient into the suite's computer. To know how to prepare for each patient's specific surgical procedure, nurses print out cards for physician preferences, including specific supplies, equipment, room setup, and patient position and preparation. When patients are added to the surgical schedule at the last minute, nurses again retrieve cards from the OR suite's computer.

The OR computer is part of the hospital's system, which holds several programs and databases, so nurses have to spend many minutes navigating through several menus and screens to arrive at the OR module. In addition, nurses who need to access databases to learn details about particular patient treatments or specifics about prescribed medications have to leave their patients' bedsides and walk back to the computer at the nursing station to find this information. These efforts take extra time that nurses could be spending on direct patient care.

For security and organizational reasons, this hospital permits only surgical team leaders to access the part of the database where changes to preference cards can be made. This process presents a problem if time is short for already harried team leaders. Nurses can access current records and compile and print data, but unless they are team leaders, they cannot add or delete data. In that case, nurses have to pencil in last-minute corrections on the cards and ensure that team leaders receive the annotated cards. Team leaders' responsibility for entering and updating all preference card changes into the system is daunting. At this hospital, each of about 50 physicians performs 25 to 30 different types of procedures in the OR, so 1,500 preference cards have to be updated regularly. When team leaders fall behind in their updates, they can leave a backlog of as much as several weeks and a database that does not necessarily reflect physician wishes.

The system for requesting and reporting changes also is problematic. For example, during a procedure, a surgeon casually might tell the surgical technologist about a different type of suture the surgeon wants to use the next time he or she performs the procedure. The surgical technologist might not be responsible for ensuring that these changes are made, so the technologist might not relay this information to the team leader for updating. Physicians gradually are becoming accustomed to communicating preference-card changes to the circulating nurse, who notifies the team leader. Team leaders often cannot find time to make updates for several days, however, so when the surgeon performs the same procedure the next day, the preference card might not be updated yet.