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I do believe that there will be areas in health care where it could be very useful and could make a difference. One example that comes to mind is the typical office visit. My primary care doc uses the computer in the exam room while in the midst of our visit. He can look up past visits, lab values, meds and all the ephemera of a medical visit. Instead of staring at a computer through the visit, he can look at me and be more engaged with the patient, instead of being engaged with the computer. Another w0uld be for rounding on the wards. How useful could it be to have everything at your fingertips when you’re at the bedside conducting rounds?
But for the average nurse at the bedside it is a horrible idea. First, it does not appear to be very durable, able to deal with the crap a bedside nurse could unleash upon it. Us nurses are hard on equipment, especially things we use near continuously in our work. It is more a repetitive stress type brutality than “give a shit” mentality. I don’t think Jobs’ fancy, purty piece of engineering could stand up to a typical 12-hour floor shift. Then there is the issue of exposure to bodily fluids, urine, blood, mucus, poop. Bedside nurses deal with all of that on a daily basis and while we wold probably be careful with it, shit happens. No one starts a shift wanting to get pooped on, but it happens y’know? Then there is the infection control issue. We have enough issues with nosocomical infections like MRSA and VRE in health care and a portable tablet could be a very effective fomite. Not only would we then be reminded to wash our hands, but to sterilize our iPads.
Second, it’s lacking in important features. Bar code scanner? Nope. With our new EMR, all meds will be bar-coded, lab slips will be the same, even the patients will be bar-coded, so not having that is fairly significant. If you’re going to have a device to help with the tasks and functions of a bedside nurse, we better not have to carry multiple devices, like the pad and a bar code scanner. Swappable batteries? Uh-uh. We work 12-hour shifts and according to the press, battery life is around 10-hours. I don’t have the time on shift to stop, plug in my device for an hour to get more juice so I can finish my work. Device integration to monitoring equipment? Not yet and probably not without a very expensive software patch. In our new EMR, our monitors and vital signs machines are supposedly going to be integrated so that instead of entering values, we click and the values populate. Now I’ll believe it when I see it, but having used that before, it is cool beyond a doubt. But is Apple going to open things up to support multiple standards? Not without a hefty price tag, if at all. And these were only the first three I came up with.
Third, and probably most important is price. Even if we get the barebones version, with academic pricing, it’s still going to be expensive. And if each nurse, on each shift needs one…that could get costly. If my floor is full, we have 7 nurses, 2 aides, a unit secretary and a tele tech on days, at night, it’s 7 nurses, 1 aide and a tele tech. To cover the needs we would need to have 14 tablets – at least, probably with one or two for back-up. That’s one unit. My manager handles 3 units of varying size, so you do the math. And that’s just one group of units. So what? Do you issue them to nurses on hire? Are we now responsible for the upkeep and cost should it be damaged? Hard questions. What about the “walking away” of the devices? Some people will steal anything that isn’t bolted to the floor (and some will try to steal that as well) so a tablet you can slip into your coat could disappear quickly.
Would I love to see imaging results live at the bedside? Sure. Would it be great to have the last set of vitals, labs and meds at my fingertips when assessing the patient? Yes, but we already have that thanks to in-room computers. Would it be awesome to have a cool Apple toy to play with every day I work? Yeah, it would be cool. But cool doesn’t always make sense.
So what would I find useful as a bedside nurse when it comes to a tablet-type device? Here’s a short list:
- Small form factor – bigger than the iPhone, not quite so big as the iPad. Big enough to view screens without scrolling too much, but possibly be able to slip into my scrub pocket.
- Durability/ease of cleaning. It’s going to get dropped, exposed to fluids and bugs. It needs to be able to stand up to that.
- Bar-code scanner. It’s the wave of the future in EMRs, so any device coming into the arena will need that.
- Good battery life. At least 12-hours worth, or with hot-swap capability.
- Easy transfer of notes. I can think of how this would revolutionize the report-process. You gather the info needed and send it to the next caregiver’s pad, report becomes easier.
- Solitaire. We need a moment of brainless fun every now and then!
- Device integration. I want to see the current telemetry on my patient and be able to review past alarms. When I take vitals, I want it to populate the fields with one click. I want to see what pumps I have going, volume left in an infusion and even order new meds if necessary from another patient’s room if I need to.
- Multi-tasking. We’re doing it all the time, why can’t the device? I want to be able to look up a drug in the database while calculating the dose, as one example.
These are just few things I came up with off the top of my head. Sure some of this may sound like it based off of laziness (see infusion pumps and ordering), but I believe in working smarter, rather than harder, so if I can see what’s going on in another room without having to go there,I’m all for it. I do think that at some point we’ll have tablet-type stuff at the bedside. But right now, I think devices like the iPad are more suited to physicians and non-bedside nursing than to the bedside nurse. Time will tell.