A Nurse’s View on the iPad in Healthcare

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According to the already gushing reviews, the iPad is a “game changer” and “the device health care has waited for.”

Not really.

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.

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12 Comments

  1. I work in Healthcare IT and I wanted to share a few points that play devil’s advocate to this.

    * Small form factor have not been very welcomed at my hospital. The term used often is “Old Eyes” We tried Symbol tech with barcode scanners, these did not last long. The text was too small. The iPad offer a larger screen with larger text an an ability to zoom in.

    * Durability will always be key, but like other vendors, you can create durable cases if there is a demand. There will more than likely protective cases. The most vulnerable piece will be the screen, but we use Motion Tablets here they are about the same level of durability as the iPad, slightly more so. I think I have personally seen 3 come into the department after cracking all of 3 times, and they cost $1200 each.

    * Barcoding, true…however Does an iPhone have a barcode scanner? Don’t be so quick to say no. Visit a Mac Store. The staff carry iPhones that plug into a scanner base with credit card readers. They will see a need to adapt the iPad to do the same if there is a demand, but this brings to light the biggest issue…infection control. Unless there is a way to keep this thing from transmitting an infection…I don’t see this being embraced by nursing. Again though…if there is a need there will be something developed for Healthcare…hence the lack luster Motion C5.

    * Battery life. I seriously doubt that it will ever be on for exactly 10 hours. There are breaks there are times when a nurse will not be using the iPad. It can easily make through a shift. In that case even if charting were capable on it you can always dock it where it would charge and you could use the keyboard attachment.

    * Transfer of information is obtained through application development…cloud computing. An EMR allows for this already…if let’s say EPIC, McKesson, CERNER…what not would be well suited to look at app development for iPhones and iPads. Even little things like alerts on STAT orders, Critical results etc. We are already seeing PACS image apps on iPhones. What do you think a larger HD screen will do for Radiologists at home or a Physician who are not near a PACS station…again if we could reduce the ammount of PACS stations to free more area for nursing.

    * There are games on the iPad…didn’t I remove the games from your computer a month ago? 😉

    * Device integration, should also be handled through cloud computing. Apps or an EMR integration. We need to look less at multiple apps to do relay the information. Make it quick and make it central. Physician Portal and Nursing Portals do this.

    * Multitasking, can be a root for medical mistakes in some instances. If you want to look-up and drug and dosing there are Apps now that do that. Look at Epocrates, it has that already. That aside, Apple is looking into multitasking in the future.

    There is a lot that this offers, and we need to look at this with realistic eyes. I for one am on the list to get one with the sole purpose of seeing if this a viable option. The price, the advantages and the speed of it really have caught our eyes in Healthcare IT.

    Reply

    1. Thanks for being devil’s advocate! I’m a believer in technology – but when that technology can make my life easier. Selfish? Yeah, maybe a little. I don’t want technology for technology’s sake. Show me how it can affect patient outcomes, increase workplace satisfaction and make a positive impact on my workflow and I’ll be behind it 100%. I worry that too may will get caught up the “OOOOOOHHH, this is cool!” aspect it will do none of what it is capable of and make the positive impact it can.

      Reply

      1. I’m a heavy mac user, and I was on the skeptical train myself. I also have a bad back from a motorcycle accident, so after having to take some heavy narcotics.. well only perc’s but still… and a coffee with an iPad a friend brought I thought it was at least worth a try.

        I just got mine and actually love how it changes the relationship with the screen. It takes is like an actual page in the way you pick it up, turn it, read on your side and back. I love the thing, great experience. I would definitely recommend one to any student, but like you before I recommend it to a Chief Nursing Executive I would like to see a bit more research on it.

  2. After researching quite a few waterproof cases, I tested a ziploc one gallon bag.
    The ipad worked fine….sanitize the outside as needed between patients, then you can use it tomorrow to bag your lunch.
    JJC

    Reply

  3. iPads are used by the military in the most extreme places and being a former military nurse I have seen some of the strangest things. I think a 12 hour shift and a little bit of bumping inside a defender case for the iPad is nothing. I am also a home healthcare nurse and I depend on mine quite a bit, so far so good. You take care of it, it will take care of you. I do wipe it down between home visits. Not too shabby.

    Reply

  4. The infection control issue SHOULD be a deal breaker, but instead, the “powers that be” focus on efficiency. Let’s be honest how often do we NOT see our colleagues wash their hands between patients or worse….not wash them ourselves. Sanitize an iPad? Forget it. It just won’t happen. I’ve lost count of the number of patients who have blamed medical staff for their colonisations of MRSA and VRE. And they’re right!! I probably carry them both and so too do half the people I work with.

    Reply

  5. This is my personal opinion, you can take it for what it is worth. I believe the iPad would be a good thing, especially working in a Emergency Room. Nurses and Physicians would be able to spend more time in the patient’s room and focus more on the patient care, rather than trying to rush back to the computer station to chart a med given etc. Yes infection control is a issue but as one of the previous posters said where the is a demand someone will create something to cover the iPad from infection and protect it from damage.

    Reply

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