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Reprinted with permission from
Nursing Management, 33(10):36–41, 44, 2002.
As described in Part 4 of this 6-part series exclusively endorsed by the American Association of Critical-Care Nurses (AACN),1 consider technology’s improvements in quality and safety of care. You’ll also want to review organizational and system factors such as staffing, admission criteria, and your environment of care. Only eight states define "special care unit": Arkansas, California, Missouri, New York, North Carolina, Pennsylvania, Utah, and Wyoming.2 Twenty-one state administrative codes and regulations don’t define "special care unit."
You and your care team should well-acquaint yourselves with your state’s nurse practice act, which you can use to evaluate your PCU’s practice and care delivery. For guidelines, consult associations such as the AACN and the American Nurses Association, which offer position statements on end-of-life care, accepting assignments, and staffing.
Let JCAHO Help
Consider the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) National Patient Safety Goals for 2003 when developing PCU patient care plans. JCAHO targets patient identification confusion, caregiver miscommunication, wrong-site surgery, infusion pumps, medication mix-ups, and alarm systems in its 2003 standards. JCAHO’s six goals are to:
When creating a patient safety plan, consider its scope, structure, coordination mechanisms, patient and staff education, and safety improvement activities.4 (See "Patient safety outline.")
Become Techno Savvy
Technology in the PCU can save time and labor, improve patient care, and make nursing practice more scientific.5,6 But it can also create extra work for nurses who have to learn about its mechanical operation, use, maintenance, and troubleshooting techniques before using it safely and efficiently.7,8
When evaluating progressive care technology, seek out established safety, reliability, and validity standards for the type of technology you’ll be using. The Food and Drug Administration (FDA), the primary regulatory agency for technology, requires that a manufacturer provide evidence of the safety, effectiveness, efficacy, clinical utility, and risks of a technology before allowing its use in patient care.9 The Society of Critical Care Medicine (SCCM) has also published safety and effectiveness standards for critical care monitoring devices, and a model for assessing technology.10 These standards apply to new equipment but not to upgrades of older equipment. The FDA approval and SCCM standards may provide a false sense of security about the safety of these upgraded technologies. So when selecting equipment, consider all safety records and repair reports.
JCAHO doesn’t regulate technology prior to its use in the patient care environment. Its standards provide for safe effective use of technology in all hospital environments and are rather generic in scope, recommending the frequency for inspecting and maintaining technology to keep it in proper working order. JCAHO also suggests that you keep records indicating dates of inspection and problems encountered with the technology. Although they call for adequate patient monitoring, the JCAHO standards don’t stipulate what type of equipment to use in a clinical area. The hospital decides the amount and type of technology in the PCU as it applies to its specific patient population.
After you’ve selected a piece of equipment, inform the vendor of your expectations for product support and staff training and competency. Decide if you’ll need ongoing support only during the start up period.11
Stay in the Know
Manufacturer representatives, hospital educators, peers, and audiovisuals typically instruct nurses about using technologies. The PCU nurse manager should develop a close relationship with the bioengineering, risk management, and education departments to ensure consistency in the amount and type of information presented to staff.
Although standardized educational requirements for using technology don’t exist, educational programs from vendors do address solutions such as templates for preparing policies and procedures, as well as competency checklists. If the vendor doesn’t provide competency checklists, obtain them from the AACN. Although not specific to a certain brand of device, you can customize them to meet your needs. Most PCUs use checklists upon first use of a technology or procedure and annually for determining and maintaining employee competence.
Several of these checklists aid in the use of telemetry systems. They help nurses work smarter and streamline patient flow between PCUs and intensive care units (ICUs). Telemetry systems and central station monitoring have advanced the use of non-invasive monitoring for use in PCUs.
As more patients undergo continuous respiratory monitoring in either PCUs or high acuity medical surgical units, more regulatory and professional groups have also provided guidelines. One example is the guidelines for continuous respiratory monitoring.12 Educated caregivers can apply them to ensure safe, non-invasive oxygenation monitoring to patients outside of the ICU.
When Technology Fails
Unfortunately, technology sometimes malfunctions. Nurses prepared to handle malfunctions provide a safer patient care environment. Because malfunctioning technology may inaccurately portray a patient’s condition, nurses should fully develop and rely on their assessment skills to ensure safe, effective, and efficient patient care in conjunction with their knowledge of the technology.
When a piece of equipment malfunctions, whether it’s an IV infusion pump or an enteral feeding pump, initial concerns should address the patient’s safety. Once the patient is stable and the situation corrected, inspect the technology and review events surrounding the incident.
Managers and staff should complete occurrence reports to ensure technology evaluation and repair and to help identify consistent or recurrent problems. Make technology reporting part of the patient safety plan and provide the PCU staff with a clear definition of terms. A willingness to report errors must be part of the culture in your care environment.
Encourage staff to view the occurrence report as a way to identify and track problems. Researchers found that critical care nurses felt these reports helped to identify problem areas, but they also felt that an occurrence report would suggest they were to blame for the malfunction, resulting in a "black mark" on their record.13 Emphasize the importance and the positive aspects of occurrence reports in avoiding future problems, and reassure nurses that no one will blame them.
Report any problems with technology to the bioengineering department and the manufacturer. If the nurse manager feels that the manufacturer isn’t responding in a meaningful way to the concerns with the technology, escalate the discussion to the risk management department. If a resolution with the manufacturer doesn’t occur, the hospital should file a report with the FDA, which compiles information on problems with technology and follows up with manufacturers to promote staff and patient safety. Obtain forms for reporting problems to the FDA from its Web site, http://www.fda.gov.
Plan on It
Consult national, state, and association regulations and recommendations to forge an appropriate PCU patient safety plan. Once you establish these guidelines, you’re best suited for effective and efficient use of available technology.
References
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