‘COWs’ finding a new home in John Sealy Hospital
By Michele Rainford
OCT. 10, 2005--Chances are, if you’ve visited a nursing station in John Sealy Hospital recently, you have seen the new computer carts currently being utilized. These computers on wheels, or COWs as they are being called, are making their way into the inpatient non-critical care areas where the nurses and physicians working in pod settings can use the carts as their primary source of patient care orders and instructions within the units.
Because of the accidental acronym, the carts are causing clever, but good-natured puns and smiles from UTMB nurses. Yes, the Electronic Medical Record (EMR) leadership has heard them too including a rather funny one from a nurse who wasn’t very sure why they were getting the nice units, “but didn’t want to kick a gift COW in the mouth.”
“I think that the computers on wheels are an excellent tool,” said Timothy Hilt, nurse clinician V and EMR project team member. “They will allow us to begin moving nursing documentation to the patient’s bedside and this is where we will see additional benefits to the system. We anticipate that having the nurses document at the bedside will improve patient satisfaction as well as improve patient safety through the use of timely alerts based on best practice guidelines.”
With the continued implementation of the Epic EMR project, there will be an increased need to access the system. Once the EMR is fully implemented, printed care orders will no longer be available for the nurses to use. In 2006, the next phase of the project will require nurses to document their activities and chart the progress of their patients within the system.
Each nursing pod in the inpatient non-critical care areas is made up of four rooms. A nurse is assigned to monitor and care for the patients in these four rooms. Patients need to be within the nurse’s view at all times, which necessitates the current nurse’s charting table located just outside these pods.
From this vantage point, the nurse can monitor patients and complete the manual charting activities associated with patient care. The new Epic EMR system requires that these charting activities be performed electronically, which means computer terminals must be located at the charting table locations.
The Epic Inpatient Order Entry Transition Team, a group formed to plan and direct the transition from the existing Order Entry System to the new Epic system, researched the situation and recommended the use of mobile, wireless, rechargeable computer carts. This solution met the requirements for system access, safety and mobility for patient/visitor movement.
UTMB’s existing extensive wireless network in the clinical areas was an available resource that could be effectively utilized and thus Information Services (IS) avoided the cost of renovation and the inconvenience associated with cable pulls in patient care areas.
The carts were first used in a pilot phase early this year in the Emergency Department. Recommendations were made and EMR team leaders collaborated with Atos Origin, the computer support and help-desk contractor on campus, to define the configuration of the carts. Atos then developed several models that were piloted in various inpatient care areas.
The carts are designed to work with wireless “thin-client” computers, which are network devices without hard disk drives that allow users to access a remote server; all applications reside and all the processing takes place on the server. While to the user, a thin client PC may seem like a regular computer, it’s really just a keyboard, monitor, some memory and networking hardware, and the pieces to tie it together.
While the thin client PCs will not work without their host server, there’s a tremendous advantage: all updates, system management, access and permissions are managed centrally on a single machine. If there’s a problem, there’s a single place to fix it quickly. This makes the thin clients and wireless carts the perfect combination and the right fit for the nursing stations.
The putty-colored, height-adjustable, ergonomically-designed carts are made of metal and are specifically designed for patient care environments. The carts are primarily intended for clinicians involved in direct patient care and access to the computers on wheels is granted via the UTMB network logon.
Additionally, each cart is assigned to a specific nursing unit and is marked, or branded, with that unit’s designation. The printers are configured to print only at the printers in its home area.
The carts are powered by rechargeable batteries built into the bases of the carts. Battery life is expected to be 10-13 hours. The units must be plugged into 110-volt outlets for recharging.
The nursing staff in each pod will implement their own processes to keep the carts fully powered and help ensure the highest level of patient care.
The carts will soon be available in Texas Department of Criminal Justice Hospital (TDCJ) as well.
The COWs are the newest tool in the major undertaking of UTMB to transition to electronic medical records from paper patient records. The computers on wheels underscore the importance of the EMR system and will enhance the already excellent care the UTMB nursing staff provides to patients.