The AAMI Foundation has announced that they are “spearheading efforts to provide nurses and other healthcare staff with device training to ensure proper use of healthcare technology.” While they also concluded that new devices should be more intuitive and easier to use, they will focus on re-designing training methods to assure that nurses are better equipped to cope with the changes in technologies. I believe that by focusing on training methods, AAMI has missed the target on this one. Instead, we should bring manufacturers, designers and clinical engineers together to begin an all out effort to make devices more intuitive and easier to use. The first step should be to agree to standardize the location and operation of critical controls on all bedside devices. This would reduce the amount of time spent training nurses and improve patient outcomes by enabling nurses to react instinctively to change device settings during a crisis.
We have been talking about nursing education for years while forgetting that each year hospitals face increased shortages of nurses while adding additional duties and technologies to their already heavy workload. In a recent article in the New Yorker by Atul Gawande, he cited an Israeli study from a decade ago in which “engineers observed patient care in I.C.U.s for twenty-four-hour stretches. They found that the average patient required a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them posed risks.” He pointed out some of the difficulties nurses and physicians faced. “There are dangers simply in lying unconscious in bed for a few days. Muscles atrophy. Bones lose mass. Pressure ulcers form. Veins begin to clot off. You have to stretch and exercise patients’ flaccid limbs daily to avoid contractures, give subcutaneous injections of blood thinners at least twice a day, turn patients in bed every few hours, bathe them and change their sheets without knocking out a tube or a line, brush their teeth twice a day to avoid pneumonia from bacterial buildup in their mouths. Add a ventilator, dialysis, and open wounds to care for, and the difficulties only accumulate.”
Performing an average of one hundred and seventy-eight individual actions per day on an ICU patient may be only a part of a nurse’s duties. They also perform countless other tasks including constant documentation, discussing their patient’s status with visitors, locating extra equipment, running back and forth for medications and attending meetings. To often, they are required to do all of this while their departments are understaffed. It is no secret that nurses in this nation are already overworked. According to the projected economics of healthcare, this problem will only get worse. When we consider all of these conditions, I think that we are missing the target when we suggest that we place emphasis on improving nursing training methods.
We are part of the healthcare team. We have a unique combination of knowledge because we understand devices, their design and application, and the clinical environment where they are used. We should use this knowledge to find ways to make life easier for caregivers and assure that the devices and systems they use are safe. One of the best ways we can do that is to work with designers, manufacturers, and nurses to develop standards requiring that all of the important controls be located in the same relative position for each type of device. Every defibrillator, monitor, infusion pump and ventilator, regardless of manufacturer or model shares certain similar controls. If manufacturers were able to agree to a “standardized” location for critical controls, nurses would require less training and we would reduce the possibility for user errors.
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