Quality health care: Nursing Workload and Patient Safety

Excellent health care is a multifaceted issue that requires specific consideration. At any hospital, nurses serve as the primary link between the patient and the physicians, as well as the quality of care. Although nurses are unquestionably the greatest task force in health care delivery, they face various problems in service delivery. Patients tend to spend more time with these caregivers because it is a nurse’s responsibility to carry out medical instructions issued by the attending physician on the patient’s treatment. The procedure of implementing these instructions, for example, the administration of medications, can be time-consuming if done only by hand. Other services tend to be tiresome due to their intensity thus posing a risk of exhaustion which leads to increased stress among staff. Technology has been cited as one of the means to help reduce the amount of workload endured by nurses in the hospital environment thus leading to reduced fatigue and increased nurse-patient contact time.

The number of nurses working in hospitals has been reducing significantly as the number of admitted patients increases. One of the factors contributing to low staffing of nurses in hospitals is the increased cost of health care. Hospitals have opted to reduce the number of nurses due to reduces the high expenses of paying them while implementing overtime policies to try and meet the high demand for service delivery (Carayon & Gurses, 2008). The few staff members that remain behind are forced to handle more workload as they strive to execute their duties. Their duties become more daunting due to the increased admission rates of patients. The population in the United States has been projected to rise by 18% -31 million- by 2020 while a 54% -19 million- increase is expected for the population above 65 years, who tend to require the most medical attention (Carayon & Gurses, 2008). Consequently, the demand for nurses also increases and since there exists a shortage already, hospitals end up overworking their staff. Most nurses undergo burn out due to fatigue which leads to poor service delivery. The safety of the patients is also put at a risk since numerous errors occur easily during instances of fatigue and burnout in nursing staff. Studies reveal that the rate of burnout in nurses stands at an alarming 40% while more than one out of five nurses contemplate on leaving the hospitals they work in within a year due to dissatisfaction (Vahey, Aiken, Sloane, Clarke, & Vargas, 2004). The high turnover has led to shortages of nursing staff in hospitals posing a risk to the quality of care offered to patients.

One indicator of quality care is the amount of time spent with the patient. A study postulated that the time spent by nurses with their patients is approximately 37% of their total working hours (Westbrook, Duffield, Li, & Creswick, 2011). The rest of their time is divided between direct and indirect care, communication with other professionals, doing paperwork, and medication tasks. The level of satisfaction among nurses increases anytime they do clinical work as opposed to handling paper work and communication tasks. Patients have also shown greater satisfaction rates when they are allocated attention from caregivers thus hastening their remission. Many hospitals are trying willy-nilly to increase the amount of level of nurse-patient interaction which is directly proportional to the level and quality of care discharged. In case the contact time is achieved, interruptions also arise which necessitate the nurse to abandoned the patient care. A high number of interruptions occur mostly during medication and paperwork tasks which have an adverse impact on the final quality of health care (Westbrook, Duffield, Li, & Creswick, 2011). Technology is being embraced to help bridge the disparity between the nurse-patient ratios. A good solution is the use of mobile robots that can perform some clinical and nonclinical tasks such as delivery of medication and patient samples, delivery of food and the movement of linen in the hospital.

Technology

The handling of logistics inside a hospital can be facilitated by the use of mobile courier robots such as the TUG robots developed by Aethon Inc. The robots are capable of transportation of different items around the hospital including medication, food for patients and linen hospital beds thus offering assistance to the hospital stuff, especially to nurses (Dahl & Boulos, 2014). TUG robots are used to deliver relatively bulky items like linen, clinical supplies, and food to the patients and nurses’ stations (Calderon, Mohan, & Ng, 2015). The Aethon Inc postulates that a hospital can save the labor of 2.8 full-time staff when the TUG robot works two shifts a day for seven days every week (Qureshi & Syed, 2014). These mobile robots can maneuver from one nursing station to another depending on the goods being delivered thus reducing the workload for nurses. A user-friendly interface has been put in place to enable all cadres of staff to operate the TUGs. The University of Maryland Medical Center reported that nurses were able to save up to 6,000 hours used that were initially being used in locating medication (Bloss, 2011, p. 569). Initially, nurses had to wait for approximately 74 min to receive medication from the pharmacy after placing an order. With the advent of TUGs, the delivery time has been reduced to 30 min thus allowing nurses to concentrate more on their direct care to patients.

The design and functionality of all mobile robots appear to be similar, with a common function of navigating around the hospital rooms. Three basic elements can be found on each TUG:

A steer and drive unit that is powered by a battery

A control module which is capable of detecting hazards and performing other functionalities

Load modules which can be detached to allow for assignment diversification (Bloss, 2011, p. 567).

The drive unit, which weighs 25 kg, measures height and width of 19cm and 51 cm respectively powered by a 24V rechargeable battery (Bloss, 2011, p. 567). When the battery is low, The steerable drive unit is capable of return the robot to a charging point where it charges for approximately 10 hours. A drive unit is capable of moving a load of 227 kg together with the weight of the TUG (Bloss, 2011, p. 567). The control module is located on top of the drive unit and is made up of a Wi-Fi enabled control computer, sensors for detecting obstacles and people, an audio speaker for communicating with humans and abilities to open elevator and room doors. The sensors, which are developed by Aethon with the name Light Whiskers, incorporate both infrared, laser and sonar technologies. The commands that are given via the audio system from the TUGs include instructions that notify humans of the delivery or the presence of the robots, especially on their routes. Elevator control modules are installed in the TUG system thus enabling the robots to signal for the opening and closing of elevator doors after requesting for an elevator and still give instructions regarding the destination floor (Bloss, 2011, p. 568). Service elevators are used preferentially due to the congestion that is found in staff and visitors elevators. Finally, the load carts, which have different designs, can easily be detached from the control and drive units. Some of the carts include the food carts, linen carts and the pharmacy carts which are fitted with special security restrictions to maximize the safety of the patients’ medication.

Quality

Quality patient care is expected to deliver on six key tenets: equitability, efficiency, timeliness, patient-center care, effectiveness and safety (Hughes, 2008). Mobile robots are being used to solve logistical issues in the hospital environment, therefore, meeting the expected quality of patient care. The retrieval and delivery of clinical and nonclinical items such as medication, food, and linen can be performed by the TUG machined after appropriate programming. Evidently, nurses spend a good proportion of their time participating in the delivery cycle at the expense of their patients’ care. The time saved by employing the new logistical solution will accord the staff more time for patient care. Undoubtedly, the more time spent on the patient, the greater the patient satisfaction and remission rate. With this, the principle that calls for a patient-centered system will be achieved. Nevertheless, nurses end up feeling satisfied with the work is done thus improving their level of participation in clinical roles.

Quick delivery of items is paramount for the achievement of a timely, safe and effective health care system. At times, patients require being administered with emergency medications depending on the physician’s prescription. In most clinical settings, the pharmacy unit is usually located away from patients’ wards and may even be found on different floors. Consequently, patients take time navigating through floors. Delivery of clinical content by TUGs is fast and effective thus increasing the urgency of administration (Bloss, 2011). Nevertheless, incorporation of a security system in the loading modules enhances the safety of medications and prevents the drugs from landing in the wrong hands (Capezio, et al., 2011). Therefore, the right medication is delivered to the patient directly from the pharmacy thus reducing medical errors. Also, TUG robots are capable of transporting heavy linen from the wards of patients to the cleaning sites thus reducing workload for nurses. As a result, staff can become productive without fatigue or burnout, which also reduces the number of medical errors (Vahey, Aiken, Sloane, Clarke, & Vargas, 2004).

Stakeholders

The acquisition of the TUG machines can be made from trusted outlets that have been authorized by the Aethon Company by the hospital’s procurement department. Once introduced in the hospitals, the information technology (I.T) department will be responsible for ensuring functionality and integration of all the relevant systems to the new mobile robots. Still, all staff should be trained how to operate the devices effectively. A trained professional, whom can either be a permanent or hired staff, will be needed to deliver constant teaching on the dynamics of operating the robots. The training will include the nurses, physicians, and the pharmacists. Patients also need to be coached on how to interact with the TUGs once delivery of food or collection of linen is in progress.

Nevertheless, periodic management and evaluation will be done on the mobile robots. The lead I.T in charge of the project are to recruit a team of support staff to be trained on the upkeep of the robots. This personnel will only be involved in cleaning the load modules and other components of the robots while the I.T experts perform system cleanups and updates. Further management will include periodical monitoring of the activities TUGs’ activities during around the hospital that can be done remotely from the control room. The monitoring will help reduce the navigation delay time thus increasing the efficiency of the delivery system.

Evaluation

The success of the program will closely be monitored to determine whether solutions to logistics have been provided. Therefore, a trained personnel is required to analyze and collect relevant data that pertains to the TUG devices and relay it to the profession. Before initiating the program, piloting will be done to assess the practicality of the solution after which the more machines will be used. In both cases, data is to be collected to assess the success rate. The data collection can be done either on the robot’s system itself or in documents. Software can be modeled to allow the staff who receive the goods to do the recording on their own. Data entry can be done at two points: at the source and the destination of goods. Upon delivery of the goods, nurses, for instance, can input their name and the goods received into the computer interface on the control module. Further adjustments can be made on the interface to try and incorporate a biometric verification system which will accomplish security and data entry simultaneously. Alternatively, the TUGs can be fitted with a data entry books onto which relevant information is filled manually by the source and recipients of the medical goods.

The collected data has to be analyzed to yield the results of the new technology. Apart from the involvement of an I.T expert, data analysts will also be required to sum up the finding into a coherent report. Data entries from the manual book and that fed directly into the system will be utilized for this phase. After consistent use of the TUGs, the manual phase of capturing data can be eliminated to allow for a more seamless and non-labor intensive electronic method. Another parameter that will be utilized to reach a conclusion on the success of the robots will include the success rate of patient care and the level of satisfaction in patients and nurses. These new data will be captured through periodic surveys by the use of questionnaires and other effective data collection techniques.

Conclusion

Logistic issues can easily be neglected as healthcare administrations focus on direct clinical interventions. Albeit staff are required to be hard working and committed in their duties, burnout, and exhaustion lead to reduced morale thus encouraging errors. Technological solutions can be employed to reduce incidences of time wastage while delivering secure and efficient services. Mobile robots can be used in the transportation and delivery of several clinical and non-clinical goods including linen, medication ad food stuff to patients. As a result, nurses end up saving time, which is later spent on offering direct patient care to increase remission rates.

References

Bloss, R. (2011). Mobile Hospital Robots Cure Numerous Logistic Needs. Industrial Robot: An International Journal, 38(6), 567-571.

Calderon, C. A., Mohan, E. R., & Ng, B. S. (2015). Development of a Hospital Mobile Platform for Logistics Tasks. Digital Communications and Networks, 1(2), 1-16.

Capezio, F., Mastrogiovanni, F., Scalmato , A., Sgorbissa, A., Vernazza, P., Vernazza, T., & Zaccaria, R. (2011). Mobile robots in hospital environments: an installation case study. EMCR, (pp. 61-68).

Carayon, P., & Gurses, A. P. (2008). Nursing Workload and Patient Safety-A Human Factors Engineering Perspective. In R. Hughes (Ed.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality.

Dahl, T. S., & Boulos, M. N. (2014). Robots in Health and Social Care: A Complementary Technology to Home Care and Telehealthcare? Robotics, 3(1), 1-12.

Hughes, R. G. (2008). Nurses at the “sharp end” of patient care. In R. G. Hughes (Ed.), Patient safety and quality: an evidence-based handbook for nurses. Agency for Health Care Research and Quality.

Qureshi, Q. M., & Syed, R. S. (2014). The Impact of Robotics on the Employment and Motivation of Employees in the Service Sector, with Special Reference to Health Care. Safety and Health at Work, 5(4), 198-202.

Vahey, D. C., Aiken, L. H., Sloane, D. M., Clarke, S. P., & Vargas, D. (2004). Nurse burnout and patient satisfaction. Medical Care, 42(2).

Westbrook, J. I., Duffield, C., Li, L., & Creswick, N. J. (2011). How much time do nurses have for patients? A longitudinal study quantifying hospital nurses’ patterns of task time distribution and interaction with health professionals. BMC Health Services Research, 11(319).