wireless networks & point of care technology

Miami VA Healthcare SystemMiami VA Healthcare System

Wireless Networks & Point of Care Technology:

Implications for Implications for Interdisciplinary CollaborationInterdisciplinary Collaboration

Kathryn G. Sapnas, PhD, RN, CCRN, CNORKathryn G. Sapnas, PhD, RN, CCRN, CNORWayne G. Martin, MS, RN, Thomas Shelton, MS, RNWayne G. Martin, MS, RN, Thomas Shelton, MS, RN

Kevin Hope, BS, Kathryn WardKevin Hope, BS, Kathryn Ward--Presson, MSN, RN, CNAA, BCPresson, MSN, RN, CNAA, BC


ObjectivesObjectivesIdentify key considerations in an evolving Identify key considerations in an evolving wireless paradigm. wireless paradigm. Discuss development of a structured Discuss development of a structured multidisciplinary wireless local area network multidisciplinary wireless local area network management program.management program.Describe examples of effective interdisciplinary Describe examples of effective interdisciplinary relationships and practice are led by Nurse relationships and practice are led by Nurse Informaticists.Informaticists.Assess and evaluate wireless program Assess and evaluate wireless program management and lessons learned.management and lessons learned.


AcknowledgementsAcknowledgements


BackgroundBackground

Evolution of Technology in NursingEvolution of Technology in NursingNightingale and Crimean War Nightingale and Crimean War Modern NursingModern NursingInformation AgeInformation AgePatient SafetyPatient SafetyPoint of Care TechnologyPoint of Care Technology


Nursing EmergesNursing Emerges

PlatosCave.gif PlatosCave.gif

PlatosCave.gif


Historical Background Historical Background 19601960’’s s –– 19701970’’s Digital spread spectrum radios s Digital spread spectrum radios

High available bandwidthHigh available bandwidthGovernment use for covert communicationsGovernment use for covert communications

19801980’’s s –– 19901990’’s Expansions ExpansionNarrow band Narrow band -- ultra high frequency ultra high frequency First wireless bar coding First wireless bar coding Cellular digital packet dataCellular digital packet data

1993 Wireless technology healthcare 1993 Wireless technology healthcare implementation implementation Present Wireless Local Area NetworksPresent Wireless Local Area Networks

(Retterer, 2004)(Retterer, 2004)


Nurses as Nurses as PartnersPartners at at Point of CarePoint of Care

Nurses should not abdicate technical Nurses should not abdicate technical troubleshooting responsibility for point of care troubleshooting responsibility for point of care technology solutions because they are too technology solutions because they are too busy, itbusy, it’’s s ““too technicaltoo technical””, or because , or because ““itit’’s not s not my job, call ITmy job, call IT””


Wireless Applications Wireless Applications

Point of care servicePoint of care servicePatient Safety Patient Safety Error reductionError reductionFlexibility Flexibility MobilityMobility


Wireless technology overview Wireless technology overview

Dynamic environment Dynamic environment Changes with user movement Changes with user movement

Static environmentStatic environment““fixedfixed”” wireless installation wireless installation

Mobile client endMobile client end--user devicesuser devicesWireless infrastructure devicesWireless infrastructure devices


Wireless 101:Wireless 101:How Wireless WorksHow Wireless Works


Partial Partial CoverageCoverage

Complete Complete CoverageCoverage

Wireless 101:Wireless 101:Signal CoverageSignal Coverage

(Carlson, 2006)


StrategiesStrategiesAssess physical plant, equipment, wireless system Assess physical plant, equipment, wireless system reliability, security, stakeholder and endreliability, security, stakeholder and end--user education. user education. Collaborate with stakeholders Collaborate with stakeholders

Information TechnologyInformation TechnologyBiomedical Engineering Biomedical Engineering Information Security Officer, Privacy OfficerInformation Security Officer, Privacy OfficerAdministration Administration Nurse CliniciansNurse CliniciansPharmacyPharmacyPatient SafetyPatient Safety


StrategiesStrategiesEvaluate current clinical nursing practice Evaluate current clinical nursing practice Illustrate Illustrate ““lessons learnedlessons learned”” using examplesusing examplesDevelop Develop ““best practicesbest practices””Focus on multidisciplinary team, nursing Focus on multidisciplinary team, nursing leadership & endleadership & end--user educationuser education


Wireless Issues in Mobile Wireless Issues in Mobile Computing Computing

Mobile medication workstation selection, PDA Mobile medication workstation selection, PDA implementation, mobile computingimplementation, mobile computingDiscriminating scanner, barcode, hardware, Discriminating scanner, barcode, hardware, software issues, and/or network issuessoftware issues, and/or network issuesTroubleshooting wireless infrastructure Troubleshooting wireless infrastructure EndEnd--user knowledgeuser knowledgeRapid Response Rapid Response

““Just in timeJust in time”” Nursing and IT Nursing staff reporting Nursing and IT Nursing staff reporting responsibilityresponsibility


Clinical ExamplesClinical Examples

Point of care BCMA interruptionPoint of care BCMA interruptionNurse in patient room Nurse in patient room –– patient arm band patient arm band does not scandoes not scanNurse in room, medication cart loses signal Nurse in room, medication cart loses signal cannot bar code scan and administer cannot bar code scan and administer medicationmedicationAmidst medication administration loses signal Amidst medication administration loses signal strength or network connectivitystrength or network connectivity


Network Associated RisksNetwork Associated Risks

Rogue access pointsRogue access pointsHardwareHardwareBandwidthBandwidthAccess pointsAccess pointsSecurity vulnerabilities Security vulnerabilities

Range and intended coverageRange and intended coverageIntrusion detectionIntrusion detectionDenial of service Denial of service


Equipment NeededEquipment Needed

Spectrum AnalyzerSpectrum AnalyzerAssess wireless signal strength Assess wireless signal strength Evaluate roaming history Evaluate roaming history Audit Audit ““traffictraffic”” (loading) on(loading) on access pointsaccess points


Spectrum Analysis

Mobile Medication Workstation Signal Strength Analysis


Equipment NeededEquipment NeededSpectrum AnalyzerSpectrum Analyzer

Assess wireless signal strength Assess wireless signal strength Evaluate roaming history Evaluate roaming history Audit Audit ““traffictraffic”” load on access pointsload on access points


Lessons LearnedLessons Learned

Signal strength Signal strength Signal quality Signal quality Wireless Wireless ““drop offdrop off””Loss of data packetsLoss of data packetsWireless phone interferenceWireless phone interference


Signal Strength & Quality Signal Strength & Quality Link Status MeterLink Status Meter

Signal strength indicator


Potential Threats to Point of Care Potential Threats to Point of Care

Wireless Wireless ““drop offdrop off””Signal Signal SoftwareSoftwareHardwareHardwareLoss of data packetsLoss of data packetsInterferenceInterference


Best Practices for Site SurveyBest Practices for Site Survey

Type and location of antennaType and location of antennaNoiseNoiseAssessment toolsAssessment toolsSecurity considerationsSecurity considerations

(Carlson, 2006)(Carlson, 2006)


Best PracticesBest Practices-- SummarySummary

Develop open interdepartmental Develop open interdepartmental communication mechanism communication mechanism

Early planning and physical plant Early planning and physical plant assessment assessment

Schedule and conduct quarterly routine Schedule and conduct quarterly routine overall network assessmentoverall network assessment

Schedule and conduct frequent random Schedule and conduct frequent random unitunit--based network based network ““sweepssweeps”” or or ““sitesite––surveysurvey””


ConclusionsConclusionsCollaborative interdisciplinary strategies are Collaborative interdisciplinary strategies are needed for timely and safe health care. needed for timely and safe health care. Nurse leaders must focus awareness of potential Nurse leaders must focus awareness of potential impact of networks and wireless technology on impact of networks and wireless technology on nursing care workflow and technology nursing care workflow and technology dependent operational systems. dependent operational systems. Nurse Informaticists must be knowledgeable on Nurse Informaticists must be knowledgeable on wireless technologies.wireless technologies.Seamless care delivery occurs in environments Seamless care delivery occurs in environments where stakeholders address and respond to where stakeholders address and respond to clinical issues that impact patient care using this clinical issues that impact patient care using this emerging technology.emerging technology.


Nurses Rise to the ChallengeNurses Rise to the Challenge


Next Generation Application Next Generation Application


ImplicationsImplications

Nurses should not abdicate Nurses should not abdicate troubleshooting responsibility for point of troubleshooting responsibility for point of care technology solutions because they care technology solutions because they are too busy, or because itare too busy, or because it’’s s ““too too technicaltechnical””Wireless technology is to nursing at the Wireless technology is to nursing at the point of care in electronic environments as point of care in electronic environments as the stethoscope is to patient physical the stethoscope is to patient physical assessmentassessment


Future Future Nursing researchNursing research

Patient safety Patient safety Human factors Human factors Nursing ScienceNursing Science

New wireless applications New wireless applications Remote POC applications Remote POC applications wBANswBANsVoiceVoiceVideoVideo


QuestionsQuestions


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wireless networks & point of care technology

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