The MobiNurse
The MobiNurse is a complete solution to support mobile patient identification in hospitals. It addresses the following issues:
- quality assurance – capability of tracking events of the patient care and treatment
- eliminate the complications coming from a false patient identification
- dramatically reduce the administrative workload and decrease the stress caused by it
- tracking the consumption of drugs and other treatment related consumables (e.g. gloves, syringe, bandage, etc.)
- insight into costs associated with treatment of a particular patient
- decreasing number of nurses
The MobiNurse does not require to replace the existing HIS[1] but it is fully integrated with them instead. There are references in Hungary[2]. It has no separate database parallel to that one which is managed and maintained by the HIS.
The concept
The key concept of the solution is to identify every patient before he / she receives ANY treatment, medication, etc. The patient id is carried by him / her is a barcode / QR code printed on a wristband which is worn by the patient all the time during the care.
This identification eliminates the physical distance between the boundaries of the IT infrastructure supporting the patient care and the place that patient care is actually done. This is carried out with handheld devices and some basic infrastructure (Wi-Fi network which can be even limited).
Nurses will be mentioned many times in the following. Why? Because it is the nurse who meets the patient most frequently and has to identify him / her. However, the MobiNurse is flexible enough to support patient identification in every processes of in and outpatient care whenever the patient identification is necessary.
The hardware workhorse of the unambiguous patient identification is the Smart Badge HC manufactured by Zebra (Zebra Technologies, Inc. © www.zebra.com). Its main features are:
- small and lightweight, fits in a pocket of a white coat or nurse uniform, can be worn on a arm / wrist / belt clip or lanyard
- it can be operated with one hand in most of the use cases – it is there whenever a nurse needs its services but does not interfere with the physical work which is rather common in the daily work of nurses
- it has a precision barcode reader capable of reading 1D/2D codes
- battery operated – capacity of which is enough for a whole shift
- it is able to communicate with the HIS and use its services through the Wi-Fi network
- can be easily integrated with other devices – e.g. can receive automatically generated alarms from monitoring equipments of the intensive care
- supports PTT (push-to-talk) using which the employees can talk to each other in predefined groups (nurses of a particular department, orderlies, etc.)
- can be disinfected with wiping it with special clothes and can be operated in gloves
- endures multiple dropping on concrete from 1,2 m
- cheap
However, the MobiNurse does not limit the set of supported Zebra devices to the Smart Badge only. The client has been ported to TC51 HC, e.g.
Offline operation
It is possible to acquire data in places or rooms not covered by the Wi-Fi network. If the devices do not sense the presence of Wi-Fi then the entered data is temporarily stored in an internal storage of the handheld device. As soon as the signal is restored the previously collected data is automatically sent to the HIS without any human intervention.
This allows to use MobiNurse even in those buildings where the signal is not stable or missing. It is enough in this setup if the signal is available in the nurse station or on the corridor. The MobiNurse is operated in the above described offline way. As soon as the nurse enters the area with Wi-Fi access the data stored on the device gets synchronized with the HIS.
Use cases
The other hardware elements of MobiNurse and their interoperability is presented by the use cases during the patient care.
The other leg of the patient identification is the HC100 wristband printer. Its main features:
- the raw wristbands are fed from a cartridge which ensures sterility – the wristbands are available in different sizes (adult, children and newborn)
- the wristband is made of hypoallergenic material which is water and disinfectant resistive
- the cartridges can be changed without even touching the wristbands
- the device can be disinfected with suitable wipes
The HIS generates a uniques code for every patient during the admission which is printed on a wristband by the HC100. Only the HIS is able to map the code to the concrete person. Therefore this code can be used for the patient identification during the whole patient care process. The code reading is carried out by using the handheld devices running the MobiNurse clients. Since these devices (Smart Badge or TC5x) control the user access to the HIS only those can identify the patient who has this right anyway.
After reading the barcode from the wristband the patient can be identified by the HIS. It makes possible to download the list of prescribed treatments for that particular patient in full detail. Application of a prescribed treatment (e.g. medication, screening, etc.) can be administered using the same device and it is immediately reflected in the HIS. And this happens WHEN the treatment is accomplished practically eliminating the human errors doing it later. The nurse is not loaded with the stress of the not fully finished job since the associated administrative work is also done at the moment of actual finishing of the treatment. Every employee (from doctors and nurses to the operational theaters and orderlies) taking part in the patient care have the same concise and fully up-to-date view of the process in real-time.
It is worth to mention that the MobiNurse fully supports UnitDose solutions. By reading the code printed on the prepackaged set of drugs (UnitDose) the MobiNurse informs the HIS that the associated medication is getting done. The HIS is able to check if that package was prepared for the patient the nurse has previously identified. As a result of this checking the nurse is either instructed to perform the prescribed medication or gets warned not to do so since the package identified contains somebody else’s drugs.
There are numerous occasions a patient has to be identified during either in or outpatient care. It can happen in a lavatory in case of finding an unconscious person there or before starting an operation. Generally speaking: whenever the quality assurance requires this. The MobiNurse sends the code read from the patient’s wristband (or plastic ID card in case of outpatient care) and the HIS is able to inform the nurse about all the necessary conditions of the patient: critical illnesses like diabetes and allergies like intolerance to any drug. Having these information at hand can be vital at that moment.
The MobiNurse provides a self-contained solution for tracking the drug and consumables consumption. Using the barcodes printed on the packaging of consumables the application of them can be associated with the treatment of a single patient. There are compulsory changes which are driven by the EU legislations. The solution applied by the MobiNurse is able to keep track of using consumables and drugs which are a bit harder to measure and identify than the pills (e.g. bandage and ointments).
These help not only the nurses but the institution as a whole. The management has a much more precise insight of the stock level which helps (stock) planning and financial processes, too.
The MobiNurse makes easier of performing many other daily / weekly administrative tasks. These are the followings:
- checking the refrigerator content
- checking the cleaning
- expiry date checking on consumables and drugs in the hospital department related drugstore
- checking the minimal necessary stock
- checking some vital set of instruments, e.g. defibrillator, etc.
- etc. – this list varies from country to country