Overview
Reducing wasted effort and increasing time available for patient care yields direct benefits in terms of nurse productivity, quality of care, patient safety,improved outcomes, and nurse satisfaction. Recent peer reviewed studies1 have drawn a correlation between hospital unit layout and achieving improvements in these areas. This is particularly true when hospital design forces nurses to deviate from nursing best practice, which is often the case with documentation and meds policy. In an effort to ascertain a quantifiable comparison of hospital unit layout options for meds and documentation, a study was performed that included four scenarios using Layout-iQ, Rapid Modeling Corporation’s workflow modeling engine. Layout-iQ merges an industrial engineering database of workflow with a CAD drawing of the layout and calculates the total travel distance in feet that nurses will walk in a given design. The study took into account factors including location of medication, location of documentation equipment, and a typical number of medication cycles per day. The study looked at models in which medication retrieval, preparation, and documentation were tied to central nursing stations and pharmacy dispensaries and then compared the impact of using medication carts, computer carts and wall-mounted workstations containing medication and IT equipment.
Scenarios
Scenario 1: Central Nursing Station and Central Meds Layout This scenario served as baseline for the study and considered three processes: patient medication (6 times daily); unit medication replenishment from a central pharmacy (1 time per day); and event documentation (12 times per day).
Scenario 2: Use of Computer Carts (50/50 Cart Storage/Retrieval Factor)The use of computer carts was evaluated on a conservative basis, assuming processes would be completed 50% of the time while moving from patient room to patient room with the cart and 50% of the time requiring travel to and from a central cart storage point.The use of carts required four processes: patient medication (6 times daily); cart medication replenishment (3 times per day); unit medication replenishment from a central pharmacy (1 time per day); and event documentation (12 times per day).
Scenario 3: Use of Computer Carts (80/20 Cart Storage/Retrieval Factor) This scenario offered a “best case” evaluation for the use of carts by increasing the frequency with which the four processes described in Scenario 2 could be completed without travel to a central cart storage point. Processes were completed based on room-to-room travel 80% of the time. Travel to and from a central cart storage point was reduced to 20% of the time.
Scenario 4: Use of In-Room Workstations The workstations evaluated were those designed and manufactured by Proximity Systems which place computer technology, medical equipment, secured patient medications and supplies at the point of care. This scenario considered four processes: patient medication (6 times daily); workstation medication replenishment (1 time per day); unit medication replenishment from a central pharmacy (1 time per day); and event documentation (12 times per day).
Results
When compared the four scenarios yielded the following results:
| Scenario |
|
Distance per day |
| 1: Central Nursing Station and Central Meds Layout |
|
45,406 ft. |
| 2: Use of Computer Carts (50/50 Cart Storage Factor) |
|
37,892 ft. |
| 3: Use of Computer Carts (80/20 Cart Storage Factor) |
|
16,796 ft. |
| 4: Use of Proximity WorkStations |
|
8,387 ft. |
Placing IT equipment and patient medications in wall-mounted workstations, strategically positioned in or near patient rooms, reduced the distance nurses walked by between 50% and 80% by allowing per-patient processes to be completed in that patient’s room.
• In-room workstations were at least 2 times more efficient than the most optimistic Computer Cart scenario.
• In-room workstations were 4 times more efficient than the conservative Computer Cart scenario.
• In-room workstations were 6 times more efficient than the Central Nursing Station (for documentation) and Meds Station scenario.
Conclusion
The Proximity option enables nursing best practice with respect to documentation and meds, causing significant improvements in the quality of documentation and in the reduction of errors, omissions, and mistakes. Limiting physical stress on nurses from excess walking,and providing an environment that enables the nurse to follow nursing best practices and provide better patient care can positively impact nurse satisfaction and retention. The results of this study indicate that strategically placed, wall-mounted workstations–specifically those with the combination of information, medication and patient care features offered by Proximity Systems –have a greater potential to reduce excess walking, increase productivity, impact the hospital’s bottom line and improve the opportunity for improved care as compared to the other options evaluated.
