Innovations in Nursing - PRN Alerts (With Barrister Perez)
Joe Gaccione 0:08
Hello, and welcome to vital views UNLV School of Nursing Podcast. I'm Joe Gaccione communications director for the School of Nursing. One of the most important tasks for nurses is to double check a patient's medication, also known as PRN, or as needed medication. Nurses are required to reassess how often and effective these medications are for their patients. Without proper reminders, however, that process can break down increasing risks not just for the patients, but the nurses as well. Joining us today is barrister Perez. He's a UNLV nursing graduate student who works here in Las Vegas at the VA hospital of Southern Nevada, he found a technological solution that should not only streamline the system, but in fact, this fix could be the first of its kind in Las Vegas. barrister joins us today to talk about this new solution that you currently work at the VA hospital of Southern Nevada. which unit Do you work in?
I work in a unit called Five East which is pretty much the COVID ICU. But we also take med surg and step down patients.
Okay. talk about this problem that you first noticed with the PRN medications.
It's less of a normal day. But I remembered, our manager came out of her office and started issuing these written disciplinary actions to nurses who I thought were good nurses. But they still receive these disciplinary actions for not to reassessing PRN medications in a timely manner. Because it's they also explained that it is within our practice to reassess how effective the medication was. So that we know we have a metric to see whether they need more, or they need less whether it's effective or not.
And how often are they supposed to do this? every 30 minutes? every hour?
Yes. So our in our hospital, it's every 30 minutes that they should be reassessing the patient's response to the medication and given
and it's really just remembering, there's no like alert or button or phone call or anything like that. It's really just their responsibility to go, Okay, I need to go back after this amount of time to double check.
That's correct. There's actually a built in manual reminder that it takes minutes for it to be to be set up. I mean, by the time you're done setting up the reminder, it's already time to to reassess the patients. yeah, that's an exaggeration. But that's what we talk about.
but you found a way to fix this. Can you talk about that?
Yeah. So I figured there's got to be a way for this process to be automated. And I inquired, I inquired with the Vocera, which is the company, our pager company that we use? Have, they said that it is possible with a little programming, but they also said that it's going to cost money. And, like I said, manpower to reprogram the device. So I asked the company Vocera if another facility has done this in Las Vegas, and they said, No, I don't think there's any here in Las Vegas. But I believe there are several VAs in the east west coast. I mean, that, that has this feature. So they told me it's Seattle, and Long Beach. So I connected with my manager, I started making phone calls from to Long Beach and Seattle. I connected with their education department, their IT department, and pharmacy. And they're even their director in Long Beach, the hospital director in process, they gave me the data from when they started using before they started using the Vocera. Immediately when they implemented it, and after. And amazingly, it's very, very effective. You could almost see if you graph the data, you can see an inflection point, a sharp rise in a PRN compliance from when they started using the feature. And it's sustained from from 2018 to 2021. They're still above a national metrics on their compliance.
How long would it take for you to put all this together between the research and the context of the other hospitals?
About three months, gathering the data and surveying the nurses and actually trialing the the feature in their hospital there The nurses to say, actually, I've been very receptive to it. Initially, we thought it's going to be a nuisance for the nurses, because you know, in, in the ward, in Ward setting, there's plenty of alarms already. From pumps, IV pumps to heart monitors, phone calls from the doctors.
Good point, because you have to there's going to be so there have to be so many noises that you'll still have to train the nurses to hear this new sound like it's got to be distinct enough to stand out.
Yes, that's true. And we've actually had them watch a video a demonstration of on how it works. I believe we we call the approach about 100 nurses and only one said, only one said it wasn't even a No, it wasn't maybe because of that alarm is called alarm fatigue concerns. But it was very they were very receptive. And that also kind of help with the approval on the leadership side. Or they're very happy that the nurses are are receptive with this feature.
Did you have help on this putting all this together?
Oh, yeah, I had to help have with my friend with my coworker and friend. Her name is Kayla Vargas. Unfortunately, she's not able to come in today. But she pretty much she was very helpful in compiling the data, making the presentation or helping with the with the presentation with the leadership. And overall a licen a medium person to communicate with it. Leadership and in the company, the Vocera company, the pager company,
when you presented this to your leadership at the hospital. What was their response?
Initially, they were concerned, of course, with the cost. And they're concerned of the bureaucracy. But I was able to explain that it was only a one time cost of the lead. The code was at $23,000. It's a hospital wide. And it's all that it's already a feature that's being used in another VA. And I don't know if you heard about Jayco. It's a credentialing hospital credentialing system, that credentials hospital where they're they're up to standards or not. And it's actually actually said that it's it's one of their recommended practice, or Jayco. Good practice for for the credentialing. So that alone already sold them.
But you already had some of the technology in place, right? Oh, you already had maybe the groundwork for like to house this new alert, right? Yes.
Yeah, cuz you already have the pager, and Vocera. The only thing that they needed to upgrade was their servers. Because we, I guess all the information, the data that would that the servers would be receiving would overwhelm the older the oldest servers. So if they would wait for a new server, they would wait for the old server to be upgraded. In order for them to implement it. That's why it's going to be on October of 2022. Because they're waiting for those server upgrades.
How excited are you that a couple of months something that you researched and helped put together to help your fellow nurses is going to happen, like it's going to become a reality,
actually very surprised that it's happened. Because I've told my colleagues before, it's it's very hard for bedside nurses. To implement something bigger like this, it's usually a leadership or a more influential position, especially if it's requiring money and resource and actually convincing hired leadership to implement something like this. So my colleagues and I were very excited. Like I told her, you know, healthcare is one of the most difficult industry to disrupt, you know, next to, I think, energy industry. But here we are, we're making little changes in our little bubble hospital.
And when this goes into effect, it's going to reach the whole hospital, not just one unit, correct.
Not just one unit. It's the whole hospital. So whenever a nurse given a PRN as needed medication, this, this alert would notify them.
I'm always curious when we talk about technology and healthcare, they're so intertwined now, and they bring so much so many advantages to treating a patient to diagnosing a patient. But do you ever feel like sometimes technology like too much technology can be a bad thing for nursing?
You know, it can be a sometimes I sometimes compare it to, to our physical Eating are working out for say, you know, before we used to walk run, before the invention of cars, now that there are cars everywhere, we've seen to have gained a lot of weight, we're, I think we're a little weaker, it's the same with nursing, you know, having a lot of technology could often lead to a cloud, a cloud in clinical judgment. And in turn, would, we would be over reliance on technology, of the same with physicians and stuff, we can't always we all we need to sit, we still need to practice or workout our clinical judgment muscle, so to say, and not overly rely on, on technology, especially now that there are talks of, of these artificial intelligence. And the use of that to diagnose diseases, and possibly in the future, be nurses and take care of take care of patients. So we still need an edge. So I think I was having this conversation with my friend, actually, a couple of days ago, we still need that. The human the human factor in care, like having compassion, talking to the patient, having that human connection with the patient, spiritual, not necessarily religious, but the spiritual connection. So technology is an instrument, but we cannot deeply rely on it. It goes hand in hand.
Fair enough. Yeah. One of my last questions. When we spoke prior to this interview, you had talked about the long term implications of this alert system and that not only could it impact PRN medication, but it could impact other other types of treatment. Is that correct?
Yes, actually, our director, she was so ecstatic when she heard that we're doing this project. And she said, wow, directly, while this could open to a lot, this could open the floodgates of other opportunities for much more alerts, such as laboratory, laboratory alerts, critical alerts for physicians, maybe even for Ponsoldt for social workers. So she's just very excited that we're making a process improvement in terms of, like I say, clinical processes, processes and making our jobs easier. And maybe
once other hospitals in the area, see what you guys are doing. Maybe they'll say, Hey, that's not a bad system. Maybe we could apply to our facilities as well. I mean, it can only it can only help.
Oh, yeah, it can only help if they're willing to spend on it. Right. And, you know, I think, well, we know that nurses will love it. Because of our of our surveys and stuff.
That is all I have barrister. Thank you very much for joining us. That's all I've got. Thank you. Oh,
thanks. Thank you.
Transcribed by https://otter.ai