NUR 305 Module 4 Milestone Two example

Hands-Free Communication Badges for Nurses: A Review of Benefits, Risks and Evidence

[Student Name]

Southern New Hampshire University

NUR 305: Information Management and Patient Care Technologies

Final Project Milestone Two

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Hands-Free Communication Badges for Nurses: A Review of Benefits, Risks and Evidence

Nurses on the composite 44-bed medical unit that serves as the setting for this project reach each other in three ways: overhead paging, the unit's desk telephone, and walking to find the person they need. The unit runs along two long hallways joined by a central station, and a nurse at one end of the east hall may be more than 60 meters from a colleague at the far end of the west hall. When a patient's family asks to speak with the charge nurse, or when a nurse needs a second checker for an insulin dose, the usual response is to walk the halls or to ask the unit secretary to page. Milestone One selected wearable hands-free communication badges, voice-activated devices clipped to the uniform that let a nurse call a colleague or role by name, as the technology for this project.

This milestone reviews what published evidence says about such devices. Its purpose is to decide not whether badges are good or bad in general, but which benefits are supported by evidence, which risks are real, and what that means for how the unit should use them.

Time, Walking and Reaching the Right Person

The case for hands-free devices begins with how nurses spend their time. Tracking how medical-surgical nurses in 36 hospitals used every minute of their shifts, Hendrich et al. (2008) found that a large share of each shift went to documentation, care coordination and medication administration, while direct patient care occupied a smaller share than most nurses would expect. The same study reported that nurses walked between one and five miles during a 10-hour day shift, and that much of that walking was not to patient rooms. Any technology that reduces the need to walk to find a colleague could return some of that time to patient care.

Studies of hands-free systems in hospitals suggest they do change how staff reach each other. In a qualitative study across several hospitals that had adopted hands-free communication devices, Richardson and Ash (2010) found that staff could contact the person they needed more quickly, that overhead paging decreased, and that communication became more direct, often skipping the unit secretary. Staff also described new expectations of constant availability and changes in who talked to whom. The authors concluded that such systems reshape communication patterns in ways that organizations should anticipate rather than assume will be purely positive.

On the composite unit, the charge nurse estimated during a two-week informal count that she was paged overhead an average of 14 times per day shift and that staff nurses spent several minutes at a time searching for her or for a second nurse to double-check high-alert medications. Families calling the unit waited on hold while the secretary tried to locate the assigned nurse. These are the delays the badge is intended to remove, and they are also the easiest benefits to measure after implementation, because pages, hold times and searches can be counted before and after the change.

What the evidence supports, therefore, is that badges can make contact faster and reduce paging and walking. It does not show a measured effect on patient outcomes, and the qualitative findings come from staff perceptions rather than direct measurement of time saved.

The Interruption Problem

Faster contact has a cost. A device that lets anyone reach a nurse at any moment also lets anyone interrupt her at any moment, including during medication administration. Research on interruptions shows why this matters. In a direct observation study of nurses administering medications in two teaching hospitals, Westbrook et al. (2010) recorded thousands of doses and the interruptions that broke into them. Every added interruption raised the chance of a procedural slip, such as skipping the identity check, and of a clinical error, such as a wrong dose or a mistimed one, and the danger climbed further when several interruptions landed on the same administration.

The study did not examine communication badges, but its implications for them are direct. A badge that rings while a nurse is drawing up a medication creates the kind of interruption the study linked to errors. Richardson and Ash (2010) also found that staff using hands-free devices described being interrupted more often. A unit that introduces badges without rules for when nurses may be called is likely to trade walking time for medication safety. Features that allow a nurse to set a do-not-disturb status during medication passes, or that route nonurgent calls to a message queue, therefore become requirements rather than options.

Privacy in Hallways and Rooms

Voice devices also raise privacy concerns. Because the nurse speaks aloud, and in many systems the caller's voice is audible through a small speaker, conversations about patients can be overheard by other patients, visitors or staff. Richardson and Ash (2010) reported that staff in their study were aware that patients and families could hear calls and that some adapted by moving to private areas or using earpieces. A call that announces a patient's name and a sensitive result in a shared room would disclose protected health information to anyone nearby.

The evidence here is thinner, drawn mostly from staff reports, but the risk is easy to anticipate. Safeguards include earpieces as standard equipment, a unit norm of stepping out of patient rooms before discussing another patient, and caller scripts that avoid full names and diagnoses when a private conversation is not possible.

What the Review Means for the Project

The evidence supports adopting hands-free badges on the composite unit only with conditions. The benefits most likely to appear are faster contact with the charge nurse and colleagues, less overhead paging and less time spent walking to find people. The risks most likely to appear are more interruptions during medication administration and privacy breaches in shared rooms and hallways. Milestone Three will therefore propose an implementation plan built around four requirements: a do-not-disturb setting used during medication passes, routing of nonurgent calls to text messages, earpieces for all staff, and a communication etiquette agreed by the unit before the devices go live. The plan will also include measures of both sides of the evidence, such as overhead pages per day and interruptions observed during medication administration, so that the unit can tell whether it has gained speed without losing safety.

References

Hendrich, A., Chow, M. P., Skierczynski, B. A., & Lu, Z. (2008). A 36-hospital time and motion study: How do medical-surgical nurses spend their time? The Permanente Journal, 12(3), 25-34. https://doi.org/10.7812/TPP/08-021

Richardson, J. E., & Ash, J. S. (2010). The effects of hands-free communication device systems: Communication changes in hospital organizations. Journal of the American Medical Informatics Association, 17(1), 91-98. https://doi.org/10.1197/jamia.M3307

Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T. M., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine, 170(8), 683-690. https://doi.org/10.1001/archinternmed.2010.65