Nursery Chart System Development

Team Members: John Fonge, Brandy Scott, Kendra Mills

Faculty Advisor: Dr. William Walsh, Chief Nurseries Pediatrics Neonatology: Vanderbilt University Children's Hospital Department of Neonatology

Vanderbilt University NICU

61-bed, 60,000 square foot Level IIC unit that admits 1200 infants per year

Rooms are divided into 7 clusters, or pods, each containing 6 or 7 infant rooms arranged so that the nursing staff can see into all rooms

Our prototype is in a patient room in Pod C Each single-patient room is 13 feet x 14 feet Wall adjacent to the corridor is a 4-foot sliding glass

door with privacy curtains

Background

In the past, nurses have written down vital signs on paper and manually transferred them to the computer, but in a busy NICU this method has led to insufficient documentation.  Patient charting is now being entered directly into the computer to dispose of the double charting that leaves room for documentation error. 

History of Computing Systems Initially when rooms

were converted from double rooms to single rooms, each room was equipped with a mobile cart known as a COW - computer on wheels

Negatives: short battery life, wheels would fail, often difficult to locate

Background

At Vanderbilt Children’s Hospital’s NICU, Dr. William Walsh has placed a prototype of the computer nursing chart in the patient room where the nurses can directly enter patient information.

Advantages for Changing to Computing System Scanner in every room helpful for Admin RX

(used in dispensing of drugs) At Minneapolis VA Medical Center

Nurses spent 7% of their time gathering data and 17% charting data prior to the installation of the computer system

After the installation of the system, gathering time reduced to 4% and charting time reduced to 10%

Computerized charting did not alter time spent in patients’ rooms (43% before installation and 43% after installation)

Problem Statement

Is the computer station going to affect the nurses’ work area at Vanderbilt Children’s Hospital?

What adjustments can be made to the existing prototype to fix the instability?

Project Objectives

Determine an inexpensive way to stabilize the computer station setup

Assess the stability/ergonomics of the support leg/keyboard

Perform nurse evaluation of effectiveness of new prototype

Computing Systems

Dual Screen system was installed to improve upon COW.

One screen shows vital signs and the other shows informatics

Negatives: instable keyboard, system too heavy, extremely bulky

Second Prototype

Lightweight arm Vital screen above

patient bed KVM (Keyboard video

mouse) switch to toggle between informatics and vital screen

Solutions

A pole was attached to stabilize the computer station. ~$20

Pole manufactured by Shur-Line, a painting accessory manufacturer

Can vary in height 35 in. – 43 in.

Push button pole makes adjustment very easy

Projected Cost Per BedNICU Admin-Rx Equipment Proposal

Item Number Description Cost 1 28” Flat Screen Monitor $650 2 Mounting bracket for 28” $70 3 Ergotron arm and Combo $800 4 Extensions for key board $55 5 Keyboard stabilizer $50 6 Headwall adapters $100 7 KVM and misc. cables $100 8 Wall Channel $40 9 Scanner bracket $30 10 Mount for Philips CPU $40 9 Mouse and Keyboard $40 10 Plant operations work $250 12 CWS cpu and mount ?

Estimated maximum Expense ($2225 +CWS)

(Less $500 if mounts are reused, less $300 for 22 - 24” and possible extended price savings)

Stability/Ergonomics of Keyboard and Support Leg

  Dual-Screen Monitor Single Screen Monitor

Screen Size (inches) 41.125 18.25

Range of Height (inches) 16.125 15.1875

up-to-down time (sec) 7.65 2.37

down-to-up time (sec) 5.55 1.69

duration of oscillation (sec) 14.24 1.5

oscillations/sec 3 2

keyboard deflection with 2kg weight (inches) 0.75 0.1875

Results

Time it takes to raise and lower the arm decreased by 69%

Stability of keyboard improved by 75% based on deflection test

Duration of oscillation decreased by 90% Range of vertical motion comparable, but

range of horizontal motion will increase since the single screen is less than half the width of the dual screen

Current Work

Observe installation of single screen prototype in two rooms in Pod C

Survey nurses on new prototype on Friday, March 14, 2008 after the patient rooms go live

Researching more alternatives to the Shur-Line paintbrush arm for stabilizing the new keyboard

Future Work

Complete a quality function deployment (QFD) process once the surveys from the nurses are collected

Research a way to adjust the angle of the keyboard