Last October, nurses at Cleveland Clinic Florida began piloting the use of iPhones with an electronic medical record (EMR) nursing app for medication administration. The hospital, located in Weston, deployed 80 mobile phones and sleeves with barcode scanners in the medical/surgical units and the emergency department. They are loaded with a mobile nursing app called Rover from Epic, Cleveland Clinic’s EMR system.

“This is Cleveland Clinic’s first whole-house use of iPhones,” says Nelita Zytkowski, DNP, MS, NEA-BC, RN-BC, Cleveland Clinic’s Associate Chief Nursing Officer of Informatics. “Weston is the first site to trial this and help us decide if this is the right technology for all of our nurses across the healthcare system.”

App is ideal for as-needed and one-time meds

Charge nurses and health unit coordinators (HUCs) allocate the iPhones to nurses on their floors at the start of each shift. The nurses then use a workstation on wheels (WOWs) for more detailed and large-volume administrations and the supplemental iPhone app for quick medication checks and administrations. Both are connected to Epic. This allows nurses the flexibility to select the right device, depending on each patient’s circumstances, to document care at the bedside.

Andrew Kwang, RN, who works on a telemetry and intermediate care unit, prefers using the iPhone. “It is smaller and more compact than the WOWs, which can be cumbersome to pull around and push into rooms,” says Kwang. “It’s especially helpful when giving as-needed or one-time medications, where the use and process of the WOWs isn’t really necessary.” For instance, Kwang often opts for the iPhone when giving a push of morphine to postsurgical patients. With the Rover app, he can simultaneously document pain assessments.

Patient care nursing assistants (PCNAs) also use the iPhones for documenting tasks such as taking vital signs, turning patients and measuring intake and output. “These are often things that are left to be documented several hours later or at the end of a shift,” says Zytkowski. “Such big lags in time could potentially lead to patient care concerns if caregivers don’t have up-to-date information to make clinical decisions.” Using a pocket-sized device also allows the PCNAs to move quickly from room to room, allowing for efficient, real-time documentation.

Cleveland Clinic Florida offered numerous hands-on training sessions to ensure nursing staff was comfortable using the iPhone app. Instructors led one-hour classes on the basics of barcoding, how to use the mobile device and documentation pieces for PCNAs. RNs received half-hour training on their units.

Part of a sweeping initiative

The iPhone pilot is one component of a broader initiative – the Positive Patient Identification project – launched by Cleveland Clinic in 2013. The healthcare system’s main campus and eight regional hospitals implemented a barcode medication administration process using WOWs that year. It was the first phase of the Positive Patient Identification project. Two other phases – breast milk scanning and blood component scanning – went live on main campus in 2014. The project aims to meet several regulatory guidelines, including the Joint Commission’s national patient safety goal of improving the accuracy of patient identification and the Center for Medicare & Medicaid’s EHR Incentive Programs for “meaningful use” of certified electronic health records technology to improve patient care.

The barcode medication administration process reduces medication delivery errors by streamlining patient access services, pharmacy order processing and the nursing administration process. The workflow for nurses, whether they use WOWs or iPhones, is as follows:

• Notification of new order is received in the EMR
• Nurse collects medications (in barcoded packages) and administrative supplies
• Nurse takes medication, supplies and WOWs or iPhone with barcoding scanner into the patient room
• Nurse scans the barcoded patient identification wristband, opening the patient record in the EMR system
• Nurse scans each individual dose of medication
• Nurse administers the medications

Future plans for the iPhone app

The iPhone pilot recently ended, but nurses like Kwang hope the app will be adopted as a standard process. First, some glitches need to be worked out. For instance, the Rover application sometimes experiences a “connection timeout,” losing connectivity to the Internet. Then nurses need to rescan medications. Overall, though, nurses seem to like the flexibility offered with iPhone barcode medication administration.

Says Kwang, “Having a small, portable scanning device that is allotted only to nurses provides a reliable and available system to scan and administer medications in an effective and timely manner.”