The Use of Personal Digital Assistants in Clinical Practice
Posted on: Friday, 9 May 2008, 03:00 CDT
By Santori, Catherine A
The Personal Digital Assistant (PDA) is a contemporary portable memory device that operates as an extension of the computer. This compact handheld device is lightweight and easily slips into a uniform or labcoat pocket. A useful tool for nurses and other health care professionals, the PDA provides updated, peer-reviewed medical information instantly at the bedside. Revisions in information occur when the computer and PDA are connected and synchronized. This article will explore clinical applications, personal health information, and other caveats for clinical use. In addition, research data on PDA use are limited. A review of current literature reflects positive outcomes when devices are used appropriately. Advantages
PDA programs are instantaneous, with zero lag time and no booting up. The ease of moving from one program to another saves time at the bedside. Clinicians can collect and store data at the point of care, a fact that makes the PDA useful as a research tool both for efficiency and point-of-care accuracy (Stroud, Erkel, & Smith, 2005).
An estimated 7,000 Americans are reported to die annually from prescription medication errors. The Institute for Safe Medication Practice has proposed initiating electronic-based prescriptions to reduce errors (Stroud et al., 2005). Use of prescription applications have the potential to reduce fraud and medication errors, and to provide formulary and co-pay information (Joy & Benrubi, 2004). A 7-day online survey by Rothschild, Lee, Bae, and Bates (2002) randomly selected users of Epocrates, a popular online drug reference source. The query generated a response from 946 consumers; 76% of respondents believed the Epocrates medication software improved their drug knowledge, 80% of users found the software improved their drug-related decisions, and an astounding 50% of those polled stated they avoided one or more serious adverse events per week (Stroud et al., 2005).
As a reference tool, the PDA can enhance effective patient care and efficiency by providing information for medication doses, names, interactions, classification, implementation, contraindications, adverse reactions, and dosage calculation. Information can be retrieved at the patient bedside. Laboratory values, metric conversions, and diagnostics are available. PDA programs provide risk management, error reduction, stress reduction, and user confidence with the ability to access critical information (Rosenthal, 2003).
The PDA saves time and money in data entry. Capture ware, a type of software available for use with the PDA, allows providers to fill out assessment forms and then download them into a database. Patients can fill out office questionnaires on a PDA; the information can then be downloaded into the computer, saving time and labor cost (Giammattei, 2003). The nurse is able to carry the patient history and medical information in a compact device, chart at the bedside, and synchronize with the hospital or home care company computer at the end of the day. Logistics between several hospitals and offices for surgeons can be enhanced by the device's beaming capabilities (Giammattei, 2003). The Voorhees Hospital, one of four in Virtual Health, has enterprise-wide wireless access. Nurses can use a PDA to retrieve patient laboratory values, medications, diagnostic reports, and potential medication interactions (American Nursing Informatics Association [ANIA], 2006).
Patient-tracking software is useful for providers visiting facilities outside their office, such as nursing homes or hospitals. A subset of the patient care records can be carried, tracking allergies, medication lists, labs, problem lists, history and physicals, studies ordered, and results with ease of access (Spikol, 2005). The PDA can provide enhanced knowledge about patients. Portable information is particularly useful for night coverage in hospitals with patients experiencing complex conditions (Torre & Wright, 2003). Clinicians beam information on patients, which saves time while delivering a thorough report of the patient's condition, plan of care, and treatments.
The benefit of having information in the palm of one's hand not only saves time, but it reduces trips to the computer by 80%. Computer access areas located near patient charts tend to be overused by a variety of clinicians, including physicians, social workers, and therapists from various departments. It is less advantageous and time consuming to wait for computers or to have to search for an available monitor (ANIA, 2006).
Capture programs automatically generate billing codes based on medical guidelines, making the PDA a useful tool for service fees. By using this method of billing, it is estimated that practitioners earn an extra 5% per year while seeing the same number of patients (Joy & Benrubi, 2004).
Clinical Decision-Based Support Systems (CDSS) contain rules and databases of medical information using evidence-based models. Structured evaluations of critically appraised topics (CAT) from peerreviewed medical journals and other sources are found in the CDSS. Guidelines that are interactive provide evidence-based care to the patient at the bedside. A wireless PDA with Internet access has the potential to retrieve medical information. Databases could be updated regularly with the most current medical information, and retrieval time would be exceptional (Tudiver, 2003).
A study of PDAs in Taiwan implied usefulness in hospital emergency rooms, triage, and Emergency Medical Services in route to the hospital to reduce time spent on paperwork for documenting and data gathering (Chang et al., 2004).
Health Information Portability and Accountability/Security
The Health Information Portability and Accountability Act's (HIPAA) final rule refines standards for securing Protected Health Information (PHI) in electronic form. The following rules apply:
* Only the authorized person may use the device.
* An administrator will access and grant control.
* Audits of users are available by the administration.
* Data must be encrypted at both the PDA and computer level.
* Integrity of the system must be maintained and remain tamper- free.
* Transmission, which may be achieved via encryption and firewalls, must be secure (Rosenthal, 2004).
Beaming via infrared ports does not require encryption (Thompson, 2005), but the ports should be disabled except during use (Rosenthal, 2004). Most infrared transmissions can only travel a few feet, making interception nearly impossible (Thompson, 2005). Infrared transmissions should not be sent in public places (Rosenthal, 2004). Keep track of the device at all times if it contains PHI. If it is necessary to have the device repaired, all patient information should be erased (Thompson, 2005).
Wireless access is available in two main types of networks, Interoffice Local Area Network (LAN) and Internet Wide Area Network (WAN). These networks can be combined, and security is necessary with Internet access. Security may include built-in firewalls, Wire Equivalent Privacy (WEP) 128-bit encryption, turning broadcasting features off, changing the default network password, Media Access Control (MAC), setting the wireless fidelity or Wi-Fi, allowing access to devices with known MAC addresses, and the use of Virtual Privacy Network (VPN) to transmit or access via the Internet. "VPNs use encryption and authentication to allow secure point-to-point transmission of data between private networks" (Lewis, 2004, p. 69).
Caveats
* Need for training is a problem. Residents with intense schedules do not have time to learn about applications, and many are not using their PDA to its full potential (Joy & Benrubi, 2004). There was no mention regarding nursing. Research regarding a learning curve for nursing is needed.
* There is risk of colonization of the PDA with microbes. Used as a medical device, the PDA serves as a potential reservoir for cross- contamination. A New York study of infection control for staphylococcus and cleaning of 75 hand-held devices demonstrated samples from 96% of the devices were culture positive prior to cleaning. After cleaning the PDAs with an alcohol swab, 75% of the devices became culture negative (Hassoun, Vellozzi, & Smith, 2004).
* One of the problems requiring further investigation is how PDA applications and the perception of the device's value by those being trained are related (Chang et al., 2004). Training and satisfaction with the PDA as an important and useful tool are inseparable.
* More research is needed on the potential uses and problems with handheld devices.
* Available PDA medication programs are not infallible; they do not account for all medication interactions and provider oversights. Software limited to drug interactions is more accurate regarding interactions than programs intended for general drug information. The practitioner or nurse entering the order must take into account that the programs are about 90% effective. Practitioners also tend to ignore frequent interactions that may be considered unimportant, which ultimately may cause adverse events (Barrons, 2004). A study of the nine most popular drug software programs conducted in 2002 and 2003 by Barrons (2004) also questioned the accuracy of medication programs. The research reinforces that care and vigilance must be practiced when prescribing medication with the assistance of personal digital software (Barrons, 2004).
Conclusion There are many drug guides and medical references for nursing available on the Internet. Handheld device cradles plug into a port on a computer, allowing synchronization of information from one device to the other. Nurses simply download educational software from the Internet to their handheld devices. Software companies offer trial periods, and trial options may involve downloading selected portions of a program. The user will then scrutinize advantages and drawbacks for a particular software brand prior to purchase commitment. Many software programs have several applications from which the nurse can choose depending on his or her specialty. It is wise to check with the nursing organization, school, or employer with which you are affiliated because some organizations sell software to their members at a discount. Nurses can also exchange information, such as important telephone numbers, literary reviews, and text via infrared ports on their handheld devices.
Drug calculations, drip rates, conversion calculators, ICD-9 and CPT codes, lab interpretation, diagnosis, medical dictionaries, drug dosages, and adverse reactions are some of the many applications at the point of care in the palm of your hand. You do not have to wait for a computer to boot up or download. You are at the site where you need to be with a single tap. Your dose is calculated for you. The PDA is an excellent tool for those returning to nursing, starting a new career, or multitasking.
As a reference tool, the PDA can enhance effective patient care and efficiency by providing information for medication doses, names, interactions, classification, implementation, contraindications, adverse reactions, and dosage calculation.
References
American Nursing Informatics Association (ANIA). (2006, February). PDAs Give nurses point-of-care data. Retrieved March 17, 2006, from http://www.ania.org
Barrons, R. (2004). Evaluation of personal digital assistant software for drug interactions. American Journal of Health-System Pharmacy, 61(4), 380-385.
Chang, P., Hsu, Y., Tzeng, Y., Sang, Y., Hou, I., & Kao, W. (2004). The development of intelligent, triage-based, mass- gathering emergency medical service PDA support systems. Journal of Nursing Research, 12(3), 227-235.
Giammattei, F.P. (2003). Implementing a total joint registry using personal digital assistants: A proof of concept. Orthopedic Nursing, 22(4), 284-288.
Hassoun, A., Vellozzi, E.M., & Smith, M.A. (2004). Concise communications. Colonization of personal digital assistants carried by healthcare professionals. Infection Control and Hospital Epidemiology, 25(11), 1000-1001.
Joy, S., & Benrubi, G. (2004). Personal digital assistant use in Florida obstetrics and gynecology residency programs. Southern Medical Journal, 97(5), 430-433.
Lewis, M. (2004). A primer on wireless networks. Family Practice Management, 11(2), 69-70.
Rosenthal, K. (2003). "Touch" vs. "tech": Valuing nursing- specific PDA software. Nursing Management, 34(7) 58-60.
Rosenthal, K. (2004), Get "smart" with a PDA. Nursing Practice Management, 35, 17-18.
Rothschild, J.M., Lee, T.H., Bae, T., & Bates, D.W. (2002). Clinician use of a palmtop drug reference guide. Journal of the American Medical Informatics Association, 9(3), 223-229.
Spikol, L. (2005). Take your personal digital assistant to the next level. Family Practice Management, 12(10), 39-41.
Stroud, S.D., Erkel, E.A., & Smith, C.S. (2005). The use of personal digital assistants by nurse practitioner students and faculty. Journal of the American Academy of Nurse Practitioners, 17(2), 67-75.
Thompson, B.W. (2005). HIPAA guidelines for using PDAs. Nursing2005, 35(11), 24.
Torre, D.M., & Wright, S.M. (2003). Clinical and educational uses of handheld computers. Southern Medical Association, 96(10), 996- 999.
Tudiver, F., (2003). The usefulness of personal digital assistants for health care providers today and in the future. Southern Medical Journal, 96(10), 947-948.
Catherine A. Santori, CMSRN, is a Staff Nurse, Thoracic Surgery/ Telemetry, The Cleveland Clinic, Cleveland, OH.
Copyright Anthony J. Jannetti, Inc. Mar/Apr 2008
(c) 2008 Medsurg Nursing. Provided by ProQuest Information and Learning. All rights Reserved.
Source: Medsurg Nursing
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