RNSafe: Remote video checks of bedside drug dosing

RNSafe-Bunker nurse view Screenshot_2015-04-16-10-31-32When a nurse gives a complex medication at the bedside, a second nurse must come in to observe and verify the dose. But flagging down a nurse on a busy hospital floor can be pretty challenging, especially when the nurse has to “suit up” because of infection control precautions in the patient’s room. During a Nursing Morbidity and Mortality (M&M) Conference at Boston Children’s Hospital, a group of nurses expressed concern that this arrangement could potentially jeopardize safety. “We thought we should be able to do better,” says project co-developer Jennifer Taylor, MSEd, BSN, RN-BC, CPN.

Under a grant from the Innovation Acceleration Program’s FastTrack Innovation in Technology (FIT) program, Taylor and other nurse-health care IT specialists—Stephanie Altavilla, MSMI, RN; Sara Gibbons, MSN, RN-BC, CPN; and Jowell Sabino, MSN, RN—prototyped a mobile system called RNSafe. Bedside nurses point an iPod camera at the medication they’re giving and its label and complete the entire medication process with a dedicated “bunker” nurse. The bunker nurse can view the video remotely on a Microsoft Surface Pro tablet, chat/instant message with the bedside nurse through Microsoft Lync technology, verify the medication and dose, and document it on a dashboard.

RNSafe mobile medication checks

Tests have shown that the iPod pictures are clear enough to verify doses in syringes, and have stood up to tests of different medications, colors and lighting conditions. “The resolution is extremely clear,” says Taylor.

RNSafe bunker dashboard

Currently, with RNSafe in the beta testing phase, four nurses are volunteering to sit in the “bunker” to conduct the virtual double checks. The future vision for RNSafe is to dedicate experienced nurses to the remote medication verification process—similar to the electronic intensive care unit (eICU) model in which remote intensive care specialists act as a second set of eyes in monitoring patient data.

“There’s an opportunity to use digital technologies to improve safety, consistency and clinical efficiency on the medical floor,” explains Alex Pelletier, MBA, director of Digital Innovation at Boston Children’s Hospital. “RNSafe can help reduce the workload of already busy nurses dedicating their time to patient care. It’s an example of how the future of clinical care might look.”

RNSafe will find its first pilot applications in medication-heavy areas, such as busy inpatient floors or intensive care units, but “we need to get the medication administration process right all the time, no matter the location,” says Taylor. “Units are excited for this pilot, and the RNSafe team is looking forward to beginning too.”