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Tagging, Tracking Nurses Improves Workflow

 |  By Alexandra Wilson Pecci  
   March 25, 2014

Nurses at a Florida hospital are wearing electronic tags to track their daily steps. The data has been revealing and led to changes in workflow. The CNO says nurses like it and "know that it can help them."

If nurse managers could walk for a day in their staff nurses' shoes, they'd get a picture of just how busy those nurses really are. And in an ideal situation, nurse managers could use that information to make nurses' jobs easier and their days better organized.

That's exactly what's happening at Florida Hospital Celebration Health in Celebration, FL, where more than 100 nurses and patient care techs are wearing tiny electronic tracking tags in an effort to streamline their workflow.

"Nurses are really busy," Celebration Health's CNO, Patricia Jo Toor, RN, BA, MSN, tells me. "We need to be more effective and efficient in what we do, and nursing is the most expensive asset in the hospital… how can we better help their day? How can we make sure that how we have the unit set up is really efficient for nursing?"

It was these kinds of questions that drove the hospital, which was already using electronic tracking tools to keep track of medical equipment, to use Real Time Locating System (RTLS) technology on its staff. It implemented the program in 2011 in the surgical unit, and has since expanded the program to the OR and medical oncology units. The program literally tracks nurses' steps.

First and foremost, says Toor, was getting nurses onboard with the idea of being tracked. Leadership kept the program optional and promised never to use the data to punish nurses. No matter what. Never.

"Ever, ever," Toor emphasizes. "If you're a leader and you need to do this to find out what you're staff is doing, you're not a very good leader."

"Because then you lose their trust," adds Ashley Simmons, MBA, LSS, MBB, Director of Performance Improvement. "That's not what we want it for at all." Instead, the nurses were told, "here's the info and here's how we can leverage it to help your workflow and help your team."

The hospital has kept that promise for nearly three years, using the data only to help nurses make their workflow more efficient, and never using it to write someone up for professional discipline. So far, the program has been very successful. Any nurse can come in at any time and ask to look at his or her own data, which can provide insight on days when a nurse might have felt especially harried or "off."

Looking at the data in aggregate has been helpful, too. For instance, although one very long unit had two nursing stations, the data showed that nurses tended to congregate at and use the front station more often. So when it was time to build a new unit, the hospital built the front nursing station bigger than the one in the back.

The program has also helped improve hourly rounding.

"We could actually track whether or not this is happening," says Simmons. "It's not just about going in there every hour. It's about the intentionality behind it, and how much time you're spending."

As a result, they've achieved 90% hourly rounding, not to mention the hospital's highest patient experience scores.

"Each time that they round they're spending at least 2 to 4 minutes each time," says Simmons. "It's not just a quick poke your head in."

The data has also led to changes in workflow. For instance, the data showed that patient care techs always took dirty pumps to the clean sterile area around 6:00 am, which is one of busiest times for the nurses. However, the data also showed that the techs had a lot downtime between 1:00 am and 3:00 am.

"Now they actually do the pumps between 2:00 and 4:00 am," Simmons says.

They've learned about staffing, too. For instance, nursing leadership has found that having less staff at night isn't always a smart move.

"There's very little difference between the amount of time that nurses are in patient rooms on this unit between days and nights," says Toor. "There's the thought that you can staff down on nights because there's not as much going on."

They're also starting to question the effectiveness of 12-hour shifts, as well as shift start and end times, based on patient flow and what the data tells them.

Such a program takes a lot more than nurses simply wearing the tags. Because Celebration Health is piloting this technology, they've gotten some of the equipment donated from the vendor, Stanley Healthcare. But there are other costs involved, too, and this year the hospital aims to determine the tracking program's ROI, Toor says.

They've hired a full-time IT employee to analyze the data, breaking it down in many ways, such as by patient age and gender, service line, and other variables. Having someone analyze and interpret the data is important because just looking at raw data can sometimes lead to the wrong conclusions.

For instance, on the surface, it looked like nurses weren't doing hourly rounding on joint replacement patients. But a closer look shows that those patients went for group rehab for a couple of hours during the middle of the day.

"When you go down these kinds of roads, you have to understand your data before you report it out," Toor says. With that in mind, the nurse leadership brings the analyzed data to staff meetings quarterly, and the analyst meets regularly with nurse managers.

Toor and Simmons say that now, the program is well-accepted, and nurses often forget that they're wearing the tags. "They really do like it," Toor says. "They know that it can help them,"

Alexandra Wilson Pecci is an editor for HealthLeaders.

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