Nurses Save Time, Prevent Frustration with Computer Carts in Patient Rooms

When the University of Colorado Hospital (UCH) moved to a new facility in July 2007, it saw an opportunity to improve nurse satisfaction by upgrading the computer process nurses used at the bedside. The Aurora-based hospital first received ANCC Magnet Recognition Program® (MRP) designation in 2002 and was resdesignated in 2006.

In the old facility, nurses in med-surg areas had their own carts assigned to them, which they had to roll from patient room to patient room as they made their rounds so they could use the computer on the cart as they administered medication and documented at the bedside.

The carts were a huge frustration for nurses, according to Kathy Smith, MS, PMC, RN, supervisor, nursing informatics—and former MRP project director—for UCH. The carts were difficult to roll on the carpet in the hallways when moving from one patient room to another, and if the cart encountered a bump, it often logged nurses off the computer, so they had to start again when they reached the patient room. The computers also had batteries—which made the carts heavy to maneuver, and needed to be recharged all the time—and nurses found the batteries were always dying at the wrong moment.

Smith relates that many times the batteries needed to be replaced, which increased workload for the IT staff. In addition, UCH realized that having one cart per nurse wouldn't work with the new bar code medication administration it system was implementing.

"We could see right away that was not going to work," says Smith. "It would require that every time a nurse wanted to administer a medication, she would have to go find her cart, unplug it, move it into the room, then plug it back in, then boot it up, then administer the meds."

Smith relates that this was a fantastic example of the CNO advocating for nursing's needs. The hospital had already budgeted and expended money on the new bar code medication administration system, and then the CNO went back to the executive level and said that the nurses needed to have a computer in every room in the hospital. Despite the significant budget, the hospital invested in its nurses.

UCH chose another cart system, rather than a wall-mounted computer, because nurses wanted flexibility with moving the cart around to different parts of the room. Also, UCH had already planned the rooms in the new building, which weren't designed for wall-mounted computers.

To choose the best system, the hospital staged a "cart fair," at which nurses could examine the different types of carts on the market and determine the ones that would best meet their needs. They eventually chose mobile computing carts from Rubbermaid Medical Solutions.

"The new carts now stay put in every patient room," says Smith. "They are plugged into the wall, so nurses don't have to worry about the battery ever being run down." But still having the computer on a cart allows nurses the freedom to move around the room as they like and use the computer where it makes most sense for them and the patients.

The carts have a computer screen, the CPU in box, a big work space, a drawer, and a light. The light enables nurses to see medications and so forth during the night shift without turning on the lights in the room and greatly disturbing patients.

The new computers were crucial to the successful adoption of the bar code medication administration system, Smith says. "I think we would have had a revolt if we hadn't done it," she adds. "They would have been very dissatisfied. And it would probably have been a failure for our bar code medication administration project."

Smith says the carts contribute to nurse satisfaction. "The nurses love them," she says. "They made a big poster with a big thank you card and gave it to the CNO. It said 'Cow-a-bunga! ["Cow" is an abbreviation for "computer on wheels."] We love the new computers in patient rooms!'"