Digital Healthcare

The mobile workstation cart, sometimes called a COW (Computer on Wheels) or WOW (Workstation on Wheels) has become the default way to provide access to critical systems and information for clinicians in most hospitals. While there are certainly many types of devices that can provide access to hospital information systems, the mobile cart has become the tool of choice for many medical professionals. A cart by itself is not smart, but it does provide a simple and convenient platform to augment with clinical systems that allow input and retrieval of data.

So how do we make a cart SMART? First we have to look at the cart as a vehicle for change. While it provides access to clinical data, it also provides a good opportunity to revisit workflows that may be able to be streamlined based on the cart’s form factor and features. E-MAR (electronic medical administration records) with barcode scanning is one of the best applications that can benefit from a SMART cart.

Many hospitals utilize a workflow of “one to one” for medication administration to patients. This workflow is typically designed so that a nurse retrieves medication for one patient at a time from the ADC (Automated Dispensing Cabinet) or med cart on the floor. Nextthe nurse administers the medication retrieved and returns back to the ADC to retrieve the next patient’s medication, repeating the process again.  While the policy can certainly increase patient safety if followed exactly, it also creates many more steps and if very hard to enforce.

Adding medication storage to a cart can provide a basic platform to improve on the “one to one” workflow. Many carts can have some type of locking medication storage added to them. This creates an opportunity for clinicians to retrieve medications for multiple patients, separating and securing them at bedside. But such carts bring additional challenges to the hospital. Meds prepped by nurses before entering a patient room might defeat barcode safety checks, and meds can also be left in a cart and not returned to a central repository after a patient is discharged or transferred. This is where SMART cart technology can make the difference over a cart with only a basic locking system. 

The MedProx cart-based medication administration system is one way to take the carts to the next level and implement SMART features. MedProx is an intelligent bin system that controls individual bins on a cart, and can be paired with Advantech’s AMiS mobile workstation carts. Since MedProx is an intelligent medication administration system, it tackles some of the challenges faced by moving medications to the patient on the mobile workstation carts, and it provides the best platform for accountability, ease of administration, and an optimized workflow. 

When evaluating mobile carts that may include medication storage the following points should be considered:

·         What type of locking system is on the drawers (Mechanical or electronic)?

·         Can user access be centrally administered?

·         Can permissions and time outs be centrally administered?

·         Can reporting be centrally administered?

·         If the locks are software controlled can they be integrated with Microsoft active directory?

·         If the locks are centrally administered, does the system push data to the carts or does it use a real-time server based application?

·         Can the system integrate with the hospital’s information systems for advanced accountability?

·         Can the system notify clinicians when a patient has been transferred or discharged?

·         Does the system provide reporting to help enforce best practices?

These are all key features that go beyond just storing medications and allow SMART functionality and truly efficient and accountable operation.

Typically the decision to implement mobile carts with medication storage is tied to another software roll out such as E-MAR or barcode bedside medication administration. These are very large and complex projects in themselves, and many times the details of the mobile workstations and the workflow advantages they may be able to create are not considered up front. In the long run these features are important to higher barcode scanning compliance rates, meeting regulatory obligations, and enforcing overall best practices. 

Smart Medical Carts such as the AMiS mobile workstation cart with the Medprox Intelligent bin system are transforming hospitals, improving efficiency, reducing error, and making healthcare more patient-centered.