As a healthcare professional and military veteran, UNLV Nursing graduate student Barrister Perez wasn’t always fortunate to have advanced technology at his disposal. But now he’s at the forefront of introducing a unique programming fix at his hospital.
Perez works as an ICU registered nurse at the VA Hospital of Southern Nevada. One of the most important tasks for him and other nurses is to double check a patient’s medication, also known as PRN, a medical abbreviation for the Latin pro re nata, meaning to take "as needed." Nurses are required to reassess how often and effective their patients are taking these kinds of medications, which can include pain medications and breathing treatments. An ongoing assessment issue forced Perez to go outside-the-box to find a solution that won’t just benefit his unit, but his entire facility.
Sounding the Alarm for a Change
At Perez’s hospital, nurses use a system called Vista CPRS that delivers medication to a patient. They are supposed to clear or reassess the patient’s medication after one hour. But overtime, the process broke down. “It often gets missed because in bedside nursing, everything gets busy after a while, and they forget,” he says. “The nurses weren't checking on them, whether the medication worked or not, because of the lack of a reminder.”
Perez says their compliance metrics dropped, and some fellow nurses received written disciplinary actions because they failed to properly reassess. So, he began exploring the possibility of an automated alert system to alert. Through his research, Perez figured out they could connect this proposed alert system to an existing pager system some hospitals already have, including some VA hospitals in Long Beach, California, and Seattle, Washington. He dug into the data within the systems.
“I called Seattle and Long Beach to acquire the data, and it showed an S-curve adaptation,” Perez explains. “By the time they adapted the feature, their metrics just shot up. It's sustained from when they started adopting it in late 2018 to early 2019.”
The pager system is a voice-assisted program that would notify another nurse or doctor in the building. Applied to the existing alert, it would send tiered “ding” sounds automatically after a designated time until a nurse documented a PRN medication’s effectiveness.
Perez presented his findings to his hospital leadership, who approved the idea to implement the new system throughout every unit in the hospital. “We're leveraging technology to our advantage,” he says. “That's what [management is] particularly excited [about].”
He conducted a pre-survey and a one week trial, both with positive results. Per his survey, 96% of nurses agreed the pager would help. Now the hospital is upgrading its server to handle this new technology, with a scheduled launch date in October 2022.
Aside from improving medication assessment time, Perez says this technology will pave the way for other types of alerts, like critical lab values. “Whenever critical lab values come up, like really low hemoglobin or blood levels, it would automatically alert the physicians,” Perez says. “It just opened the floodgates of opportunity to leverage this device particularly.”
Prior to working at the VA Hospital of Southern Nevada, he served as a first lieutenant in the Nurse Corps as well as a medic for five years before that. Tasks like assessing patient medication proved even more challenging. “You had to manually reassess,” he recalls. “It's worse because they still have to use paper documentation, especially in a deployed environment. None of this fancy stuff.”
As Perez waits for his idea to come into fruition this fall, he feels proud to have enacted a change of this magnitude. “I managed to implement something hospital-wide, which is kind of rare for bedside nurses to do,” he says. “Usually, only people in a leadership position would be able to do such a task. I'm just glad I was able to be proactive and contribute in a way that would also improve the metrics of the hospital, and at the same time, improve care for the veterans.”