Media

The wonders of wireless

Tue, 07 Dec 2010 11:02:00 GMT

A new wifi-based nurse call system promises to offer increased flexibility and certainty for residents. Beverley Head reports.

Anglican Retirement Villages and UnitingCare have emerged as two early adopters of a new Australian-developed WiFi-based wireless nurse call system.

Wireless nurse call systems have been available for some time, generally using proprietary equipment for that sole purpose. The recent release of Questek’s WiFi-based nurse call system however, allows aged care facilities to piggyback the system over a WiFi wireless network. This can be used to run multiple applications, such as care programs or medication management, promising both cost savings and easier systems design and management.

Bart Williams is general manager of Questek Australia, which has developed nurse call systems for over a quarter of a century. By law, all aged care facilities must have a nurse call system that residents can use, but in the past most of these have been hard wired to physical networks.

While the bell-next-to-the-bed model has been extremely valuable, hard wired systems don’t offer much in the way of flexibility or additional functionality. To refurbish or remodel a room often requires cables to be ripped out and replaced.

Because Questek’s WiFi-based system is wireless the end point units can be simply relocated, or even offered as a pendant – and, when overlayed with geospatial mapping software, can also serve as resident locators.

According to Williams, while there have been wireless nurse call systems in the past, “they were really a glorified garage door opener”. He claims that some aged care facilities which installed the systems actually did find that the system would be triggered when next door’s garage was opened with a wireless control.

Harnessing WiFi networks overcomes that issue.

Wayne Donald is the network architect for UnitingCare’s IT services department and is preparing to roll out a WiFi wireless communications network at a new 100 bed facility in Shellharbour, NSW.

The organisation runs about 70 aged care facilities, providing care for 14,000 people. Although UnitingCare has used some wireless nurse call systems in the past, these were “pretty basic” according to Donald, and are now only used in some of UnitingCare’s assisted living units.

The benefit of moving to a more comprehensive WiFi-based system hinges around the flexibility that it promises, and also the certainty for residents that their call has been registered. Many early wireless systems were mono-directional. They would send the signal for help, but if it could not get through because of network congestion, the resident would have no way of knowing their call had not been received.

The Questek system indicates to the user with visual and audible alerts that their call for help has been received. Residents can either use an in-room battery powered unit (which can be simply relocated as there are no wires) or provided with a pendant (batteries are rated to last for three years of standard use).

Either way, when they use the system, they get feedback to let them know their call for help has been registered. “It’s very very important for residents to have confidence in the staff and their care,” said Donald.

By overlaying a location management layer on the wireless network it’s also possible for nurses who get a call from a resident’s pendant to know that they’re not in their room, but in the TV lounge.

Each of the end points checks in to the central server over the wireless network with its temperature, battery life and status every ten minutes. UnitingCare may also eventually harness that functionality, particularly the room temperature monitoring, and “Setting alarms for when the room is too cold or too hot. This is not just about comfort, but safety,” said Donald.

The system can also be used to monitor fridge temperatures or thermostatic mixing valves, which moderate the temperature of hot water. According to Questek, not only can this temperature monitoring ensure a clear audit trail for accreditation and safety purposes, it can save money by ensuring proper temperature regulation throughout the facility.

The implementation at Shellharbour is intended as a pilot for UnitingCare, which will consider a move to wireless systems as it has to upgrade systems in its other facilities.

Martin Barber is an IT and communications specialist at Anglican Retirement Villages, which provides aged care services to 6000 people in the Sydney Diocese. Its 18 aged care facilities all feature hard wired nurse call systems at present, but Barber says these are pretty unforgiving in terms of flexibility or refurbishment.

“One of the big difficulties is in our older buildings, you can only change the current technology with difficulty as it involves pulling cables,” he says.

ARV’s introduction to Questek’s technology came when it experienced problems with one of its existing hard wired nurse systems. Barber worked with Questek to develop a workaround solution, and in the process learned about the planned WiFi-based system.

As ARV’s corporate strategy involved a gradual move to Cisco supplied WiFi networks, which is expected to be completed by the end of 2011, the ability to piggyback another service on that network was attractive as it meant one network could be used to support multiple applications.

Williams says it was this ability to leverage off existing networks that encouraged the company to develop a WiFi-based nurse call system in the first place. He said that historically nurse call systems could be installed for $1200 to $2000 a bed, but “if we’re not supplying the network the WiFi nurse call is about 20 per cent cheaper”.

By the end of October Barber hopes to have rolled out a pilot of WiFi-based nurse call in 10 to 15 rooms at ARV’s Donnington Court facility. While the wireless nurse call system is the core issue, “the idea that there will be a thermometer in each room is an added value.”

If the pilot goes well ARV will look to using the system more widely and its long term roadmap includes switching on some of the additional functionality such as location based services.

Barber adds that WiFi networks, which are based on the IEEE 802.11 standard, operate at different frequencies to devices such as hearing aids or pacemakers and so pose no problem to residents using such devices. While there can be some challenges associated with WiFi network interference from microwaves or lifts, he believes careful network design can overcome such issues.

This article first appeared in the Oct / Nov 2010 issue of INsite.
Go to www.agedcareinsite.com.au

The future is here, and it's wireless

Wed, 03 Nov 2010 07:02:00 GMT

There’s a revolution underway in the provision of nurse call systems, and Questek are leading the way. Already a leading player in the development of integrated and sophisticated systems for the aged care sector, Questek are ready to launch their products into a new era of integrated wireless networking. Bart Williams, General Manager of the company, was one of the first to realise the potential application of integrated platforms throughout the sector and is enthusiastic about launching the system at ITAC 2010. “It’s a whole new way of approaching nurse call systems that nobody we know of in Australia has done,” explains Bart. “Wireless has been done in the past, but it’s been done poorly, now it’s time to do it right.”

The development of Questek’s new wireless nurse call system is a timely response to the wireless revolution already taking place in homes and institutions across the country. “More and more aged care facilities are putting in wifi networks for computers,” says Bart. “They’re using wifi for staff computers so they can enter clinical documentation and resident data by the bedside. Some are offering that mobile computing capability to residents to enable them access to the internet, or the ability to Skype their families. It’s certainly early days, but what we are seeing is just the beginning of the installation of wireless networks in aged care facilities.”

Bart and the engineers at Questek were quick to notice the trend for major providers of aged care to install to wireless networks when upgrading or fitting out new builds.The company’s technology experts were also impressed with the safety, speed and reliability of platforms offered by major suppliers such as Cisco, Trapeze and Meru Networks. The development of their new wireless nurse call system was a matter of fitting the two pieces of the puzzle together.

A traditional nurse call system may be a sophisticated piece of technology in terms of the functionality it can deliver, but the developers at Questek were keenly aware that with that sophistication came some downsides. “Traditionally we’ve installed hardwired systems which involves running cables right through the building,” explains Bart. “It’s fairly costly to do the physical installation because there’s so much labour involved and the installation of devices can be limited by the design of the building. So, we thought, people are putting these wireless networks in for computers, why not piggyback off these wifi networks for a truly flexible nurse call system that’s simple to install and maintain?”

Wireless call systems do already exist, but only in a very simple form. To illustrate the difference, Bart compares them to a garage door opener. “Historically, wireless systems have been pretty average,” says Bart. “My theory is when you drive up to your garage door and press the button, if it doesn’t work the door doesn’t open, so you push it again, maybe a third time and the door opens and hey presto you’re in. but when you’re in a nursing home bed, the nurse call system is the button you push to hopefully save your life in a time of need. You’re not facing the world and you don’t hear any dings and dongs and bells, how do you know that pressing the button has worked? You don’t.” It was solving this issue that topped the Questek agenda and drove the development of their new wireless system.

The revolutionary aspect of Questek’s wireless nurse call system is all in the detail

To address the ‘fear of failure’ aspect, the company have a developed a two way system that both sends an alert and lets the resident know that the message has got through. Once the button is pushed, there is a period of time where the button negotiates with the wifi network and with the central call control system, and then the central system sends a message back to that resident to let them know that their call has been received and registered. This response system offers reassurance to the resident. In the very rare instance the initial call fails, the button will continue to call until a response is achieved and the resident notified.

The second key feature of Questek’s wireless nurse call system is the complete flexibility it allows when it comes to designing the system and locating the device units. “We’ve now got the flexibility of putting the button wherever we want,” enthuses Bart. “You can put it in the traditional locations like in the shower, by the toilet and by the bed, but you could even stick the button on the bed head and now you can wheel the bed around the room. So the bed’s no longer fixed in one location, and the resident has freedom of choice as to where the bed goes. Take that to the next step, and the resident has a mobile button, in the form of a pendant, and that pendant can be used anywhere on the site where there’s a wifi network coverage. Most importantly, with the right network that mobile pendant can offer real time location tracking. “This is the function that can make a real difference in an emergency situation,” says Bart. “Not only do you know that, say, Mary from room 105 has pushed her pendant, but you can also know where Mary is when she calls for help. So without being really big brotherish, it’s extraordinarily powerful.” It’s extraordinarily powerful in aged care because trying to find fairly mobile residents, especially in a hostel type environment where they could be anywhere from their room to the lounge to the café, shouldn’t be a matter of chance. “It’s most likely that they’re not in their bed when they pushed their button,” Bart points out. “If they’ve tripped over in the corridor, historically pushing a pendant would only alert nurse control central to who is in trouble, not where. Now we can know who it is and where they are and help.”

Location, location, location

There are multiple applications for a two-way wireless nurse call system within a residential facility. Real time location tracking can help locate a resident in need, but the aggregated data can also give managers a real time picture of how residents use the facility, when and where people congregate for example. It also allows any wireless device on site to be tracked, allowing visiting service providers’ actual location to be monitored, a powerful safety device. The flexibility of the system also makes it ideal for use in both community care and in home care situations. Wireless networks are increasingly the norm in residential style situations, and easy to install where they are not pre-existing. The use of a pendant offers easier and more secure access to help for highly mobile users. The device talks to the home router and reports to one of the monitoring centres, such as Baptist Home Care.

Pain free retrofitting

The beauty of Questek’s wireless nurse call system lies in its marriage of cutting edge technology and truly simple solutions. This combination extends to one of the system’s greatest selling points, the ease and economy of upgrading or replacing an existing nurse call system with the new wireless system. “If you already have a hardwired nurse call system, then the wireless system simply integrates at the head end,” explains General Manager Bart Williams. “Whether a facility has one of our nurse call systems installed or not, they don’t have to start again at the beginning, we can build on what they have or, if they’re not happy with the existing system, then we can install an entirely new one.”

Bart has seen the future of nurse call systems, and is convinced the future is wireless. “It’s the next step in all systems, nurse call systems and beyond,” he says. “For a new building, retrofitting is not too hard, but when you’re retrofitting an existing building, then wired systems bring all kinds of extra issues and costs. It’s complicated and often pretty ugly. With this system you can just say ‘I want one there’ and bang, there it is.” The ease of installation with a wireless system extends to moving devices as needed. The system offers facility managers much greater flexibility in managing and changing the use of each room as the device is not tied down to one location, or to one functionality. “If you start off with a fairly low care facility, then increasing the level of care over time is simple and painless with a wireless system,” says Bart. “It can just grow with you, and is pretty much unlimited, you can have as many devices as you need, or as few, as a pendant can replace the need for multiple fixed devices in a single space.”

Questek’s wireless nurse call system offers immediate practical benefits, whether you’re retrofitting an old building or at the design stage for a new facility. Cabling an existing building can be a messy and expensive business. Cabling a new build can add expense and compromise design. “Builders will, for example, put enormous effort into waterproofing a bathroom space to prevent building damage, then someone has to come along and cut a hole in that wall to install a hardwired button,” points out Bart. “With a wireless, there’s no penetration to the wall at all. Clients can opt for hard screwed holders, but we designed it so it will double tape to the wall and can be moved at will without leaving any damage.”

Flexibility is built into the details of Questek’s wireless nurse care system, whether big or small. “It’s so flexible,” stresses Bart. “You can site buttons anywhere, get them mobile, track them, respond to them anywhere. So long as there’s a wireless access point that the button knows it needs to speak to, then we can put one anywhere.”

Building successful networks

The future is wireless and the future of wireless networks is integrated. “You’re isolating yourself if you go for a limited, stand-alone network,” cautions Bart Williams, General Manager at Questek. Historically aged care facilities have relied on a number of self-contained systems operating alongside each other. A facility would install a telephone network, then a computer network, a nurse call network, a security network and a cctv network, all of them stand-alone systems. “What happens is you then have to maintain and manage all those disparate systems,” explains Bart. “With advanced wifi technology you can integrate all those systems into one and avoid doubling up on costs and time. Put in a good wifi network, then you can layer everything on top of it.”

Questek’s wireless nurse call system is a logical extension of existing technology and it really is as simple as a button. “We’re trying to be infrastructure agnostic,” says Bart. “We don’t really care which network it is, though we prefer to deal with one of the networks that actually works and as part of the installation we can assess whether it’s a quality network and recommend which are.” ..

A world of potential

If anything that has Bart and the team at Questek buzzing with excitement, it’s the potential inherent to their new wireless call system. As the development process unfolded, the team realized that the flexibility of the system meant that it would be capable of meeting the needs of wide range of situations and industries. “Now that the button is flexible, we can actually make the button do whatever we want,” says Bart. “The device can be anything, it doesn’t have to be a nurse call button. It could, for example, be a mobile staff duress button.”

"Information overload" What is it and what does it mean at the coal face of aged care?

Wed, 27 May 2009 00:01:00 GMT

By Brett Gilbert RN, Nurse Consultant for Questek Australia Pty Ltd

Since the 1970’s there has been an exponential growth in information technology. As a result we are being bombarded with masses upon masses of information every day. By attempting to process all the information in a timely and accurate manner we can experience “information overload”. Information overload is a term coined in 1970 by Alvin Toffler in his book Future Shock. It is a term that accurately describes what many of us experience everyday in our modern lives. Whether it is by the breathtaking amount of information a search engine such as Google can produce in less than 1 second.

(Results 1 - 10 of about 30,600,000 for information overload. (0.25 seconds))

The amount of spam in your inbox or by the shear number of passwords, pin numbers and access codes we are expected to have committed to memory for instant recall, information overload is an ever present evil in our daily lives. The best way to define information overload would simply be having to much information to know what to do with, and therefore preventing us from being able to make timely decisions and take action.

The aged care sector like many businesses is taking on information technology at a rapidly increasing rate. All staff involved in making decisions in the care of residents find themselves experiencing information overload. Whether it be care staff members getting back up to speed with the status of their residents after a few days off or management staff ensuring that all care plans, progress notes, assessments, forms and charts are being completed in a timely, accurate and up to date manner, it seems that all healthcare professionals are experiencing information overload.

Facilities are expected to produce increasing amounts of documentation to demonstrate the level of care provided in order to obtain an appropriate level of funding from the Federal Government. It is important that documentation systems utilised by facilities reduce information overload rather than amplify it. Depending on your position within the hierarchy of an organisation, the way you view and receive clinical documentation/information will vary greatly.

For the care staff member that has just returned from a number of days off, it is important for them to be informed of pertinent changes in the care and condition of the residents they look after. For that reason it should be integral for the clinical documentation system to enable staff to easily and quickly update their knowledge of any changes in the residents care. To prevent staff from having to sift through the documentation made on all residents, IT based clinical documentation systems can organise within their databases, relationships between staff and residents in their care. By automatically filtering the clinical documentation down to only the residents in a staff members care, staff can gather any pertinent information, get on the floor in a timely manner having confidence that they are able to uphold the duty of care they have to their residents.

For senior clinical staff it is important that they maintain individualised care while having a more global view of the documentation/information being gathered at the facility. Due to the amount of documentation collected it is important that clinical documentation systems highlight issues of clinical significance, whether that be assessments, forms or charts that have not been completed, or recorded observations that are outside of expected ranges. With the coming together of technologies it is now possible for senior staff to be alerted instantaneously of assessment, form or chart entries that require the attention of staff with a higher level of clinical expertise. This can be achieved by the expected ranges within an assessment form or chart being predefined and the clinical documentation system forwarding this uncharacteristic entry to a senior clinician as a high priority message. Senior clinical staff have an alert sent to there DECT telephone informing them they have received a high priority message. Having automatic alerts is just one way that IT based clinical documentation systems can ensure that the right information is reaching the right people at the right time.

IT based clinical documentation systems provide a seemingly infinite amount of information for management to analyse, but with simple filtering they can quickly and easily evaluate the care being provided in their facility. The clinical documentation system provides the manager with the ability to produce analysis and reports that convey all that information in a discernable fashion. Because the IT based clinical documentation system provides all of the clinical information gathered at a facility, management are able to combine this view with their intimate knowledge of the workings of their facility to extract meaningful data. By management informing staff of positive and negative trends in the care provided at the facility, staff are able to focus on what is important, which again reduces information overload.

As the population ages, the average number of residents per aged care facilities will increase and it is important that clinical documentation systems do not erode the viewing of residents as individuals. As important as the numbers are to the funding arrangements of aged care facilities, we must do everything in our power to prevent a case of caring by numbers. By using an IT based clinical documentation system, staff can be confident that the information they collect is not simply an overwhelming task of collecting data for the sake of funding but is in fact guaranteeing the highest quality of life to the people they care for through evidence based practice.

When is a nurse call system no longer a nurse call system?

Wed, 03 Nov 2010 07:03:00 GMT

By Bart Williams MBA, General Manager, Questek Australia Pty Ltd

Over the past decade we have witnessed some radical changes in the way in which technology has changed the delivery of care in residential aged care. Some notable changes have been the introduction of the DECT (Digital Enhanced Cordless Telecommunications) phone, computerised clinical documentation and improved security through networked access control. During this time we have also seen substantial changes in the humble nurse call system. Today we are seeing a move toward converging technologies but should some technologies be converged?

Many of us would remember a nurse call system based on lights and buzzers (still referred to as the buzzer system today), often created in someone’s garage using components that were at hand. I have seen some interesting adaptations in my time, from light switches relabelled – Nurse Call, to car trailer lights as over door indicators. Over time these systems have become more sophisticated with the advent of paging, then DECT and now VoIP (Voice over Internet Protocol) communication. We have seen the introduction of advanced dementia monitoring as well as voice communication to the bedside. But what is a nurse call system and when does the shift in technology take away from the original intent? When does the intent of the nurse call system shift to total integrated communication?

In 1998 a number of manufacturers formed a committee to write the Australian Standard AS3811 – Hard Wired Patient Alarm Systems. The standard is used today as a basis for comparison and accreditation. Most new nurse call project specifications are written with the requirement to comply with AS3811, but as technology moves on, more and more systems are moving away from complying with the standard. In fact many new features requested in specifications not only fall outside of the standard, they contradict the standard and this puts manufacturers in jeopardy when formally documenting that their system complies. Is it time for a review of the standard or do we change the project specifications so that the nurse call system is just that, and the extra features required are specified separately?

So what is a nurse call system and what does the industry require for onsite communications?

Traditionally the nurse call system was stand alone and designed so the patients in acute care could call for nursing staff in times of medical need. The belief was that this system translated well into aged care, with little or no modification. Residents used the nurse call system to call for staff attention in the same way. But the difference in aged care is that not all nurse calls are based on medical emergencies. Without differentiation between calls, nursing staff are unable to prioritise the call. As manufacturers we have tried to combat this with different levels or priority of nurse call, i.e. call from the bed, call from the ensuite, nurse assist for staff to staff and even emergency (a flow on from acute care), but still this did not truly prioritise the call, it only identified from where the call was initiated. In aged care there is a shift from a medical emergency to an emotional need and therefore ‘nurse call’ was no longer definitive enough.

So how do residents get their message across? Do we need to break the nurse call system into two halves, medical emergency and emotional need?

These questions could result in two different response requirements, from different staff. For instance nurse call buttons are installed in the traditional locations for true medical needs but then a separate system could be installed for emotional or non-medical needs. Currently we are offering a combined system and this has been confusing for the resident and the staff. If we were to supply two systems would it not be easier to meet the expectations of the resident, and then wouldn’t this in turn improve staff responsiveness and increase resident’s independence?

So how should the second system operate, now that the nurse call system is again for medical emergencies only? One idea is to provide bedside telephony similar to that in a hotel where a resident can call reception for service, but then you would need a full time operator to respond to these calls. Or would it be better to supply a panel where the resident can select the option they require? This panel could be mounted on the wall but would a resident be able to operate it? The extra services could be delivered through the television. If it were delivered through the television through a menu system, other services could also be provided such as meal options or booking bus trips or even pay per view movies. The choices are endless. The nurse call system is again being used as it was intended and an alternative communication system is providing extra services that may even attract residents to a facility. Although I have suggested the systems being separate, behind the scenes they can remain as one IP based service, or convergence.

So where to now?

Convergence of systems onto one network makes sense and we will need to review the standards as more and more devices become IP enabled. When specifying a system we should consider at what point it needs to integrate to other systems but before we jump into a solution let’s think of the end user, will they be able to use it, will they benefit from it and is there a return on my investment?

Article published in IT:Informer - Australia's aged care technology resource from aged care direct, Issue 9 April 2009

The future on call

Wed, 03 Nov 2010 07:04:00 GMT

By Francesca Newby

Bart Williams, MBA (MGSM) General Manager, Questek

When it comes to talking about Questek with Bart Williams, things quickly get personal. Not just because he heads a flourishing family business, but also because the experiences gained through his long-term involvement in the aged care sector. “When I first started off as a project manager, there was a resident in one of the sites with no limbs,” remembers Bart. “There was no system in place he could operate. All he could do was yell, which he found frustrating and undignified. He asked us to develop an alternative so we came up with a blow tube. When we came to install it, he was in tears and he said, “Mate, you’ve given me a voice”. That’s great stuff, giving somebody a voice, that’s when you know you’re doing something that delivers a real human benefit.”

It’s clear that Bart takes a lot of pride in knowing that Questek is at the front of the field when it comes to assistive technology in the aged care sector. “We were the first company to do it, and still the best,” he states. “There are some other systems out there, some of them are ok, some are just plain bad, but nobody can do it like we do.” As far as Bart is aware, Questek was the first company to produce a system specifically geared to benefit patients with dementia. In 1993, Trish Shields and Bob Price of Alzheimer’s Education (part of the Alzheimer’s Association of Australia) came to Questek to create a system that was “world’s best practice” for dementia care. “They said, ‘we have a problem, when we give residents a button they either press it all day and annoy the staff or they don’t press it when they need help.” This was just the kind of problem the Questek team relished. “We sat down and came up with a modelling system that tracked the patient everywhere they went in their room, that could recognize the pattern of a normal day and that would ring an alarm at any unusual behaviour.”

Breaking new ground is a business method that Bart has made his own. “It’s all about convergence now, and the catch cry is IP,” explains Bart. IP, or Internet Protocol, is considered by many to be the future of all the systems installed in hospitals and aged care facilities. “What we’re looking at is a situation of taking lots of different systems and making sure that they can talk to each other seamlessly,” says Bart. “Access control, CCTV, MATV and nurse call systems historically all sat on their own network doing their own thing, now the future is to link them up but it needs to be done properly.”

As well as taking Questek into the networked future, Bart is looking to build the company overseas while maintaining the growth they’ve achieved here in Australia. When we met, Bart was just a few weeks away from his forthcoming wedding to his fiancé, Donna. After the honeymoon, he’s due to hit the road for six months building Questek’s profile and contracts through South East Asia and the Middle East. “ We’re in talks with a whole load of distributors and outlets,” says Bart. “We’re looking at expanding in Dubai, Brunei, Singapore, Malaysia, India, Indonesia, Vietnam and Laos.”

It’s a big step forward, and a long way from the beginning of the Questek story. “Over the past 13 years we’ve grown to a company of 30 employees,” says Bart. “We provide excellent solutions for our clients and a great working environment for our staff. We’ve just moved into new premises that are four times the size of the old one, but we’re still a family run company and we’re very proud of that.”

Taking Questek Overseas

Careful and steady would best describe the approach Questek has taken to moving into markets internationally. “It’s been a slow road, but you can’t rush this if you want to do it right,” says Bart Williams. Questek have supplied their products in the international market previously, but generally under a client company’s brand. The move Bart is making now is to build a network of international distributors for Questek’s own products.

“Indonesia is one of our biggest markets, I think we have nine hospitals there now,” says Bart. The company has chosen to focus on the South East Asian market rather than the US, where Questek already has a sister firm, or Europe. “We’ve done special projects in Hong Kong and Japan,” adds Bart. “We always work with public hospitals when we do projects in the region, and so far always at someone’s request.”

The benefit of choosing South East Asia for the planned expansion isn’t simply about proximity, but about standards and reputation. “Interestingly, there’s not a lot of legislative regulation in South East Asia, but there are very high standards,” explains Bart. “Hospitals there know that in Australia we have to meet high standards and comply with legislation so there is a lot of confidence in our products.”