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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.
 

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

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.”