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Informatics Project: Patient Interaction Automation System

Lewis Smiley
Delaware Technical Community College
Nursing Informatics NUR 410
Mrs. St. John
April 13, 2023
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The process that could be enhanced by nursing informatics is the call bell system in the

hospital and its connection with the documentation of interactions with the patients that we work

with as nurses. There has always been so much time taken after we interact with our patients to

then sit down and chart everything, we completed with them. Also, some interactions with

patients are never charted and thus in the eyes of someone looking at the patient's chart after the

fact were not done. For these reasons being able to track when a nurse or patient care technician

(PCT) leaves the room after a call bell. Once they are tracked leaving the room then a

notification could be sent through a program to the handheld device that they are using (most

likely a cell phone or equivalent device) that would prompt the nurse or the PCT to answer

questions about their interaction with the patient. I set to describe a way with technologies that

are already available to put together a way to track these interactions and document them

automatically to the electronic health record (EHR). This system I would call the Patient

Interaction Automation System (PIAS).

Call bell technology has been around for a long time but there have not been many

advances from the patient hitting their call light, the nurse or PCT answering the light at the

nurse's station and the nurse or PCT interacting with the patient and completing the task that the

patient had called for. Many patients have had problems with the call light system in that they

feel that the call light was answered but then there is a long time between when it was answered

and when they received the care they had called for. In a study described in the article

“perspectives of nurses and patients on call light technology” (Galinato et al., 2015) patients

were unhappy with the timeliness of their call bells being answered, lack of follow through on

the task and the also the amount of time it took to complete the task they had asked for (Galinato

et al., 2015). Also, on the other side of call bells nurses and PCTs are always explaining that they
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are unsure of whose responsibility it is to answer call bells and most nurses find call bells to be a

hinderance on the work they are trying to complete with their patients (Galinato et al., 2015).

The way that patients and nurses and PCTs feel about call bells shows that there is a problem

with this system. For there to be a problem with this system is a problem for the hospital because

call bell responsiveness plays a big part in patient satisfaction, patient safety and the quality of

individual patient care (Galinato et al., 2015). Also, timeliness in answering call bells is related

to less nosocomial pressure ulcers and less patient falls and if there is a fall call bell

responsiveness corelates to less injury from the fall (Galinato et al., 2015).

In addition to call bell responsiveness by the nurse or the PCT answering the call bell if

the unit clerk answers the call bell and cannot communicate the information to the nurse or PCT

because they do not have their handheld device on them or if the unit clerk doesn’t even pass on

the patients request the task can be forgotten and the patient is left wondering if anyone is

coming to help them (Digby et al., 2011). Also, many of these original call bell system designs

cannot track how long the call bell took to be answered if the task was completed in a timely

manner or completed at all (Digby et al., 2011). The Patient Interaction Automation System

(PIAS) that I propose would be able to fix a lot of these problems, increase patient satisfaction,

safety and the quality of their care.

All these interactions with patients, besides giving medication, need further

documentation outside of the room after the nurse or PCT completes the task. If the nurse or the

PCT does not document the interaction, then technically it didn’t happen in the eyes of someone

looking at the patients EHR after the shift is complete. Documentation of these tasks is very

important part of the care of the patient because not only does there need to be a record of these

interactions and these tasks that are completed for the patient overall but also anyone checking
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the EHR during the shift may need to see this documentation to get a picture of the patient’s

health. This includes vital signs, toileting and outputs from drains and tubes, intake through

drinking and Intravenous fluids and documentation of turning and ambulation.

The Patient Interaction Automation System (PIAS) would communicate with the

electronic health record (EHR) which holds the largest ability to cause issues that will have

ethical and legal ramifications. The electronic health record (EHR) as of 2017 has now been

instituted in 95% of hospitals in America because of the initial passage of the Health Information

Technology for Economic and Clinical Health (HITECH) Act in 2009 (McBride et al., 2018).

Electronic health records are a very important part of documentation of healthcare delivery in

hospitals and as a guide for clinical decision making (McBride et al., 2018). The use of the PIAS

system to communicate directly with the electronic health record could always cause possible

ethical and legal issues because of the use of a secondary device to document patient interactions

could allow for mistakes just as any documentation device could and a mistake in documentation

could lead to the system making its own determination of a clinical decision. If documentation of

a patient's urination is not documented correctly or if documentation of the patient having a

bowel movement is not documented correctly then it may look as if the patient has not urinated

or had a bowel movement in an extended period. Documentation of urination is very important

after surgical procedures as patients may have retention issues or also may not be producing

enough urine. Documentation of bowel movements is very important in that patient could have

undiagnosed constipation and this may lead to an obstruction which can be very serious.

The Patient Interaction Automation System (PIAS) would entail new technologies that

are available such as the ability to track the nurse through their handheld device going into the

room to answer the call bell and document the patient interaction directly on their handheld
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device by having a sensor on each patient room door that would track when the handheld device

left the room and it would notify the nurse or PCT that they should document the specific

interaction they had with the patient after they finished helping them. The company Centrak has

developed a call bell tracking system that works with the nurse or PCT badge that is tracked by a

sensor above the room and timeliness and accuracy of call bell answering is tracked efficiently

through this system as described in their nurse call automation pamphlet (Centrak, 2021). This

system would be linked to the PIAS system that would help in the documentation of the reason

the patient rang their call bell. The nurse or PCT would be tracked going into the room and when

they left the room the call bell would be turned off and then the Centrak system would work with

their handheld and prompt the PIAS system to ask the nurse or PCT what they had answered the

patients call bell for and give them the ability to directly chart intakes through drinks and food,

outputs through helping the patient to the bathroom, patient turns, patient ambulation etc.

Often a lot of these interactions with patients may happen but because it was not

documented it looks like these tasks did not happen. Having a way to not only track that a nurse

or PCT answers the call bell by using a sensor on the entrance to the patient’s room but also

having a way that once you enter the patients room you would get a notification on the PIAS

handheld device (probably the same device one would use to communicate with other nurses and

PCTs such as a smartphone). The nurse or PCT would get this notification that they had exited

the room and then it would give them a diagram that they could document this interaction with

the patient. Not only would this save time by being able to document quickly using a series of

choice clicks to common reasons you would enter a room after a call bell, but it would be real

time documentation.
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There would be no chance to forget what they did with the patient because it would be

automatically asking them to document what task they just completed directly as they leave the

patient's room. It would also hold PCTs and nurses accountable for checking on their patients

within an appropriate amount of time and would make sure that everything that was completed

with the patient was documented correctly and at the right time.

This system would not only increase nurse and PCT productivity it would improve

patient outcomes in that there would be more documentation of patient interactions without all

the time it normally would take to sit at a computer and document the interaction after the fact. It

would also increase patient satisfaction because this call bell door tracking system would log in

that the PCT or nurse went into the patient’s room and helped them with what they had needed.

Patients would have much more face to face interaction with either a PCT or a nurse. And for

nurses they would know based on the EHR whether the PCT went into the room and checked on

the patient and how they interacted with the patient through the documentation.

The Patient Interaction Automation System (PIAS) workflow maps that I have created

are designed to change the way that nurses and PCTs or patient care technicians document

interactions with the patient via the call bell system when doing tasks other than medication

administration which is already directly real time documented. The first workflow map

(Workflow #1 - Process as it is now with manual computer charting, see page 7) describes the

current way that nurses and PCTs are interacting with patients for non-medication tasks when

answering call bells. The second workflow (Workflow #2 – Process with the addition of

Handhelds with automated room recognition, see page 7) would be the process improvement that

would be put in place to replace this current workflow (PIAS).

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The use of the workflow maps with the description of the original workflow and the new

workflow (PIAS) and how it would increase productivity, improve patient outcomes and

improve the documentation of patient interactions was very descriptive and easy to follow. One

can see clearly where the changes in the workflow appeared and where the workflow originally

had problems and this new workflow through the Patient would improve those problems. The

use of a color system to show the automated parts of the new workflow show how this new

process has been improved because these tasks would be automated by the handheld in PIAS to

send to the Electronic Health Record (EHR) and would not require the nurse or the PCT to do

anything further. The patient interaction automation system is a hypothetical creation that with

the technology available could be easy to accomplish and put into practice. The PIAS’s real time

documentation and call bell tracking can not only help with patient satisfaction, but patient safety

regarding falls and patient’s quality of care by ensuring on time call bell answering with on time

completion of patient tasks and care. The PIAS system by increasing patient safety, decreasing

falls, decreasing pressure ulcers, and increasing patient satisfaction can also save the hospital

system money by decreasing these nosocomial injuries. The PIAS would require a policy to

incorporate this system into the hospital not only to keep caregivers and management on the

same page as to the expectations of the patient interaction automation system but also to make

sure it is implemented correctly (see page 9).

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Patient Interaction Automation System Policy

I. PURPOSE: The purpose of this policy is to establish guidelines for the Patient

Interaction Automation System or PIAS.

II. POLICY: The Patient Interaction Automation System (PIAS) is to be used by the

Nurse and the Patient Care Technician (PCT).

III. PROCEDURE:

A. When the call bell is initiated by the patient the nurse or PCT will answer the call

through the call bell system.

B. The nurse or PCT will verify what the patient needs and decide if this is a PCT

task or the nurse is needed.

1. If the patient is asking for medication, then the nurse can travel to the patient's

room with the medication.

2. If the patient is asking for a food item or drink the nurse or the PCT can travel

to the patient's room.

3. If the patient is asking to use the bathroom the nurse or the PCT can travel to

the patient's room.

4. If the patient is asking for any other type of help the nurse or the PCT can

travel to the patient's room.

5. If the patient makes a mistake by ringing the call bell the nurse or the PCT can

travel to the patient's room.

C. The nurse or PCT then carries their PIAS handheld device to the room and

completes the task that the patient requested.

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D. The nurse or PCT as they leave the room will get an automated response from the

PIAS handheld device to answer how they interacted with the patient.

1. If the patient is asking for medication, then the nurse answers the prompt for

medication administration and the PIAS handheld stops the documentation

since medication administration is handled through the Electronic Medication

Administration Record (EMAR) already.

2. If the patient is asking for a food item or drink the nurse or the PCT answers

the prompt through the PIAS handheld for food or drink.

3. If the patient is asking to use the bathroom the nurse or the PCT answers the

prompt through the PIAS handheld for bathroom use.

4. If the patient is asking for any other type of help the nurse or the PCT answers

the prompt through the PIAS handheld for “other”.

5. If the patient makes a mistake by ringing the call bell the nurse or the PCT

answers the prompt through the PIAS handheld for mistake, the PIAS

handheld stops the documentation.

E. Once the nurse or PCT answers the prompt through the PIAS handheld for what

interaction they had with the patient they can then give the specific details of the

interaction.

1. If the nurse or the PCT answers the prompt through the PIAS handheld for

food or drink, then they can add what food item the patient ate and or what

amount of drink they gave the patient into the PIAS handheld.
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2. If the nurse or the PCT answers the prompt through the PIAS handheld for

bathroom use, then they can document directly in the PIAS handheld what

type of bathroom use.

3. If the nurse or the PCT answers the prompt through the PIAS handheld for

“other”, then they can free text type information directly into the PIAS

handheld about the specific reason for the call bell.

F. The PIAS handheld then will automatically send this information to that specific

patient chart in the Electronic Health Record (EHR).

IV. RESPONSIBILITIES:

A. All nurses and patient care technicians (PCTs) will receive training and

demonstrate competency in the use of the PIAS handheld device.

B. All nurses and PCTs will ensure that the information they input into the PIAS

handheld device is promptly done after leaving the room to ensure timely and

accurate charting.

C. All nurses and PCTs will clean their PIAS handheld device with PDI Sani cloth

wipes after each patient interaction.

D. All nurses and PCTs will properly place PIAS handheld devices in their proper

charging locations if they need to charge or if the nurse or PCT are completing

their shift.
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References

Galinato, J., Montie, M., Patak, L., Titler, M. (2015, August) Perspectives of Nurses
and Patients on Call Light Technology. Computer, Informatics, Nursing, 33(8), 359-367.
doi: 10.1097/CIN.0000000000000177.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546527/

Digby, R., Bloomer, M., Howard, T. (2011, July). Improving call bell response times: Robin
Digby and colleagues studied the effects of raising awareness of call bell response on
how promptly staff attend, patient falls and satisfaction. Nursing Older People, 23(6),
22. https://go.gale.com/ps/i.dop=AONE&u=googlescholar&id=GALE|A266139654&v=
2.1&it=r&sid=AONE&asid=342105da

McBride, S., Tietze, M., Robichaux, C., Stokes, L., Weber, E., (2018, January 31). Identifying
and Addressing Ethical Issues with Use of Electronic Health Records. OJIN: The Online
Journal of Issues in Nursing 23(1) Manuscript 5.
https://doi.org/10.3912/OJIN.Vol23No01Man05

Centrak. (2021). Nurse Call Automation.

https://content.centrak.com/hubfs/RTLS%20Brochures/CenTrak_Nurse%20Call%20Aut
omation_030320.pdf