APNA 30th Annual Conference Session 2034: October 20, 2016 Using - - PDF document

APNA 30th Annual Conference Session 2034: October 20, 2016 Wagner 1

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Using Electronic Devices to Improve the Patient Care Experience on an Inpatient Behavioral Health Unit

APNA 2016 conference Session ID # 2034

John Wagner MA, M.Th., RN Director of Behavioral Health Nursing University of Iowa Hospitals and Clinics 2

Disclosure

• This presenter has no conflict of interest to

disclose.

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Objectives

• Participants will identify security and privacy

concerns regarding patient use of cell phones and personal electronic devices on inpatient psychiatric units.

• Participants will be able to identify interventions

that can be taken to minimize the security and privacy risk of cell phones on BHS units.

• Participants will identify the benefits to

behavioral health patients, of maintaining contact with family and friends throughout the hospitalization.

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History of Cell Phones Development

• 1992 The first digital cellphone
• 1996 The first flip phone
• 2002 The first camera phone
• 2003 The first Blackberry
• 2004 The first Smartphone
• 2007 The first I-Phone

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Adults in the USA who own a:

Cellphone Smartphone

• 2002

64% 0%

• 2004

68% 0%

• 2008

78% 0%

• 2010

82% 35%

• 2012

84% 45%

• 2014

90% 58%

• 2015

92% 68%

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Cellphones have become imbedded into the lives of many adults.

• Much like individuals who smoke or drink

may experience varying withdrawal reactions when hospitalized

• Loss of access to cell phones can cause anxiety

ranging from minimal to severe

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Cellphone use by hospitalized patients

• Once use was prohibited
• Safety Concerns
• Now use is common
• Even expected
• Tool to increase patient satisfaction
• Avoidance of negative encounters
• Maintain contact with friends and family

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Smart phone use in hospitals?

Study done at a large hospital in California

• 79% for Entertainment or Games
• 48% Access their Personal Health Record (PHR)
• 44% Read about Condition/Treatment
• 29% Read about Providers
• 27%Read about Hospital Polices

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Use of cellphones by those with persistent mental illness

2014 Study involving over 1,500 individuals

• 98.8% owned a mobile device
• 91.6% used it to talk
• 38.8% used it to text
• 33.2% used it to access the internet

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Things Change?

• Most patients on BHS units own cellphones

– Of these, more and more are smart phones

• BHS patients like to use their cell/smart phones
• Just like everyone else
• Not allowing access to cell phone causes issues
• Don’t know the phone numbers of family and friends
• Text is often the preferred method to communicate
• View this restriction more and more as unacceptable

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Why cellphones aren’t allowed on Behavioral Health Units

• Confidentiality
• Cameras
• Sound recording
• Expense
• Perceived danger

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Why Cell Phones aren’t allowed on BHS units (cont.)

• Unforeseen consequences
• Unknown Contacts
• Illicit contacts
• Loss of control

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Why we considered change at UIHC

• Patients were becoming increasingly affected
• Staff spending more effort on this issue
• An unnecessary restriction for most patients
• Because of the concerns of a few
• Inconsistent with other precautions
• Suicide
• Phone Restrictions
• Sexually acting out behaviors

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In the end, the difficulties were to great

• Psychiatrists
• Administration
• Hospital Legal
• Compliance
• Security

And then it all changed with one visit And a strong partnership with Psychiatry

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Cellphone Camera

• Industrial Espionage Tape
• Changes color when removed
• Check the phones daily to determine if phone has

been removed

• Zero tolerance for removal of strip
• Collaboration with Hospital Legal and Security
• Most Wired Hospital status is helpful

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Develop patient cellphone expectations

• All staff/disciplines need to be in agreement
• Use of cellphone is a privilege not a right
• No use of cellphones in groups
• Camera strip must remain inplace
• No use of sound recording
• Patient cannot choose to use phone instead of

attending therapies

• Assess every patient for risk
• Sexually Acting Out Behaviors
• Manic patients

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Lessons learned from previous innovation

• There is an expectation to determine what

success looks like

• To determine an intervention
• Measure the effect of the intervention
• Evaluate the data
• Make decisions improvements based on that data
• The Iowa Model

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Methodology of the Study

Established survey tool

• Social and Emotional Loneliness Scale for Adults

UIHC developed survey tool

• No survey tool existed to meet our needs
• Developed for inpatient psychiatric unit
• Measured perception of remaining connected
• Measure connectedness to society

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Methodology of the Study (cont.)

• Pre and Post Survey Strategy
• Magnet Project
• One pre survey group
• Three follow up survey groups
• Survey population
• Types of units involved
• Types of patients

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Results

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Lessons Learned

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Questions?

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