I agree that the combined med cart /COW is not a good idea. We evaluated several different ones and never found anything we liked. We settled on what has become known around here as "skinny COWS". They are Dell laptops with an add on 12 hour extended battery pack mounted to a stable but small footprint stand. The stand is very basic but it does at least adjust in height. It has a basket, a moveable tray and a recessed shelf that they basically just keep the scanner in. The stands come from GCX. They were cheap enough (approx 2500.00 each)to be able to have one for each nurse (RN's and LPN's have their own). The nurse still works off of the med cart. Most units already had 2-3 med carts that worked well for them. They pull their COW up to it, prepare their med pass to the point of the patient verification prompt and then take the meds and their COW into the room to complete their pass. This has worked well for us even on our most busy med/surg unit. We use the tethered scanners with a 6 foot cord. At first we were afraid they would be too long and get in the way but the excess just lays in the basket (an unintentional but good use for it). We placed the COWS on the units at least 2 weeks prior to their go live and had them use them for their competency testing as well as general charting so they had some time to get used to the laptop keyboards. We are now seeing the nurses use them for more then just their med passes. They keep their COW with them and use them throughout the day for their other charting. As far as patient confidentiality goes we use the status board and the nurses minimize it as they leave one room and then maximize it when they get back to the med cart. So far this has not been an issue for us. Thanks, Susan :-)
________________________________ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Davis Daniel - Southern Hills Sent: Monday, July 30, 2007 9:48 AM To: Cheryl Drexler; [email protected] Subject: Re: [MEDITECH-L] Bedside computer versus COWS Our facility was "hardwired" with dumb terminals in every room. Then with the advent of eMAR and BMV (should be one product as far as I am concerned) we moved to wireless COWs. Now we are in the process of moving back to a wired computer in every room. Here is a list of issues we found with each device: Wired in the Room 1) Staff don't really like staying in the room to document unless they are in the process of giving meds. Patients and family ask questions, or if you are catching up other documentation begin to wonder why you are taking so long. 2) Staff must log in and log out each time they go in a room to document, can result in tighter times before the system logs you out to keep HIPPA information safe, requires some kind of proximity system to make it efficient. 3) Loose the ability of having "extra" room on a cart to help carry some stuff with you. 4) If one computer is "down" you don't have the extra wireless cart to pull into that room to give meds. COWs 1) Higher rate of staff injury due to push/pull of the cart, especially across thresholds. 2) Higher rate of maintenance as laptops were not really designed to work well 24/7 in an enclosed space. 3) Higher rate of maintenance as chargers, batteries, cords, etc go bad. 4) It can also be difficult to distinguish if staff are plugging the carts in appropriately to get the batteries charged. 5) Allow staff to remain logged in from room to room, but can created HIPPA/JCAHO, etc violations as staff get used to remaining logged in and auto logout times get relaxed to accommodate user practice of staying logged in. I believe it has been a mistake to attempt to combine the COW and Med Cart ideas. The COW was designed to be a light, small foot print device that can reasonably easily navigate a crowded patient room. The Med Cart was designed to remain in the hall and be pushed only a few feet in a straight line at a time. As you can see from my list, each path has its own set of problems. Just depends on which set your facility is willing to deal with as staff start to complain! Daniel Davis ________________________________ From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED] On Behalf Of Cheryl Drexler Sent: Monday, July 30, 2007 7:57 AM To: [email protected] Subject: [MEDITECH-L] Bedside computer versus COWS Anyone working with Nursing and Nursing workflow, I'm new to this position and my first task is to look at devices to help the nursing staff. We are in the process of going back on-line documentation with Nursing and are going to begin with BMV. My question is what is the better way to go, using a hard wired in patient room computer or a COW. I'm concerned about using the COW with multiple med drawers due to size and weight and the fact that I know of some facilities that purchased COWs and now they are pushed into corners not being used. From your experience, what would you use if you looked at workflow and not the financial side. If you are hardwired, are the nurses using the device in the room or are they going outside the room to do the documentation? If you are using COWs, are they being used and what type of cart are you using, one with multiple drawers or one with maybe one or two drawers. The last of my questions is; what type of scanner/imager are you using? Are you using Meditech's recommended version that has to be hard wired or are you using a wireless system that then has be to be interfaced into Meditech? Is anyone using the Motion C5 that was recommended in another listing? Thank you very much for your input. Cheryl Drexler RN Application Specialist Lima Memorial Health System Lima, OH 419-226-5197 ext 2901
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