Assessing Technology
When we are fresh out of school, a lot of us are infatuated with all the neat gadgets and toys but in reality, every piece of technology we use on our patients is a double-edged sword. Whether it be as simple as an IV or Foley catheter, to an A-line or ETT, each one has both a potential to do good AND the potential to do harm. And that is why we must train ourselves as nurses to assess the need for each piece of technology being used.
Here you will learn:
Here you will learn:
- Why limiting technology is important
- The Dark side of technology
- Pre-reqs to this skill
- 3 tips to get you rollin’
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Why Limit Technology?
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The Dark Side of Technology
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Pre-Reqs
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3 Tips
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Still Unsure?
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There are three basic types of technology we encounter (granted, a lot of these belong in more than one category):
Under the right circumstances, even the “safest” technology can create problems or hurt the patient. In the ICU especially, when so many patients are teetering between stable and unstable, a technological mishap could be that factor that sends them in the wrong direction or to their ultimate downfall.
As you strengthen your practice, it is crucial that you encompass technology in your mental sphere. It is up to you to see the big picture and to assess the technology currently being used to see if its strengthening the stability or taking away from it. And as circumstances change, it is again up to you to reassess if something else needs to be added, or if a piece of technology has lost its purpose.
It is important to remember that technology in itself is not the solution to a problem. More technology is not always better. In fact, as you will read here, more technology is a sign that things are may not be going so well.
- technology that helps with patient care- beds/specialty mattresses, compression devices, chair lifts, medication pumps and tubings, Foley catheters, IV’s/central lines, wound care, oxygen, NG Tubes or dobhoffs, etc.
- technology that helps gather data for clinicians- heart monitors, glucometers, arterial lines, rectal thermometers, BIS monitoring, Imaging procedures, etc.
- Technology that keeps patients alive- IABP, ventilators, ECMO, LVAD, blood infusions, chest tubes, a variety of medication, pacemakers, etc.
Under the right circumstances, even the “safest” technology can create problems or hurt the patient. In the ICU especially, when so many patients are teetering between stable and unstable, a technological mishap could be that factor that sends them in the wrong direction or to their ultimate downfall.
As you strengthen your practice, it is crucial that you encompass technology in your mental sphere. It is up to you to see the big picture and to assess the technology currently being used to see if its strengthening the stability or taking away from it. And as circumstances change, it is again up to you to reassess if something else needs to be added, or if a piece of technology has lost its purpose.
It is important to remember that technology in itself is not the solution to a problem. More technology is not always better. In fact, as you will read here, more technology is a sign that things are may not be going so well.
While technology has its use and often saves people’s lives, there are some risks associated with using technology that every nurse must be aware of:
- Too much technology can sometimes give too much information. The truth is that good use of technology should be designed to INCREASE clinical grasp. But when there is too much of it being used, there comes a point where there is simply to much data to manage and interpret, and it actually ends up taking away from the clinician’s ability to be attentive and engaged with the patient. In fact, when this happens, a lot of data becomes redundant or irrelevant. This all will have a snowball effect where clinical grasp is eventually lost, and in the process, probably puts the patient at risk for harm.
- Too much technology leads to technology-dependence. This is very clearly seen in patients that are intubated long-term, but it also extends to anyone on any piece of technology for long periods of time. The fact is that technology dependency is a very powerful symbol for the patient that adds to feelings of helplessness, powerlessness, and a distancing from the world. And that is never a good thing.
- Using technology in the wrong way leads to complications (discussed under “Interpreting Equipment Performance”)
- Commitment- For the most part, safety work and assessing technological uses is thankless work. It is mostly noticed when its absent (like when an error occurs or harm is done inadvertently). It takes commitment to do this every day but it can pay off big time when patients survive because things went smoothly.
- Practiced Attentiveness- Most of the time, the problem is not lack of knowledge, its lack of attentiveness and response to safety measures that could/should be in place (Like in the case of ICU core measures)
- Clinical forethought- Since every piece of technology could potentially cause harm, it is imperative that we take a moment to remember the potential risks of using it and what could happen with continued use.
- Clinical judgment- the concept of “judgment” entails a level of uncertainty. Adding, withholding, or withdrawing interventions/technology requires the ability to think and reason about that specific patient and making a judgment call on how to move forward.
Tip #1
At the start of your shift (or when possible) review each piece of technology and reason about why you are still using it. Is it necessary? If you don’t find a strong reason to keep using it, bring it up with the team and see if there is a better alternative. If you do have a good reason, keep a close eye on it and make sure you are utilizing/managing it correctly. There will come a point when its time to remove it, so come back to reassess as things move along.
One good way to look at this is considering if whether that technology (A-line, Foley, CVPs, etc) will provide any data that will likely change the course of treatment. If its not going to change what we are doing, then its probably not necessary. This happens a lot with people that have IJ’s and we were monitoring CVP’s but now their BP is stable and the doctors aren’t using it so much anymore (same with A-lines and blood gases).
Always remember: If the device/technology is not helping, it is probably hurting.
Tip #2
Consider the mid-term and long-term consequences of each technology. This is where clinical forethought comes in. If you can see a potential problem, you can also take steps to prevent it.
It works the other way, too. If you can foresee that a patient might be weaning soon or this specific piece of technology will be unnecessary in the near future, you can start preparing and coaching the patient and take steps to prepare for a successful transition.
Tip #3
Only work with technology you’ve been trained on. Although they shouldn’t do this, sometimes hospitals will say its ok to be the nurse for a patient that has a device or technology you are not trained in (or have had sufficient training with). This puts you AND the patient at risk.
If this happens to you, speak up to your charge RN. You should not only be trained in how to manage and use it, but also to troubleshoot it in case something goes wrong.
At the start of your shift (or when possible) review each piece of technology and reason about why you are still using it. Is it necessary? If you don’t find a strong reason to keep using it, bring it up with the team and see if there is a better alternative. If you do have a good reason, keep a close eye on it and make sure you are utilizing/managing it correctly. There will come a point when its time to remove it, so come back to reassess as things move along.
One good way to look at this is considering if whether that technology (A-line, Foley, CVPs, etc) will provide any data that will likely change the course of treatment. If its not going to change what we are doing, then its probably not necessary. This happens a lot with people that have IJ’s and we were monitoring CVP’s but now their BP is stable and the doctors aren’t using it so much anymore (same with A-lines and blood gases).
Always remember: If the device/technology is not helping, it is probably hurting.
Tip #2
Consider the mid-term and long-term consequences of each technology. This is where clinical forethought comes in. If you can see a potential problem, you can also take steps to prevent it.
It works the other way, too. If you can foresee that a patient might be weaning soon or this specific piece of technology will be unnecessary in the near future, you can start preparing and coaching the patient and take steps to prepare for a successful transition.
Tip #3
Only work with technology you’ve been trained on. Although they shouldn’t do this, sometimes hospitals will say its ok to be the nurse for a patient that has a device or technology you are not trained in (or have had sufficient training with). This puts you AND the patient at risk.
If this happens to you, speak up to your charge RN. You should not only be trained in how to manage and use it, but also to troubleshoot it in case something goes wrong.
Just remember, when in doubt, the less technology the better. You can bring it up with your team or with your charge RN to hear their thoughts. No one will give you the side eye for thinking about how to wean the patient off of technology as appropriate, I guarantee it!
And if ever you are unsure about something, always, always, always ask nurses around you for help. Better safe than sorry!
And if ever you are unsure about something, always, always, always ask nurses around you for help. Better safe than sorry!
30-Second Summary
- Technology is awesome sometimes, but it also carried a lot of risks.
- It is up to us to assess these technologies and devices for necessity and to use them appropriately.
- To practice this skill, one needs clinical forethought and judgment, a commitment to safety and practiced attentiveness.
- Review each piece of technology and if you can’t come up with a good reason for it, try and get it discontinued as appropriate.
- Remember the mid-term and long-term consequences of continued use.
- Never take an assignment that includes technology or devices you have not been trained in.