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Healthcare has come a long way from the days when cell phones were banned from hospitals because of the interference with radiofrequency cardiac monitors. Mobile phones are now used for call systems, reference, and documentation. Although healthcare professionals have been using mobile computing devices for more than a decade, beginning with the Palm brand of personal digital assistants, until recently there was little institutional support for using mobile clinical references.
More and more nurses are using clinical references and other tools that are now available on smartphones (cell phones that have Internet access and computer-like functions, including running applications). Mobile clinical references are becoming a necessity to access current and evidence-based information at the point of care (POC). This article describes this emerging technology and how it can be applied to your practice. (Electronic medical records and other types of software integrated into a facility's secure network are beyond the scope of this article.)
Mobile applications (commonly called apps) are software programs for smartphones and other handheld computing devices. Apps let you perform functions similar to those you'd do on a desktop or laptop computer, such as looking up drug information. In healthcare, the most common mobile apps downloaded are clinical references also known as POC references, such as electronic drug manuals, drug calculators, tools to facilitate analysis of lab and diagnostic studies, and differential diagnosis guides.
These references make accessing current information much easier for nurses. For example, you can research drug interactions while preparing to administer medications without taking valuable time to search for a drug reference book. Unlike a print drug reference, many mobile reference apps provide updates, including new drug indications, warnings, and newly marketed drugs. Updates usually are available with subscription programs or included in the purchase price of the software. Free references usually have limited features and may not include automatic updates. See Free mobile apps and where to get them for a selection of free POC apps.
Not all apps are available for all mobile operating systems. Most new mobile apps are being developed for Apple's iOS mobile operating system, and can be found in the iTunes App Store online. Other online sources for specific operating systems include Android Market (http://www.android.com/market), BlackBerry App World (http://appworld.blackberry.com/webstore), and Palm App Catalog (http://www.palm.com).
Start by determining your specific needs, such as the types of clinical problems that you encounter frequently. For example:
* Float RNs need to have a wide variety of reference information at hand, including pathophysiology, drugs, and lab values related to the specialty units where they may be assigned.
* Nurses who routinely encounter patients who can't remember the names of their medications (but can describe the medication's appearance) would find a pill identifier useful.
* Most nurses can use a drug calculator to help avoid serious errors with complex medication -infusion formulas.
Check your device's app store. Search major publishers' websites-Lexi-Comp, Lippincott Williams & Wilkins, and McGraw Hill are traditional book publishers that also have mobile apps. You also can put the appropriate keywords (for example, "drug infusion calculator") into a search engine. Be aware that using a search engine casts a wide net-the keywords above will return links to universities' recommended mobile references, general interest mobile application websites, and publishers with mobile references.
If the application you're interested in is available in free and paid versions, downloading the free version is one way to gauge how easy it is to use and to evaluate the quality of the data. (Remember that free versions often have limited features.) You can also search for online reviews of the app to see what other users have to say about it. Another method is to consider buying apps from a publisher or developer whose other products you trust.
See Some smartphone prices and operating systems for a selection of what's on the market. In addition to the standard voice packages for cell phone service, customers with smartphones must buy a data plan that provides Internet service. Before signing a cellular contract, be sure you understand the contract terms and early cancellation -charges-and that the network's coverage area and quality of service will meet your needs. If you're planning to use your smartphone at the POC, research wireless coverage and reliability at your workplace or -workplaces.
Although in the past, many healthcare professionals were buying and using POC apps on their own, academic medical centers are gradually seeing the value of these apps for employees and students. Among the universities and schools of nursing that require students to have smartphones or handheld computing devices are Drexel University College of Nursing and Health Professions in Philadelphia, Pa.; Northeastern Ohio University Colleges of Medicine and Pharmacy in Rootstown, Ohio; Ohio State University College of Nursing in Columbus, Ohio; and the University of Virginia School of Medicine in Charlottesville, Va.
As more of the healthcare professionals entering the workforce have been exposed to POC apps during their education, it won't be long before hospitals and health systems fully embrace the technology. But there are still some practical barriers to be resolved:
* Battery life. Nurses work a minimum of an 8-hour shift with many nurses routinely working 12-hour shifts. Mobile phones that are in constant use have to be charged in the middle of a shift, and this downtime can be a disruption. Until device makers can increase battery life, healthcare executives and informatics nurses seeking to implement a POC app program need to find solutions such as accessible charging stations or backup devices.
* Network overload. Apple's exclusive contract with AT&T has pointed up the problems when data usage exceeds network capacity. iPhone owners have discovered that network coverage is weak or nonexistent in some areas.
As these issues are resolved and more health systems integrate POC apps into their information technology infrastructure, the use of mobile devices will surge. In a few short years, smartphones will be as indispensible as the stethoscope.
Prices vary depending on retailer, and are based on smartphone purchase with a new wireless service -contract. Apple's iPhone is only available through AT&T; the others are available from various wireless carriers.
* iPhone 3GS, 8 GB, $99
* iPhone 4, 16 GB, $199
* iPhone 4, 32 GB, $299
* Pearl, $0
* World Edition, $99
* Bold, $149
* Motorola My Touch, $49.99
* Motorola Devour, $79.99
* Droid Incredible, $199
* Palm Pixi Plus, $0
* Palm Pre, $49
* Palm Pre Plus, $149
* Kin One, $29.99
* Kin Two, $49.99
* HTC Imagio, $99
* HTC Touch Pro2, $199
Cassey MZ. Keeping up with existing and emerging technologies: an introduction to PDAs. Nurs Econ. 2007;25(2):121-123,135.
Lu YC, Xiao Y, Mills ME, Soeken K, Vaidya V. Top Barriers and facilitators to nurses' PDA adoption. AMIA Annu Symp Proc. 2006:1016.
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