"You really can’t predict what every nurse or every unit, or every hospital will find important," acknowledged Jeffrey Chochinov, senior product marketing, Rubbermaid Medical Solutions, Huntersville, NC. "If you make your cart flexible then you can better please more people." With a focus on features designed to make the nurse’s job easier, Rubbermaid’s customizeable, flexible mobile computing solutions help ensure "that each nurse or unit can have what they need to be efficient."

With the addition of lockable drawer systems, many of the workstations and computing carts on the market today can also serve as medication dispensing carts. Chochinov noted that nurses can easily add, remove, or reconfigure drawers on the Rubbermaid computing carts without relying on the Biomed department, for example.

Omnicell’s base model mobile point-of-care carts serve as a platform that users can build upon by adding hardware, software, as well as drawers to the carts. "Customers are looking to use the carts for much more than just clinical documentation," observed Len Hom, product marketing manager, mobile medication solutions, Omnicell, Mountain View, CA. "You can easily add drawers to our cart in the field so that it serves now as a medication cart where it provides safe and secure transport of medications to the patient’s bedside."

Armstrong’s auto-locking cart with Prox card reader

Hom highlighted the benefit of the individually locking drawers featured on Omnicell’s mobile carts. Operated via Omnicell software, the system allows for one drawer to be opened at a time while the rest remain locked, versus systems where all of the drawers must be locked and unlocked at once. "This provides improved security, especially when transporting and administering medications," he said. It also "minimizes the risk of taking the wrong medication out of the wrong drawer."

Observed Hom, "Because we’re seeing more and more interest in carts with drawers, versus a workstation on wheels, we see mobile carts playing a key role in the medication management process for our customers, and the integration with other systems. From a strategic standpoint, Omnicell sees mobile carts aiding in the medication management process by providing better workflow efficiency, safe and secure drawer location for med transport, and then the added security of individual locking drawers for safe medication practice at the bedside."

Optional software applications such as Omnicell SafetyMed provide additional safeguards for medication administration. A soon to be released application called Anywhere RN will provide remote medication management, integrating Omnicell’s mobile carts with the Omnicell automated medication dispensing system. Nurses can remotely request medication issues and returns, document waste and review the patient profile, without having to go directly to the cabinet.

By combining Rubbermaid’s mobile medication carts with the company’s transfer and exchange carts, hospitals can achieve a significant workflow advantage over traditional point-of-care carts for medication dispensing, noted Chochinov. With patient medications individually bar coded and kept in locking drawers, nurses can go from room to room dispensing meds without having to go back to the medication room or dispensing cabinet in between patient visits.

A ClearView Security Drug Box that can be mounted onto Armstrong Medical’s A-SMART carts secures medications while also allowing for easy visibility. The ClearView could be used in anesthesia cases, for example, to set up instruments and medications in advance while still keeping them secure.

Omnicell mobile cart

Locking options available from Armstrong Medical include Breakaway Locking, Key Locking, Push-Button Locking, and Auto-Locking with an optional Proximity Reader where users simply wave their Prox card in front of the reader to access the cart’s contents. Users can lock the cart either by pressing the lock button or setting the Auto-Lock timer for anywhere from 1 to 998 minutes.

Stanley InnerSpace, Grand Rapids, MI, rolls out its Intelligent Locking System (ILS) this fall starting with its line of small procedure carts. The system consists of a Web-based software application and a series of command modules placed throughout the hospital to track and communicate remotely with the carts. Using the intuitive ILS software, administrators can easily add and manage user information, assigning users to groups and authorizing access to specific carts via a keypad, proximity card or both.

Value-added reporting capabilities available through ILS allow the administrator to track groups of cart users and drill down to see who accessed the cart and when, as well as get an idea of what they were doing with the cart at that time. ILS also provides the ability to send out e-mail alerts to selected users with notices and updates; as well as track cart performance including battery life and network connectivity. Stanley InnerSpace is in the process of gathering feedback from its pilot customers to help shape future enhancements to ILS.

New offerings in the Stanley InnerSpace small procedure carts include bedside charting accessories with options to house a laptop computer and articulating keyboard arm; additional drawer colors; and a Mini Cart with an ultra-slim footprint and 3" instead of 5" casters.

The new Flo 1760 wireless mobile workstation from Flo Healthcare builds upon the flexible and versatile platform established with its predecessor model 1750 computer cart, adding a number of features as standard versus an upgraded option. High-quality tente wheels are standard features on the Flo 1760, as well as a tilting, rotating monitor and tilting keyboards. "We also included Microban in our exterior plastics to help with infection control in between the hospital’s cleaning process," said Chad Ramage, vice president, sales and marketing, Flo Healthcare, Norcross, GA.

A removable back column and an internal cord and cable management system on the Flo 1760 allow for easy device and hardware additions in the field. "As more and more technology is added to the workstation, you’re running more and more wires down the column," said Ramage. With peripherals such as vital signs capture, bar code scanners and consent signature pads becoming more commonplace, "we realized, the customer doesn’t always give all these things to us when we build the workstation for them. So having access to that column in the future and being able to run that wire, if we can make that easier that’s going to take a lot of load off hospitals and their staffing as they upgrade and work on their workstations."

Stanley InnerSpace Mini Cart with ILS

Ramage described the importance of wireless signal strength in accessing electronic medical records and other network systems from a mobile computing cart. "In order to be able to access EMRs at the bedside, one you have to have power, but the other piece is, you have to be on the network. If you don’t have a strong wireless signal, you’re not going to get on the network. We have our own high gain omni directional antenna that boosts the signal, so that you can get access to your electronic medical record system. Granted if they have complete dead spots we can’t overcome that, but we give them the best opportunity to be live and productive on the network. Hospital wireless environments are tough environments and if you don’t give that wireless signal all the strength that it needs, you’re setting yourself up for disappointment," he added.

Standard features on the Rubbermaid computing carts include an LED "night light" for the keyboard and drawers, document protector, and a host of ergonomic attributes including a contoured steering handle, and height-adjustable keyboard tray and work surface. A column on the back of the carts features a mounting system that allows for easy accessorizing.

Metro Healthcare’s newly upgraded Lifeline emergency cart contains even more features that make it ideally suited for responding to a code situation. According to Dave Salus, Metro Healthcare market manager for InterMetro Industries Corporation, Wilkes-Barre, PA, "Lifeline was designed specifically for a code with some built in features that are unique for code response. For instance, the top recessed storage area provides instant access and visibility to first-line medications. In putting it in the top storage location, in addition to gaining visibility and access, we’re also providing multi-user access. So while the pharmacist is accessing medications in the top of the cart, we also have other clinical users who are able to access the front of the cart by opening the top one or two drawers."

A new defibrillator swing arm that conveniently clamps the defibrillator securely into place, along with a power outlet strip included on Lifeline, means the cart is ready to go at a moment’s notice. "A lot of times, the responders will start pushing the cart without realizing that the defibrillator’s still plugged into the wall," said Salus. The outlet strip adds a layer of protection by protecting defibrillators from accidental falls. Other accessories vital for code response that are built into the side of Lifeline’s compact footprint include O2 tank and suction pump holders.

Rubbermaid M38

For easy maneuverability, Lifeline’s ergonomic handle features a lever that engages a fifth wheel to provide steering control to the code site. "It acts like a tracking device to stabilize the cart as it’s being pushed in a straight line," explained Salus. "With four swivel wheels, you’re fighting uneven floor surfaces, you’re fighting the momentum as you start the cart because it tends to keep going in the direction you started it. The fifth wheel overcomes that and allows you to push in a straight line and maintain control around corners."

A choice of 39", 42" and 45" high versions of the modular Metro Lifeline cart provides the ability to choose the right drawer combination at the right height. Side tilt-out bins fold into the body of the cart when not in use and are secured with the cart’s locking system. "Every code cart in the hospital is standardized and stocked identical to every other one, so that responders, no matter where they respond to in the hospital, know exactly where their contents are," said Salus. "Securing the side as well as the drawers ensures that what they’ve put into those carts is there when they need it for the code."

Microban antimicrobial protection is also now a standard feature on Metro’s Lifeline as well as Flexline modular procedure carts. "The crash cart is sitting out in the hallway exposed to everything that’s going by," noted Salus. "In some instances the carts can sit out in the hallway for a month before they’re reprocessed back down through materials management to be cleaned and restocked, so this helps keep the cart cleaner between cleanings."

Additional upgraded features to Metro’s Flexline carts include full-extension, self-closing drawers as well as an electronic touch pad that allows for Proximity, magnetic stripe and bar code identification readers. "We’ve gone from keyless now to even PIN-less, where a customer can actually just scan their ID to access the cart contents," said Salus.

Salus encouraged facilities looking for ultimate workflow efficiency to consider Metro’s Starsys line of carts and storage units. "If you’re looking for something you can build on and create a truly interchangeable system of components within a facility, Starsys would be the choice, because the drawers and accessories that are used with Starsys carts can also be exchanged with the full size supply units and even work centers. It uses the same components to build various configurations."

RFID-enabled carts featuring SpaceTrax clinical inventory management system from Stanley InnerSpace allow facilities to keep track of high-dollar supplies such as those found in the OR, interventional radiology and cath labs. "Consider storing supplies with price points over $1,000 to $1,500 in RFID carts," said Bob Potter, product manager, technical solutions, Stanley InnerSpace. He described how one hospital customer is using the RFID carts. "Out of about $1.2 million worth of inventory, they have approximately $500,000 of their products sitting in four carts altogether," said Potter.

LogiQuip’s LogiCell closed system and ParStor-III open system

The Stanley InnerSpace RFID carts also feature biometric locking. "As we continually strive to innovate and introduce new product features, we certainly understand that security and ease of use tied to that security is of utmost importance," noted Shannon Kennedy, marketing manager, Stanley InnerSpace.

Omnicell’s half-cell supply mobile carts allow clinicians to bring supplies to the point of care while wirelessly connecting with the company’s stationary supply cabinets to ensure automated charge capture and inventory management for more expensive supplies used in the OR and cath lab, for example. "The thing we focus on is the reliability and the consistency of experience for end users so that they’re using the same type of interface and have the same type of reliability and the same kind of uptime that they expect from a stationary cabinet," said Suzanne Alexander-Vaughn, product manager, supply business, Omnicell. The half-cell carts can be equipped with shelves, suture racks or drawers for optimal flexibility. "Any of the components that you could utilize in a full-sized stationary Omnicell supply cabinet, you can utilize within the mobile cart as well," said Alexander-Vaughn.

More efficient and longer running battery options are becoming crucial as carts continue to carry a heavier technology load, explained Ramage, Flo Healthcare. As facilities seek larger monitors, and more robust computer systems, for example, power consumption can increase dramatically pushing conventional batteries to their limits. "More and more technology is getting added, you have bar code scanners, you have vital signs, blood gas oxidizers, all these other pieces of technology that hospitals are adding on, so you’ve got to realize that cycles are king," said Ramage. "If you don’t have a super high cycle life battery, the hospital’s going to be frustrated." With the company’s new lithium nano phosphate battery options customers can get up to 3,000 cycles before the battery needs to be replaced. A DC architecture provides a very efficient power source.

Rubbermaid now offers a DC powered option for its M38 line of computing carts, along with AC powered and non-powered carts. According to Chochinov, "If you’re smart about the device combination you could start to see 16 hours with the [DC powered option]. It gives the nurse the capability to get a full shift’s worth of run time before it needs to be recharged. The other thing is, there’s a longer life span to the battery itself. Because you’re not using as much of the battery up, the battery will last longer and will need to be replaced less frequently."

He described the sealed lead acid battery technology available in Rubbermaid’s DC powered M38 as providing a "happy medium" to more expensive nickel metal hydride or lithium batteries; still providing a long life in a more affordable, off the shelf product. The DC powered system is also lighter weight as well. It has less components, and you can use a smaller battery, noted Chochinov. "Anything you can do to reduce the physical demand for nurses is helpful."

Flo 1760 wireless mobile workstation

While many cart manufacturers, including Flo Healthcare offer "swappable" battery options in which the batteries can be recharged independently of the cart for uninterrupted run time, it’s a strategy best reserved for environments with the most demanding operating requirements. "That’s really the most expensive option of all for departments where they may never get a moment where they can plug the cart into the wall for two to three hours a day to let it charge. For example, emergency departments where they’re always on the go, or some places are facing regulations where they’re not allowed to charge workstations in the hallway."

Power management software from Omnicell provides audible, visual and/or e-mail alerts about the state of the batteries on its mobile carts.

Flo Healthcare’s Dashboard software allows customers to manage their entire fleet of carts with visibility to battery performance and other "critical information that hospitals need to make decisions by," said Ramage. Flo Healthcare also provides options for power upgrades and technology "refreshments" that can keep a still-functioning but outdated cart in peak performance.

Rubbermaid’s pre-wired carts are upgradeable from non-powered to powered, for example. End-of-life upgrade programs and servicing options can help extend usage of the carts. In addition to next-day on-site service options and preventative maintenance programs, Rubbermaid provides a battery exchange service where they will come to the facility to replace the batteries on the facility’s full fleet of carts at once. "Rubbermaid is focused on the life cycle of the product, whether it’s upgrading or service to keep the carts going," said Chochinov.