In July 2007, our hospital moved to a
new, 410-bed facility. Not fully appre-
ciating the changes in store, we intended to keep the mobile computer carts we had been using for bedside clinical documentation.

We soon realized that our approach — assigning a cart to each medical-surgical nurse — would no longer work. The new hospital had much longer hallways to navigate. Nurses were assigned patients in rooms that were not always adjacent. Carpeted hallways made carts harder to push and maneuver. Door thresholds jostled equipment. All of these factors, compounded by the weight of on-board batteries, combined to cause frustration – and even a few back injuries.

IT staff members were also dissatisfied with the old carts for reasons unrelated to the relocation. Battery maintenance presented a host of problems, from cost, to leakage, to the need for frequent replacements. Getting repair parts could take as long as 12 weeks. And theft of peripherals and accessories was a persistent problem.

Research and discussions with Denver-area colleagues quickly convinced us to abandon the one-cart-per-nurse approach. Instead, we decided to place a computer in each patient room to support electronic medical records (EMR) and electronic medication administration (eMAR).

We carefully considered the benefits of mobile carts vs. wall-mounted work stations. As we evaluated our options, we became concerned about the practicality of wall-mount units. How significantly would they restrict access in patient rooms designed to accommodate family members as well as additional portable medical equipment? How would wall mounts work in rooms with limited power outlets? Cost was an additional concern. Although mounted stations might be less expensive initially, the cost of retrofitting the rooms would have canceled out any savings.

We also contacted only manufacturers that offered a cart with no battery. To reach our final selection, we hosted a vendor fair for potential users. Everyone was invited to evaluate six vendors, using a standard ranking scale, across about a dozen factors including mobility, ease of adjustment, ease of cleaning, stability, cable management, method of LCD monitor mounting, size of medication drawers and security.

During this session it was also useful to observe the vendors unpack and set up. We noted that, in some cases, even the vendors’ representatives struggled with assembly or missing parts. The carts that were difficult for the reps to set up, we reasoned, would also be problematic for us.

IT and nursing management also considered a range of issues outside of functionality. Expanding upon our original set of criteria, we wanted to take advantage of the opportunity to find a vendor with responsive maintenance program options, a longer warranty and a willingness to customize the equipment.

At the conclusion of the vendor fair, we were gratified to learn that both IT and nursing were unanimous in their decision to select the same cart by Rubbermaid Medical Solutions.

Kelly Rozsa, RN, BSN using Rubbermaid Medical Solutions Cart.

Roll out and customization

We approached implementation in two phases, one immediate and the other gradual. We rolled out about 65 carts in September 2008, deploying them on floors and departments that had already begun using eMAR. Even with such a large implementation, the roll out was uneventful and the carts worked flawlessly. The second implementation phase has been gradual, coinciding with our ongoing eMAR installation. As we deploy eMAR to additional units, we are placing one cart in every patient room.

Soon after implementation, we discovered one complication: As we had requested, the vendor ensured that the new carts secured our computers and accessories. But we did not anticipate needing access to the units when, for example, a malfunctioning wireless scanner has to be replaced after hours. An IT or maintenance person had to come in from home just to plug in a USB device. To solve the problem we repurposed one of the existing openings in the cart to add a USB "tail cable" to the thin client in the locked box so nurses could attach a backup scanner if necessary.

Rubbermaid helped customize our solution in other ways as well. They were able to fabricate a special shelf for the base of the wireless scanner used for bar code scanning. It’s an effective solution that doesn’t consume space on the nurses’ work surface. The vendor also supplied a soft, nylon sheath to wrap scanner cables connected to the cart. In addition to making the system neater, these sleeves make the carts easier to clean. All of the other cables are contained in the pedestal of the cart.

Every stakeholder within UCH has been satisfied with our new solution –

• Because nursing job satisfaction is so critical, it’s perhaps most important that our nurses responded well to both the cart design and the selection process. In fact, some have made their appreciation known directly to the president of the hospital.

• The IT staff’s battery maintenance work load has decreased as Rubbermaid carts have been put into use. They also save time and frustration with Rubbermaid’s online ordering system for parts and service, although it may not get much use: Rubbermaid offers a three-year parts and labor warranty.

Karen Henz, RD, MS

• Housekeeping is also pleased with the switch. The new carts have more curves and fewer right angles, making the surfaces easy to wipe down and sanitize.

• Even the finance department is happy with our selection: The Rubbermaid carts came in under budget, freeing surplus dollars for other uses.