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By Bart Williams MBA, General Manager, Questek Australia Pty Ltd

Over the past decade we have witnessed some radical changes in the way in which technology has changed the delivery of care in residential aged care. Some notable changes have been the introduction of the DECT (Digital Enhanced Cordless Telecommunications) phone, computerised clinical documentation and improved security through networked access control. During this time we have also seen substantial changes in the humble nurse call system. Today we are seeing a move toward converging technologies but should some technologies be converged?

Many of us would remember a nurse call system based on lights and buzzers (still referred to as the buzzer system today), often created in someone’s garage using components that were at hand. I have seen some interesting adaptations in my time, from light switches relabelled – Nurse Call, to car trailer lights as over door indicators. Over time these systems have become more sophisticated with the advent of paging, then DECT and now VoIP (Voice over Internet Protocol) communication. We have seen the introduction of advanced dementia monitoring as well as voice communication to the bedside. But what is a nurse call system and when does the shift in technology take away from the original intent? When does the intent of the nurse call system shift to total integrated communication?

In 1998 a number of manufacturers formed a committee to write the Australian Standard AS3811 – Hard Wired Patient Alarm Systems. The standard is used today as a basis for comparison and accreditation. Most new nurse call project specifications are written with the requirement to comply with AS3811, but as technology moves on, more and more systems are moving away from complying with the standard. In fact many new features requested in specifications not only fall outside of the standard, they contradict the standard and this puts manufacturers in jeopardy when formally documenting that their system complies. Is it time for a review of the standard or do we change the project specifications so that the nurse call system is just that, and the extra features required are specified separately?

So what is a nurse call system and what does the industry require for onsite communications?

Traditionally the nurse call system was stand alone and designed so the patients in acute care could call for nursing staff in times of medical need. The belief was that this system translated well into aged care, with little or no modification. Residents used the nurse call system to call for staff attention in the same way. But the difference in aged care is that not all nurse calls are based on medical emergencies. Without differentiation between calls, nursing staff are unable to prioritise the call. As manufacturers we have tried to combat this with different levels or priority of nurse call, i.e. call from the bed, call from the ensuite, nurse assist for staff to staff and even emergency (a flow on from acute care), but still this did not truly prioritise the call, it only identified from where the call was initiated. In aged care there is a shift from a medical emergency to an emotional need and therefore ‘nurse call’ was no longer definitive enough.

So how do residents get their message across? Do we need to break the nurse call system into two halves, medical emergency and emotional need?

These questions could result in two different response requirements, from different staff. For instance nurse call buttons are installed in the traditional locations for true medical needs but then a separate system could be installed for emotional or non-medical needs. Currently we are offering a combined system and this has been confusing for the resident and the staff. If we were to supply two systems would it not be easier to meet the expectations of the resident, and then wouldn’t this in turn improve staff responsiveness and increase resident’s independence?

So how should the second system operate, now that the nurse call system is again for medical emergencies only? One idea is to provide bedside telephony similar to that in a hotel where a resident can call reception for service, but then you would need a full time operator to respond to these calls. Or would it be better to supply a panel where the resident can select the option they require? This panel could be mounted on the wall but would a resident be able to operate it? The extra services could be delivered through the television. If it were delivered through the television through a menu system, other services could also be provided such as meal options or booking bus trips or even pay per view movies. The choices are endless. The nurse call system is again being used as it was intended and an alternative communication system is providing extra services that may even attract residents to a facility. Although I have suggested the systems being separate, behind the scenes they can remain as one IP based service, or convergence.

So where to now?

Convergence of systems onto one network makes sense and we will need to review the standards as more and more devices become IP enabled. When specifying a system we should consider at what point it needs to integrate to other systems but before we jump into a solution let’s think of the end user, will they be able to use it, will they benefit from it and is there a return on my investment?

Article published in IT:Informer - Australia's aged care technology resource from aged care direct, Issue 9 April 2009