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A new wifi-based nurse call system promises to offer increased flexibility and certainty for residents. Beverley Head reports.

Anglican Retirement Villages and UnitingCare have emerged as two early adopters of a new Australian-developed WiFi-based wireless nurse call system.

Wireless nurse call systems have been available for some time, generally using proprietary equipment for that sole purpose. The recent release of Questek’s WiFi-based nurse call system however, allows aged care facilities to piggyback the system over a WiFi wireless network. This can be used to run multiple applications, such as care programs or medication management, promising both cost savings and easier systems design and management.

Bart Williams is general manager of Questek Australia, which has developed nurse call systems for over a quarter of a century. By law, all aged care facilities must have a nurse call system that residents can use, but in the past most of these have been hard wired to physical networks.

While the bell-next-to-the-bed model has been extremely valuable, hard wired systems don’t offer much in the way of flexibility or additional functionality. To refurbish or remodel a room often requires cables to be ripped out and replaced.

Because Questek’s WiFi-based system is wireless the end point units can be simply relocated, or even offered as a pendant – and, when overlayed with geospatial mapping software, can also serve as resident locators.

According to Williams, while there have been wireless nurse call systems in the past, “they were really a glorified garage door opener”. He claims that some aged care facilities which installed the systems actually did find that the system would be triggered when next door’s garage was opened with a wireless control.

Harnessing WiFi networks overcomes that issue.

Wayne Donald is the network architect for UnitingCare’s IT services department and is preparing to roll out a WiFi wireless communications network at a new 100 bed facility in Shellharbour, NSW.

The organisation runs about 70 aged care facilities, providing care for 14,000 people. Although UnitingCare has used some wireless nurse call systems in the past, these were “pretty basic” according to Donald, and are now only used in some of UnitingCare’s assisted living units.

The benefit of moving to a more comprehensive WiFi-based system hinges around the flexibility that it promises, and also the certainty for residents that their call has been registered. Many early wireless systems were mono-directional. They would send the signal for help, but if it could not get through because of network congestion, the resident would have no way of knowing their call had not been received.

The Questek system indicates to the user with visual and audible alerts that their call for help has been received. Residents can either use an in-room battery powered unit (which can be simply relocated as there are no wires) or provided with a pendant (batteries are rated to last for three years of standard use).

Either way, when they use the system, they get feedback to let them know their call for help has been registered. “It’s very very important for residents to have confidence in the staff and their care,” said Donald.

By overlaying a location management layer on the wireless network it’s also possible for nurses who get a call from a resident’s pendant to know that they’re not in their room, but in the TV lounge.

Each of the end points checks in to the central server over the wireless network with its temperature, battery life and status every ten minutes. UnitingCare may also eventually harness that functionality, particularly the room temperature monitoring, and “Setting alarms for when the room is too cold or too hot. This is not just about comfort, but safety,” said Donald.

The system can also be used to monitor fridge temperatures or thermostatic mixing valves, which moderate the temperature of hot water. According to Questek, not only can this temperature monitoring ensure a clear audit trail for accreditation and safety purposes, it can save money by ensuring proper temperature regulation throughout the facility.

The implementation at Shellharbour is intended as a pilot for UnitingCare, which will consider a move to wireless systems as it has to upgrade systems in its other facilities.

Martin Barber is an IT and communications specialist at Anglican Retirement Villages, which provides aged care services to 6000 people in the Sydney Diocese. Its 18 aged care facilities all feature hard wired nurse call systems at present, but Barber says these are pretty unforgiving in terms of flexibility or refurbishment.

“One of the big difficulties is in our older buildings, you can only change the current technology with difficulty as it involves pulling cables,” he says.

ARV’s introduction to Questek’s technology came when it experienced problems with one of its existing hard wired nurse systems. Barber worked with Questek to develop a workaround solution, and in the process learned about the planned WiFi-based system.

As ARV’s corporate strategy involved a gradual move to Cisco supplied WiFi networks, which is expected to be completed by the end of 2011, the ability to piggyback another service on that network was attractive as it meant one network could be used to support multiple applications.

Williams says it was this ability to leverage off existing networks that encouraged the company to develop a WiFi-based nurse call system in the first place. He said that historically nurse call systems could be installed for $1200 to $2000 a bed, but “if we’re not supplying the network the WiFi nurse call is about 20 per cent cheaper”.

By the end of October Barber hopes to have rolled out a pilot of WiFi-based nurse call in 10 to 15 rooms at ARV’s Donnington Court facility. While the wireless nurse call system is the core issue, “the idea that there will be a thermometer in each room is an added value.”

If the pilot goes well ARV will look to using the system more widely and its long term roadmap includes switching on some of the additional functionality such as location based services.

Barber adds that WiFi networks, which are based on the IEEE 802.11 standard, operate at different frequencies to devices such as hearing aids or pacemakers and so pose no problem to residents using such devices. While there can be some challenges associated with WiFi network interference from microwaves or lifts, he believes careful network design can overcome such issues.

There’s a revolution underway in the provision of nurse call systems, and Questek are leading the way. Already a leading player in the development of integrated and sophisticated systems for the aged care sector, Questek are ready to launch their products into a new era of integrated wireless networking. Bart Williams, General Manager of the company, was one of the first to realise the potential application of integrated platforms throughout the sector and is enthusiastic about launching the system at ITAC 2010. “It’s a whole new way of approaching nurse call systems that nobody we know of in Australia has done,” explains Bart. “Wireless has been done in the past, but it’s been done poorly, now it’s time to do it right.”

The development of Questek’s new wireless nurse call system is a timely response to the wireless revolution already taking place in homes and institutions across the country. “More and more aged care facilities are putting in wifi networks for computers,” says Bart. “They’re using wifi for staff computers so they can enter clinical documentation and resident data by the bedside. Some are offering that mobile computing capability to residents to enable them access to the internet, or the ability to Skype their families. It’s certainly early days, but what we are seeing is just the beginning of the installation of wireless networks in aged care facilities.”

Bart and the engineers at Questek were quick to notice the trend for major providers of aged care to install to wireless networks when upgrading or fitting out new builds.The company’s technology experts were also impressed with the safety, speed and reliability of platforms offered by major suppliers such as Cisco, Trapeze and Meru Networks. The development of their new wireless nurse call system was a matter of fitting the two pieces of the puzzle together.

A traditional nurse call system may be a sophisticated piece of technology in terms of the functionality it can deliver, but the developers at Questek were keenly aware that with that sophistication came some downsides. “Traditionally we’ve installed hardwired systems which involves running cables right through the building,” explains Bart. “It’s fairly costly to do the physical installation because there’s so much labour involved and the installation of devices can be limited by the design of the building. So, we thought, people are putting these wireless networks in for computers, why not piggyback off these wifi networks for a truly flexible nurse call system that’s simple to install and maintain?”

Wireless call systems do already exist, but only in a very simple form. To illustrate the difference, Bart compares them to a garage door opener. “Historically, wireless systems have been pretty average,” says Bart. “My theory is when you drive up to your garage door and press the button, if it doesn’t work the door doesn’t open, so you push it again, maybe a third time and the door opens and hey presto you’re in. but when you’re in a nursing home bed, the nurse call system is the button you push to hopefully save your life in a time of need. You’re not facing the world and you don’t hear any dings and dongs and bells, how do you know that pressing the button has worked? You don’t.” It was solving this issue that topped the Questek agenda and drove the development of their new wireless system.

The revolutionary aspect of Questek’s wireless nurse call system is all in the detail

To address the ‘fear of failure’ aspect, the company have a developed a two way system that both sends an alert and lets the resident know that the message has got through. Once the button is pushed, there is a period of time where the button negotiates with the wifi network and with the central call control system, and then the central system sends a message back to that resident to let them know that their call has been received and registered. This response system offers reassurance to the resident. In the very rare instance the initial call fails, the button will continue to call until a response is achieved and the resident notified.

The second key feature of Questek’s wireless nurse call system is the complete flexibility it allows when it comes to designing the system and locating the device units. “We’ve now got the flexibility of putting the button wherever we want,” enthuses Bart. “You can put it in the traditional locations like in the shower, by the toilet and by the bed, but you could even stick the button on the bed head and now you can wheel the bed around the room. So the bed’s no longer fixed in one location, and the resident has freedom of choice as to where the bed goes. Take that to the next step, and the resident has a mobile button, in the form of a pendant, and that pendant can be used anywhere on the site where there’s a wifi network coverage. Most importantly, with the right network that mobile pendant can offer real time location tracking. “This is the function that can make a real difference in an emergency situation,” says Bart. “Not only do you know that, say, Mary from room 105 has pushed her pendant, but you can also know where Mary is when she calls for help. So without being really big brotherish, it’s extraordinarily powerful.” It’s extraordinarily powerful in aged care because trying to find fairly mobile residents, especially in a hostel type environment where they could be anywhere from their room to the lounge to the café, shouldn’t be a matter of chance. “It’s most likely that they’re not in their bed when they pushed their button,” Bart points out. “If they’ve tripped over in the corridor, historically pushing a pendant would only alert nurse control central to who is in trouble, not where. Now we can know who it is and where they are and help.”

Pain free retrofitting

The beauty of Questek’s wireless nurse call system lies in its marriage of cutting edge technology and truly simple solutions. This combination extends to one of the system’s greatest selling points, the ease and economy of upgrading or replacing an existing nurse call system with the new wireless system. “If you already have a hardwired nurse call system, then the wireless system simply integrates at the head end,” explains General Manager Bart Williams. “Whether a facility has one of our nurse call systems installed or not, they don’t have to start again at the beginning, we can build on what they have or, if they’re not happy with the existing system, then we can install an entirely new one.”

Bart has seen the future of nurse call systems, and is convinced the future is wireless. “It’s the next step in all systems, nurse call systems and beyond,” he says. “For a new building, retrofitting is not too hard, but when you’re retrofitting an existing building, then wired systems bring all kinds of extra issues and costs. It’s complicated and often pretty ugly. With this system you can just say ‘I want one there’ and bang, there it is.” The ease of installation with a wireless system extends to moving devices as needed. The system offers facility managers much greater flexibility in managing and changing the use of each room as the device is not tied down to one location, or to one functionality. “If you start off with a fairly low care facility, then increasing the level of care over time is simple and painless with a wireless system,” says Bart. “It can just grow with you, and is pretty much unlimited, you can have as many devices as you need, or as few, as a pendant can replace the need for multiple fixed devices in a single space.”

Questek’s wireless nurse call system offers immediate practical benefits, whether you’re retrofitting an old building or at the design stage for a new facility. Cabling an existing building can be a messy and expensive business. Cabling a new build can add expense and compromise design. “Builders will, for example, put enormous effort into waterproofing a bathroom space to prevent building damage, then someone has to come along and cut a hole in that wall to install a hardwired button,” points out Bart. “With a wireless, there’s no penetration to the wall at all. Clients can opt for hard screwed holders, but we designed it so it will double tape to the wall and can be moved at will without leaving any damage.”

Flexibility is built into the details of Questek’s wireless nurse care system, whether big or small. “It’s so flexible,” stresses Bart. “You can site buttons anywhere, get them mobile, track them, respond to them anywhere. So long as there’s a wireless access point that the button knows it needs to speak to, then we can put one anywhere.”

Building successful networks

The future is wireless and the future of wireless networks is integrated. “You’re isolating yourself if you go for a limited, stand-alone network,” cautions Bart Williams, General Manager at Questek. Historically aged care facilities have relied on a number of self-contained systems operating alongside each other. A facility would install a telephone network, then a computer network, a nurse call network, a security network and a cctv network, all of them stand-alone systems. “What happens is you then have to maintain and manage all those disparate systems,” explains Bart. “With advanced wifi technology you can integrate all those systems into one and avoid doubling up on costs and time. Put in a good wifi network, then you can layer everything on top of it.”

Questek’s wireless nurse call system is a logical extension of existing technology and it really is as simple as a button. “We’re trying to be infrastructure agnostic,” says Bart. “We don’t really care which network it is, though we prefer to deal with one of the networks that actually works and as part of the installation we can assess whether it’s a quality network and recommend which are.” ..

A world of potential

If anything that has Bart and the team at Questek buzzing with excitement, it’s the potential inherent to their new wireless call system. As the development process unfolded, the team realized that the flexibility of the system meant that it would be capable of meeting the needs of wide range of situations and industries. “Now that the button is flexible, we can actually make the button do whatever we want,” says Bart. “The device can be anything, it doesn’t have to be a nurse call button. It could, for example, be a mobile staff duress button.”