Industry, Nurses Address Barriers to Clinical Training on New Technologies

AAMI Foundation Industry Council. Courtesy of AAMI

Learning how to use new healthcare technology is a complex challenge, and success hinges on high-level support at any organization, according to nurses, vendors, and other experts who attended the AAMI Foundation’s first Industry Council meeting. This diverse group-which included representatives from BD (formerly CareFusion), Connexall, Hospira, Masimo, and Medtronic, as well as patient safety advocates and healthcare professionals-met at AAMI’s headquarters in Arlington, Va. recently, to discuss the current state of training, identify challenges, and describe what they would like to see in the future.

“Devices have become more interconnected and complex,” says Mary Logan, president of AAMI and the AAMI Foundation. “However, the training models we are using are based on the past. If we started from scratch today, based on the current clinical environment, we would not be training nurses in the same way.”

Nursing is a very device-heavy discipline. According to Peter Doyle, a human factors engineer at Johns Hopkins Hospital in Baltimore, Md., there has been a 23 percent increase in device types at his institution over the past four years, and many of these devices have different makes, models, and software versions.

Learning everything about every device just isn’t feasible, according to the nursing representatives, who point to increasing demands on their time, which makes it very hard to even attend training sessions. Additionally, there is an entrenched cultural desire in nursing to focus on the patient, not technology. Finally, they noted, there are limits to how much any one person can learn and retain.

Breaking information into “small digestible bites” is a strategy Maria Cvach, a registered critical care nurse and director of policy management and integration at Johns Hopkins Hospital, has used with success. In her experience, once people become comfortable with one concept you can then build on it, slowly adding to their repertoire.

Everyone around the table agreed that getting the C-suite to understand the importance of training was essential.

According to Connie Barden, a clinical nurse specialist and chief clinical officer of the American Association of Critical Care Nurses, anything that takes nurses away from the unit is considered “nonproductive time.” Therefore, chief financial officers and chief operating officers, as well as chief nursing officers, need to be in the room when these issues are being discussed.

Despite the importance of developing better educational models and C-suite buy-in, the challenges of working with healthcare technology can't be answered only with more training.

Nurses are already overloaded, and we are constantly “shoehorning so much more stuff into a finite amount of time,” according to Barden. She and other healthcare representatives in attendance called on industry to focus on usability and human factors to make devices more intuitive and easier to use.

“Keep it simple,” Barden says, “and don’t rely on education to make the device safe.”

Beyond the challenge of effective training is the question of assessing competencies. Currently, there is no uniform system or even philosophy to assess competencies in the use of healthcare technology. Several vendors pointed out that they can provide the training but would not be the ones to assess competency. Individual healthcare facilities, they said, must play a key role.

The AAMI Foundation will continue to investigate clinical preparation for nurses using complex healthcare technologies and is considering establishing a national coalition to address the issues raised during this meeting. Marilyn Neder Flack, senior vice president of patient safety initiatives and executive director of the AAMI Foundation, says that funding for such a coalition is crucial because the challenge is so complex that it will take a coordinated and sustained effort to bring about real change.

Healthcare Technology Training for Nurses

Meeting participants were asked to describe the current state of training for healthcare technology for nurses, the ideal future state, and the barriers to getting there. The following lists summarize their points.

CURRENT STATE
1.No requirements for demonstration of proficiency
2.Lack of consistency with educational materials
3.Lack of consistency among hospital systems
4.Cost of training not fully understood
5.More healthcare technology moving outside hospitals-what about training?
6.Demand by patients and families for newest technology
7.Growing number of devices; explosion of diverse technology
8.High turnover of nurses-continued training must be offered
9.Silos in hospitals between departments/people-training inconsistent
10.Industry has its own silos-some products easier to use than others of the same type
11.Device complexity increasing, number of devices increasing, usability is becoming a challenge
12.Inadequate requirements for manufacturers in designing highly intuitive and easy to use devices
13.Limited time to train and assess competency, and training is often inadequate
14.Increased demand on nurses, thus reducing their time to care for patients

FUTURE STATE
1.Simplicity
2.Education/training won’t be the only answer
3.Clinicians/user work with manufacturers
4.Instructions available on the fly, electronically, “just in time”
5.Education is ongoing-not a one-time thing
6.Systems approach-not just one entity responsible-all work together to make excellent preparation on complex technology a reality
7.Identifying and disseminating best practices
8.Peer to peer training-community
9.Leadership drives accountability
10.Tools to assess and maintain technology
11.Empowered staff to speak up when preparation is not adequate
12.At-the-elbow support available
13.Demonstrate verified competency
14.Superusers available and utilized
15.Elevated role of CNO, usability and human factors experts, and technology users in device acquisition and management
16.Visual and easy-to-use learning tools
17.Have a clinical nurse specialist on team

BARRIERS
1.Training takes nurses away from the bedside
2.Some hospital executives see training as “unproductive time” and won’t support the level of preparation truly needed to ensure patient safety
3.One size does not fit all
4.Hospitals are overloaded with change
5.Regulatory- and standard-making bodies and accrediting bodies can be too edged swords:  can have too many requirements for non-important things to be included in manuals; not strong enough with requirements for preparing clinicians on complex technology
6.Interoperability is a complicating factor
7.Business competition between manufacturers can encourage different bells and whistles on devices that make them difficult to use
8.Data overload on clinicians –impossible to learn all they need to know to use the devices safely-a significant issue
9.Liability/legal concerns to using “quick guides” on devices
10.Time and access to training
11.Training is evolving (cross-generational, technology, social media, less formal, “gamification”)
12.Who will be trained? What will they be trained on?
13.Vendors won’t work together
14.Mishmash of equipment in hospitals (age and manufacturers vary)
15.Knowledge sharing needs to happen, people keeping knowledge/power to themselves
16.Poor usability
17.Insufficient training resources/complex technological environment
18.Governance issues-appropriate governance must be in place to manage technology acquisition, training, use and maintenance
19.Inadequate change management in hospitals to quickly adopt new models of learning
20.Insufficient feedback/knowledge sharing
21.Too many gatekeepers and unclear lines of responsibility
22.Changing learning habits

Source: AAMI