Scenario: The Director of Nursing at River Valley Hospital, where I work, has requested that I research plans for new vitals equipment. There isn’t enough equipment currently and it has a tendency to be inaccurate due to its age. The Director has provided me three options to research: each CNA/RN gets their own set of personal equipment, we buy six new vitals carts per floor, or each patient room is installed with new equipment. The Director asked me to focus on three main aspects that have been issues in the past: cost, infection control, and ease of access.
DATE: May 8, 2016
TO: Director of Nursing/Writing 227 Class
FROM: Shelby Taylor, RN
SUBJECT: Feasibility Report for New Vitals Equipment
I have completed my analysis on the three options you presented to me for new vitals equipment at River Valley Hospital. I included graphs for quick information review, heading for sections, as well as bold text to help you find things you are looking for easier. I hope that you are satisfied with the conclusion I’ve chosen. Please contact me with any further questions or concerns.
Thank you for your time,
Shelby Taylor, RN
Feasibility Report: New Vitals Equipment
TABLE OF CONTENTS
This report was requested by the head of Nursing at River Valley Hospital for the purpose of buying new vitals equipment. The current equipment is insufficient and unsatisfactory for the current number or beds that are occupied and is causing issues with infection control. The CNAs that take the vitals are struggling to complete their vitals list due to the unavailability of equipment; in a hospital vitals must be timely and accurate to avoid unnecessary illness or death. CNAs and nurse may both have interest in reading this report to get an idea of what is being proposed to rectify the situation we are currently facing. In this report I will present three options that were proposed and distinguish between the choices to pick the one that will fit the hospital’s needs the best. The three main concerns to keep in mind are affordability, infection control, and ease of access.
The goal of this report is to find a solution to the vitals equipment crisis that River Valley Hospital is currently facing. We will do this by taking the three suggestions given to me by the Director of Nursing and scrutinizing them to find the best option for our facility. The three options presented to me are as follows:
- Each CNA and RN (about 660 employees) are given vitals equipment of their own to carry with them from patient to patient.
- Six new state of the art Vitals Carts are bought for each floor (Five Floors) of the hospital (services approximately 60 beds per floor).
- Each Room is stocked with its own vitals equipment, whether it be in the form of a cart or integrated into the room’s preexisting equipment.
Using these three options, we will figure out a solution that will meet the criteria of affordability, infection control, and ease of access.
While researching this problem, I considered the three aspects earlier stated that were deemed the most important. When dealing with price I focused on the different products available on the market. I compared the “cost per patient” to figure out which equipment would be the most appropriate in the long run. Using my prior knowledge of infection control I will explain the benefits and draw backs of each plan. Furthermore, I considered the ease of access by assessing how many machines/equipment there would be per patient and per CNA on shift. In addition to focusing on these three aspects, I also polled the employees that will be using the equipment to find what they thought would be best for the setting they work in. With all of these different aspects put together, the picture will become very clear on which is best for River Valley Hospital.
- PRICE: The prices for each method are listed below
- Personal Vitals Equipment (for each RN and CNA):
- Vitals Cart: Rolling Stand for Welch Allyn Spot Vital Sign Monitor is $299.00
- Room Equipment:
- Blood Pressure Cuff: AccuMed ABP802 Portable Upper Arm Blood Pressure Monitor is $39.99
- Pulse Oximeter: MeasuPro OX250 Oximeter is $32.99
- Temporal Thermometer: Exergen Temporal Artery Thermometer is $28.40
- Clock: $0 (Already present in all Patient Rooms)
- Wall Mounting Basket (to contain Vitals Equipment): Medline Basket is $30.89
- Infection Control:
- Personal Vitals Equipment: Each set of Equipment would service approximately 8.5 patients per day.
- Vitals Cart: Each cart would service approximately 30 patients per day.
- Room Equipment: Each room would service approximately three patient per day.
- Ease of Access:
- Personal Vitals Equipment: Readily available because no RNs or CNAs will be sharing the equipment.
- Vitals Cart: Slightly in demand because seven CNAs will be using six machines.
- Room Equipment: Very easy to access as the equipment will already be in each patient’s room.
- Poll: Each RN/CAN was asked, “Which method of vitals equipment would you prefer?”
- Personal Vitals Equipment: 296/660 Employees
- Vitals Cart: 99/660 Employees
- Room Equipment: 265/660 Employees
After reviewing the results, the first thing to note is the total cost of each option. The first option (using the figures above) adds up to $117.79 per person. When you take into account that there are 660 CNAs and RNs, the total of this plan adds up to $77,741.40. For the Vitals Cart plan, the math is a bit easier. The plan is for six units per floor with five floor, making the total number of carts 30. Buying 30 carts at $299.00 would cost a total of $8,970. For the final plan, the total per room added up to $132.27. With 60 patients per floor and five floors, that’s a grand total of 300 room that would need the equipment. The total of this plan would be $39,681.00. The prices range quite a bit on these projects. The price of the Personal Vitals Equipment Plan seems to rule it out. As far as price goes, the Vitals Cart Plan is clearly the winner.
Addressing the infection control aspect of each of these plans is very important to River Valley Hospital because many of its patients have very contagious diseases. Beyond the problem of making patients sicker, River Valley is held responsible for the costs of treating any infections acquired while the patient is in the hospital. For the Personal Equipment Plan, it was determined that each set would be used for 8.5 patients per day. This number was determined by the number of patients each CNA has in an average day. This is a fairly low number, and if proper sanitation occurs between uses, then this equipment will be effective and require only minimal sanitation each day. When looking at the Vitals Cart Plan we see a slightly shocking 30 patients per day will be using it. This number was determined by the fact that there are sixty patients on the floor and six vitals machines, meaning ten patients per vitals machine. Vitals are taken each shift and patients may change between shifts, thus multiplying 10 patients by three shifts makes a maximum of thirty patients per day. This number makes sanitizing cumbersome and the practicality of infection control decreases with this plan. Finally, the Room Equipment Plan is the clear winner in this contest with only three patients per day. This number was determined by one patient per room each shift. As mentioned before, patients may change between shifts making it a maximum of three patients per day. This is both easy and practical for the employees to sanitize and to prevent infection from spreading patient to patient.
When it comes to ease of access, the clear winner is the room equipment, because the equipment will always be available in an instant if that patient must be checked. The second place in this contest would go to the personal vitals equipment, which has similar benefits. The equipment is always with the CNA/RN, so if a patient needs his/her vitals taken the employee can go straight there. The Vitals Cart Plan is where a problem presents itself. There are six carts and about seven CNAs per floor, meaning they will have to share from time to time. This makes the carts hard to find because a CNA may leave the cart in a patient’s room or in a place that another CNA who needs a cart can’t find. Six machines is simply not practical to service a floor of sixty.
Lastly, the poll must be observed. The poll determined that the Personal Equipment plan and the Room Equipment plan were approximately the same. The Vitals Cart Plan scored far lower than the other two coming in at only 99/660. After receiving these numbers, a second poll was conducted on why the Vitals Cart Plan is so undesirable. The three top answers are as follows:
- The carts are hard to find, they get left everywhere.
- The carts are unsanitary because they are used so much.
- I want to have my own cart so that I don’t have to wait to get my vitals done.
After examining the results and discussing the benefits and draw backs, a few conclusions can be drawn. The vitals carts are going to be the most cost effective option. Valley River Hospital will save between $30,711 and $68,771.40 by choosing this plan. There are not enough machines and a plan would have to be devised to control infections with this option. Room Equipment is definitely the best as far as infection control and ease of access go, but would cost a significant amount. Personal vitals equipment can be ruled out easy because it is far too expensive and not the best with infection control, even if it is easily accessed.
Based on the conclusions stated above, I believe the best option is the Vitals Cart Plan, but with a twist. Instead of six machines per floor, I recommend seven machines per floor. The cost would still be manageable, coming in a $10,645 for the whole hospital. This would allow each CNA to have their own machine for their shift. Not sharing machines means more time, thus the CNAs would be available to spend a few extra minutes sanitizing the machines between patients.
Although designated places would be set up for each machine, this doesn’t always happen. In addition to designated places, it would become part of shift report for the off-going CNA to tell the on-coming CNA where they left the vitals cart. Adding a seventh machine per floor solves all the problems brought up in the polls, as well as addressing the ease of access and sanitation concerns. I recommend that River Valley Hospital purchases 35 Vitals Carts (7 per floor) to achieve maximum efficiency and quality when taking patient vitals.