Documentation is a vital but neglected part of geriatrics and disability. because of the busy and time-sensitive nature of care work, it is easy to miss or forget details when carers and nurses have to try and retain information about their residents that could be important in the short term or vital in the long term when the unexpected happens. Though some people keep notepads in their pockets, they are easily damaged or lost, and frequently contain sensitive information about residents, their needs, schedules and families. An on-hand form of documentation, an app for recording information and maintaining/storing it securely would make data more accurate, ensure information is not misplaced or forgotten and would help improve health outcomes for aged-care residents.
I work in aged-care and I often forget information that is comparatively unimportant, but still relevant to and impacts on my residents. When staff have to go from room-to-room changing, washing, re-positioning and generally assisting residents, details like "what side is June positioned on? Or "Did Judy brush her teeth tonight?" slip through the cracks. While these details seem unimportant in the grand scheme of things, skin/pressure care and oral hygiene are major problems for residents in nursing homes. Due to how the industry is structured, less importance is put on taking the time to make sure all residents needs are cared for, and staff are under pressure to look after the basics of hygiene, bodily waste and feeding while maintaining efficiency. An app that assists in documenting turns, oral health and residential notes could help relieve the pressure on staff to preform, and potentially assist in cultural and practical changes in an industry under very heavy and DESERVED scrutiny.
The central concepts of the app would be security, accessibility and efficiency. The first priority and responsibility of the developer would be to protect the identities and dignity of the residents being documented on, and their families. The second concept would be accessibility for care staff. Few staff are technologically inclined and many carers/nurses are not of the relevant age groups likely to be able to use a complex program or app without extensive training or serious documentation errors. The last concept, efficiency is related the spontaneity and bustle of a caring environment. Buzzers are going off in five different rooms! Dinner starts in 1 1/2 an hour and there is still a trolley-bath to be done! There is not much time to document things, so input and output of information needs to be simple and efficient.
The app could also be used as a secure, active rostering system to make sure staff are at the site and to make sure staff are turning up in time for handover. In addition, a dynamic roster could be open to staff who want to swap, drop or replace shifts, reducing labor for administration staff and nurses when someone calls in sick, "sick" or does not turn up for shift. Staff would need a password to log in as they usually would, and have multi-factor verification options available to them. There would be a simple index/main menu containing links to various documentation wizards, resident notes, handover information and schedules. On this same main page, a Vocera-like program would be available for staff to contact other staff for assistance, as well as a portal to the roster, or a staff portal would be available containing these features. The potential Vocera-like feature could replace the much maligned Vocera system, which is often a pain to use in a noisy and busy environment. A mobile app could easily replace the need to keep and maintain a Vocera system, and could preform most of the tasks of a Vocera, such as local brodcasting to other users, calling for help and calling other staff, and could do it in a simple and far more user-friendly manner. Residents rooms could have QR codes on or behind bedroom doors linking directly to their care-plans, profiles and physio assessments, only readable by the app and by staff holding active permissions on their phone or device.
Necessary equipment and tools are a working, mid-range computer, a reliable internet connection, and the necessary software to build an App. The desired program for developing the app would be Ionic, as it is freeware up to the point of sale or publishing, and is easier to use than Cordova or PhoneGap. Ionic comes with built in UIs that allow the developer to focus more on the features of the product, rather than focus a much larger portion of development on the UI as would otherwise be necessary. If the Ionic build works, I'd like to use PhoneGap to build a version of the product that would not require a subscription to sell or publish.
Being able to code in Java and HTML5 would be necessary for building the app, as well as an understanding of graphic design to build a user-friendly and functional Ui. For the more complex features of the app, some serious experience building corporate programs may be necessary. If all the outlined features where to be included in the proof-of-concept. Access to android and iOS devices would be necessary for testing of the app.
If this app was to be successful and possessed the basic tools (and if lucky, the other more complex features) outlined above the quality of life, health outcomes and funding given to residents in nursing homes would improve; possibly by a considerable amount. If the vocera-like feature was included, communication between carer workers, RNs, and administration would be smoother and quicker then before. Having QR codes/barcodes in or on residents rooms would making keeping up to date with a residents changing needs be easier. Things are often forgotten during handover that, while not super-important, will impact how the resident is cared for. If the app did help to improve documentation in nursing homes, documentation could be instant and convenient to those responsible for caring for the elderly. Lastly, if an active rostering system could be implemented, it would be easy to fill in shifts and track when staff are late. If all the features where present and the app functioned well, the app could potentially revolutionize the way a nursing-home works.
