Mobile computers aka COWs for Computers on Wheels have been proposed as a solution to the problem of making a computer available to clinicians at the patient bedside for direct entry of data. Potential problems can arise with these devices including:
- Power supplies: need to be securely attached to the cart. If not, these can fall off during movement and break. A potential solution is to add a velcro strap to the cart so the power supply can be attached.
- Make sure you have high quality wheels on the carts. One solution is to use large "roller blade" type polyurethane wheels.
- Make sure the carts have a large enough area to allow the user's to have a mouse and potentially enough space to let down a clip board or other paper-based charting device.
- Keyboards should have clear plastic covers to allow housekeeping staff to be able to easily clean these devices at least once per shift and more often if spills or obvious contamination result. See Neely AN, Sittig DF. Basic microbiologic and infection control information to reduce the potential transmission of pathogens to patients via computer hardware. J Am Med Inform Assoc. 2002 Sep-Oct;9(5):500-8.
- If the hallway is carpeted and the rooms are not (or vice versa), the carpet molding presents a huge speed bump that has caused havoc with any type of cart and especially those with smaller wheels or loose items on the top. Even those that are less than a quarter of an inch pose a barrier to carts.
- Once in the room, most integrated devices need to be maneuvered relatively close to the patients and still leave room for the nurse and/or physician to examine and administer care to the patient. The bed side tables, chairs, commodes, IV’s and other stand-based devices clutter the room and present significant obstacles. No matter how spacious the room there’s an amazing amount of clutter right around the bed that prevent getting the medication carts close enough to use the tethered wands. I’ve seen many tethered wands knock over liquid containers over the patient, get caught up in equipment and lines.
- Over time the wheels, unless maintained, can behave like shopping cart wheels.
- Pay close attention to the “docking” stations. The carts will not be returned to where they were originally intended to be parked. Instead they’ll be left at convenient places. Make sure all of the electrical outlets in the halls and anywhere a cart might get parked are at least waist high rather than in their normal 18 inches from the floor. I’ve seen too many dead carts because clinicians forgot to plug them in where they left them.
- Watch where people take a paper chart and note where they stopped to read. That’s likely where they’ll want to take and use the COWS, CALVES or whatever devices you select. That’s probably where they’ll leave them, too.