My Clinical Wish List: A Portable MAR for Respiratory Therapy

I recently visited a big box store to buy groceries while I host our family from out of town. The best part of this trip was that I was able to use my smart phone to scan each product and walk out of the store without waiting in the checkout line. The store owners apparently realized that they were losing profit and customers due to long wait times at checkout, and they solved the problem with an easy-to-use application.

It makes me wonder about the health tech innovation that I see these days. I see a lot of ideas for a total do-over of healthcare, but where is the streamlined checkout system? Why can’t we just update the things that work? And who is actually looking at our clinical workflows to make sure it helps?

For example, Respiratory Therapists (RTs) across the country are supposed to login to an in-room desktop, look up the patient, click on the MAR, scan the armband, and scan the medication before administering the medication. This is exactly the same process as the one used by nursing, and it is a critical mistake.

Copying the nursing process for a different discipline could waste a tremendous amount of skilled clinical time, but many RTs don’t actually use it because it is not feasible. Instead, they are forced to invent workarounds, like sitting in the medication booth and scanning meds for everyone at once, which nullifies all of the safeguards afforded by medication scanning.

I can only imagine that whoever came up with this process made a lot of assumptions without ever watching an RT do their job. Where nurses must gather a tailored list of polypharmacy for each patient, the RT has an entirely different workflow that was unfortunately pushed into the same process. They are not identical, but they are treated as such.

The RT is more likely to provide the same medications to a large number of patients on several units (in addition to their other duties). During the seasonal influx of respiratory patients, the RT may deliver albuterol every 4-6 hours for every patient on several units. It is not the same as nursing.

Rather than sending the RT to the medication booth for every albuterol nebulization, or forcing them to apply workarounds that are unsafe, why not send them with a kit of the three most common medications and a portable smart device with a built-in scanner?

If the big box stores can pull this off in their warehouses, why can’t we do it for the RT who is already walking miles just to visit all of their patients?

If there were three pouches with albuterol, atrovent, and acetylcysteine, partnered with a portable MAR scanner, most RTs would be prepared to provide medications for most patients, and exceptions would require a visit to the medication booth.

This update to their workflow would allow the RT to focus on sensitive tasks like weaning, suctioning, collecting cultures, education, and monitoring acute respiratory care. They would have a fighting chance of assessing whether humidification would be helpful, and they could check the dates on all their tubing to ensure it follows hygiene protocols. The safeguards would be restored.

That’s why one of the top items on my Wish List this season is a Portable MAR for the Respiratory Therapy team — Oh, and an innovation team that checks with the frontline first.