In healthcarePoint of Care (POC) CNA means that Certified Nursing Assistants (CNAs) provide and document care right where the patient is—like at the bedsidein the bathroomor in an exam room. It involves tasks such as helping with daily living activitiestaking vital signsand observing patient behavior—right at the moment and place where care happens.
This blog explains what POC means for CNAshighlights key benefitsand shows how technology is changing frontline care in long-term care settings.
What does “Point of Care” (POC) mean for CNAs?
The Point of Care (POC)refers to a specific time and location in which medical services are providedtypically either in an examination roombathroomor at the patients’ bedside.
For certified nursing assistants (CNAs)the point of care serves as the hub of their day-to-day job affairs. This area is where the CNA completes the most fundamental Activities of Daily Living (ADLs)including assisting with the bathdressingand transferring/mobility needs of their assigned patients. The CNA is also responsible for acting as the primary observer of the patient’s overall health.
By taking vital signsdocumenting the level of pain experienced by the patientand observing any changes to the patient’s mental status as neededthe CNA creates a critical linkage between the patient and the remainder of the healthcare team at the Point of Care.
To understand how POC supports CNAswe can break it down into three specific categories:
1). Point of Care (POC) Technology
POC technology refers to the digital tools that are used by CNAs to complete documentation and other tasks in the same location as where they physically interact with patients (e.g.bedside).
Examples of Point of Care technology include:
- Tablets
- Smartphones
- Wall-mounted kiosk systems
- Mobile apps
The purpose of this technology is to streamline clinical response times. Because CNAs can quickly enter data into their POC tool (i.e.prior to having to wait for data entry at a central lab or stationary computer)healthcare providers can quickly diagnose and treat patients.
Example of How POC Technology Helps:
Before POC technology was developedCNAs would rely solely upon memory or scraps of paper to document careand would only enter data into the electronic health record (EHR) after they had returned to a stationary computer later in the day. Oftenas a result of this processCNAs were forced to document care in a vague manner or miss documenting care altogether. Today’s modern POC solutions enable CNAs to document care in real-time at the bedside via the use of digital tools like tablets and wall-mounted kiosk systems.
2). Point of Care (POC) Charting
POC charting refers to the workflow of recording care in real-time at the exact time and location in which the care was provided.
Unlike traditional documentation practices in which CNAs view documentation as a separate chore to be completed at the conclusion of a shiftCNAs today utilize apps that enable them to log actions as part of the task itself. ThereforeCNAs are able to accurately record vital signshygiene assistanceand intake/output at the exact time of care.
Example of POC Charting:
A certified nurse assistant can verify a patient’s identityrecord their vital signsidentify a skin conditionand notify another nurse of a possible concernall within the POC application installed on the digital toolsprior to ever leaving the room.
3). Point of Care (POC) Testing
POC testing refers to the ability to conduct diagnostic tests near the patient (i.e.at the bedside)rather than shipping specimens away from the patient.
Many settings require CNAs to perform bedside glucose testingurine dipsticksor other simple assessments. A POC system enables these testing devices to communicate with the electronic health record (EHR). Upon completion of a testthe POC system either automatically transmits the test results to the EHR or enables the CNA to manually enter the results immediately at the bedside. This ensures that test results are always accurate and that healthcare providers have the necessary data to make timely and life-saving decisions.
Example of How POC Testing Helps:
Prior to the availability of POC testingresidents who exhibited symptoms of a urinary tract infection (UTI) were not diagnosed until the lab returned resultsusually 24 hours later. As a resultthe patient continued to experience discomfort and treatment delay.
Todaywith POC testinga CNA can assist a resident with a urine dipstick test at the bedside. The test strips are read immediately and the positive results are transmitted to the EHR. The physician reviews the diagnosis and prescribes medication to address the UTI within minutes of receiving the test results.
Benefits of Point of Care (POC) CNA Technology
Digital tablets at the bedside instead of paper notes can make a huge difference in how much time a CNA has to give to a patientas well as changing the experience for the patient themselves. The main benefits of using this technology include:
1). More Time for PatientsLess Time Walking
Historicallythe CNA would have to leave the patient’s bedside to go to a designated computer room in the hospital to document their patient’s progress. In many casesthe nurse and/or other CNAs were waiting in a line to use a single computer.
Using POCthe CNA carries their “computer” with them. This eliminates hours of walking back and forth between the bedside and documentation area. Thereforethe additional time spent at the bedside allows the CNA to focus on caring for the patient.
2). No More Guess Work
If a CNA writes down a detail in their notebook several hours after the incident occurredit is likely that some of the detail may be inaccurate or forgotten. With POCCNAs are able to record the patient’s details immediately. This means the medical records are exactnot just estimates based on memory.
3). Keep the Patient Information Safe
Paper notebooks can become lostmisplacedor viewed by unauthorized individuals. A modern POC tablet is far more secure than a paper notebook. A POC tablet works similar to a banking app—requires a username/password combination to enter—thereforeprovides a high level of security for protecting patient information and compliance with Federal and State regulations (such as HIPAA).
4). Patients Feel Heard
Patients feel heard when they see the CNA documenting their concerns and issues immediately after they have expressed them. Families also feel reassured knowing that the CNA documents their concerns immediately and not having to wonder whether the staff member will remember to document their concerns later.
5). Fewer Issues with Medical Billing
The biggest advantage for facilities that provide services to patients and receive payment from insurance companies is the reduction of billing issues. Insurance companies only reimburse providers for work performed that has been documented in a clear manner. When a CNA performs work but fails to document it properlythe facility may not receive reimbursement for those services. POC technology assists in ensuring that each service provided by the CNA is properly documentedthereby facilitating timely reimbursement.
How to Start Using POC Technology in Your Nursing Home?
The transition to using a new technology system involves some big changesbut those changes follow a very simple recipe for success.
Step #1: Determine Where POC Is Needed In Your Building
The first step is to determine where POC is needed in your building before you go to purchase. To do thismanagers need to take a walk through the nursing facility and observe where your CNAs are spending their timeand what types of activities are causing them to lose time.
For exampleare they taking the time to write notes by hand?
Are they waiting in a long line to access a computer?
Creating an exact visual representation of these “traffic jams,” will provide you with a clear picture of exactly where the new technology will have the greatest impact.
Step #2: Pick the Right Equipment
Now that you know where your team is strugglingyou can begin to choose the right tools to solve these challenges.
Some nursing homes may decide to simply add a “CNA App” to their current computer systemswhile other facilities may decide to buy new software designed specifically for nursing homes.
You will also need to decide which types of devices to use. Many hospitals choose to implement both tablets for use at the bedside (to allow CNAs to move around)as well as wall mounted screens for use in the hallways (to quickly check for information).
Step #3: Connect The Systems
Connecting the various systems together is the most important technical step when integrating a Point of Care system.
For examplewhen a CNA records a blood pressure reading on a tablet located at the bedsidethat reading needs to automatically be recorded in the facility’s central billing system.
This automatic connection between systems eliminates the need for the CNA to manually enter the same information multiple timesas well as provides the billing department with the information they need to process claims in a timely manner.
Step #4: Test It Out (Pilot Program)
Do not attempt to roll-out the entire facility on the same day that you introduce the new POC technology. Insteadidentify a small team or a single area of the facility (such as a single wing)to pilot test the new POC technology.
Provide extensive training to the individuals who will be testing the new technologyand allow them to use it for a period of time prior to rolling it out to the entire facility.
These individuals may identify minor issues such as a font size being too smallor a button being located in the incorrect location.
Identifying and resolving these types of minor issues with a small pilot programwill eliminate potential major issues when implementing the new technology across the entire facility.
Step #5: Track Progress
After launching the new POC technology into your nursing facilityyou must continue to track its progressto ensure that it is providing the expected benefits.
There are many ways to measure the success of the new technology. For exampleyou can look at the numbers:
- Are mistakes in the notes going down?
- Are insurance claims getting processed faster?
- Is there a reduction in claim denials?
If metrics like these indicate that the new technology is positively impacting your facilitythen the POC implementation can be deemed successful.
How POC Skills Apply to CNA Certification Exams
You may think that “Point Of Care,” sounds like some technical jargon. In realityPoint of Care systems simply replace the traditional skills testing of your CNA certification exams by electronic means.
Whether you are documenting on a piece of paper or telling a proctor (someone watching you take the test) what you didyou are still doing the core functions of nursing: turning patientsassisting them with their dressinghelping them eattaking their vitalsetc. The difference is instead of writing down everything you do on a piece of paperyou will be tapping away at a computer screen to record everything you do.
All state-approved training programs teach the student to perform hands-on patient carewhile accurately documenting all activities performed. Moving from a paper chart in a classroom to a tablet in a nursing home is a small adjustment. The hard part is learning the carethe easy part is learning to tap the screen to prove you did it!
How Much Does Point of Care CNA Technology Cost?
The cost of using point-of-care CNA technology is generally paid through software subscriptions and/or start-up costs for the systemincluding trainingsetup and possibly equipment such as tablet computers.
➜ Typicallyfacilities consider software similar to subscription services. The most common method of charging for software subscriptions is based on the number of beds per day. A Forrester study commissioned by PointClickCare used the example of $0.85–$0.95 as the price per bed per day. The monthly charge would be approximately $26–$29 per bedwhich means a 100-bed facility would have to budget at least $2600–$2900 per month for software charges alone.
➜ On top of the subscriptionthere are usually startup costs. These could include implementation of the system according to the specific needs of the nursing home facility and the initial training of staff to use the system. The amount of the start-up charge will depend upon the size of the facility and how complicated the implementation process will be. Typicallythe start-up costs will be in the tens of thousands of dollars during the first year.
➜ You should also plan for the cost of hardware or equipment that will be needed to implement the point-of-care CNA technology. Some organizations may share tablets among multiple employees. Others may install wall mounted units or stations in each room or hallway. The cost of iPad tablets ranges from $349 as reported on the Apple website. Wall mounts enclosures for tablets can vary but some examples show prices ranging from $200 to $300 (such as a $299 CAD unit). Costs for vital signs monitoring equipment can also vary depending on the type of device selected.
