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Paula Marentay, RN, of the University of Michigan Health System in Ann Arbor met her new robotic colleague last year, one year after the Food and Drug Administration approved the da Vinci Surgical System as the first robotic system to be used in American operating rooms.

The patient on the operating room table is about to undergo delicate surgery for a kidney transplant. Instead of performing the surgery at the patient's side, her doctor is positioned at a console several feet away. As he makes a tiny incision in the patient, he views the procedure through a high-resolution system that provides 3-D images of the surgical field. Slowly, he manipulates the instruments to remove the patient's kidney.

Nurses, medical assistants and a second surgeon stand next to the patient, but the doctor performs the entire surgery by operating the arms of the 7-foot robot. Although this may seem like a scene from a science fiction movie, computerized technology such as robotic surgery as well as bar coding systems to deliver medication are a reality in many hospitals.

And nurses are among the hospital workers who are on the frontlines using these cutting-edge inventions, which ultimately have the potential to improve patient care, reduce errors and even save lives.

The da Vinci Surgical System, manufactured by California-based Intuitive Surgical, is the latest advancement in minimally invasive surgery. The robot allows doctors to zero in on the surgical site and work on a smaller visual scale than ever before.

The robot's tiny camera, equipped with multiple lenses, allows the surgeon to magnify an area up to 12 times that of normal vision. The remote-controlled instruments, which the surgeon inserts in the patient through small incisions, also allow access to hard-to-reach areas.

Paula Marentay, RN, of the University of Michigan Health System in Ann Arbor met her new robotic colleague last year, one year after the Food and Drug Administration approved the da Vinci as the first robotic system to be used in American operating rooms.

Marentay's work with the da Vinci starts behind the scenes before the surgery begins.

She prepares three robotic components: the console where the surgeon sits, the video and medical monitors and the robot's arms. She covers the equipment with sterile drapes and ensures that the robot's mechanisms are in working order before the patient enters the operating room.

"The da Vinci seemed so complicated that I thought it was something we would try but rarely use," Marentay said. "Instead, it's become very much in demand at our hospital."

Sharon Krhoun, RN, of Mt. Diablo Medical Center in Concord, Calif., has assisted with minimally invasive surgery for the past eight years, and has worked with the da Vinci robot since July.

"I think it's exciting to see our patients benefit from advances in robotic surgery," Krhoun said.

"They are thrilled to find out that we have new surgical procedures that offer less pain and a faster recovery time."

For nurses working in postop, robotic surgery means seeing patients with less scarring and fewer infections. Many patients who previously would have spent weeks in the hospital now are discharged in a matter of days.

Despite the benefits of robotic surgery, medical experts don't anticipate seeing this new technology in every operating room. Patients, not physicians, are pushing for widespread use of robotic surgery. Many physicians prefer to conduct surgery using the traditional methods.

In addition, the da Vinci's $1 million price tag may prohibit many hospitals from investing in the robotic technology.
Prescription accuracy

While some hospitals are experimenting with robotic surgery, others are tapping into the latest computerized technologies with high-tech prescription delivery systems.

Nurses who use this new technology begin by scanning three things: a bar code imprinted on the patient's ID, their own ID and the prescription. These three codes must match to verify the drug, dose, time and route.

Hospital medication errors received national attention in November 1999 when the Institute of Medicine reported that thousands of deaths occur in hospitals as a result of medical errors.

At Southwest Washington Medical Center in Vancouver, Wash., nurses use a new medication delivery system called AcuScan-Rx.

"This technology reminds me of when videocassette recorders were introduced," said R.J. Melton, an RN at Southwest Washington. "The original monitors were black-and-white and much larger in size. Our newer models transmit in color and are half the size of the original devices."

Each month, the medical center prepares an average of 300,000 doses of medication. Systems such as AcuScan-Rx have proved to reduce medication errors by more than 80 percent by catching potential errors before they occur, according to a study published in the winter edition of the Journal of Healthcare Information Management.

"The system can be more time-consuming to use, but the advantage is the added layer of security it offers to both patients and nurses," Melton said.

In August, California's Sutter Health network of hospitals announced plans to implement the new Bridge MedPoint medication delivery system in all of their medical centers within the next three years. Bridge MedPoint, manufactured by California-based Bridge Medical Inc., is similar to the AcuScan system.

"From a nurse's perspective, I think this is one of the most exciting new technologies to be introduced in recent years," said Susan Bumatay, MSN, RN, assistant administrator and chief nurse executive at Sutter Delta Medical Center in Antioch, Calif., one of the first six Sutter Health hospitals to implement the technology.

Sutter is among many California hospitals working to comply with the new California Health and Safety Code that requires medical facilities to implement a medication safety plan by Jan. 1, 2005.

The MedPoint system is positioned at the bedside and provides nurses with medication- specific alerts and drug administration guidelines to help prevent errors and improve clinical decision-making. MedPoint is designed to prevent errors by sounding an alarm if an improper medication or dosage is given to a patient. The error is also automatically registered in the patient's chart.

"The task of routinely administering medication has become much more complex in recent years," Bumatay said. "There are more than 17,000 pharmaceuticals in use in the United States today, and many of them have names that look and sound alike, which can be confusing."

Costly implementation

Despite the advantages of bar coding, some experts said implementing a system such as MedPoint can be costly and many hospitals cannot afford the software, hardware and training associated with such a system.

"We need to keep in mind that systems such as Bridge MedPoint are software, and as great as they are, they don't fix underlying problems in the institution," said Cherie Galusha, MSN, RN, a nurse at Sacred Heart Medical Center in Spokane, Wash. "Attention has to be given to retooling existing processes from care models to medication distribution."

Pharmaceutical companies also could play a role in reducing medication errors, she said.

"At this point in time, pharmaceutical companies don't bar code all of their unit dose products and hospital pharmacies are having to make up the difference," Galusha said.

The solution at Sacred Heart has been to bring in an outside vendor to bar code the inventory that doesn't already come wrapped in codes. This requires the hospital to repackage or wrap over existing packaging, which adds another expense to the hospital's implementation budget.

"The Bridge MedPoint system is great," Galusha said. "But it's important for nurses not to become so reliant on the system that they give up their own critical-thinking skills."

Contact Linda Childers at eastbaypr@aol.com

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