The Heritage: Resident Safety and Staff Communications
A case report on improvements in efficiency and safety.

Situation:
The Heritage is a licensed care facility located on the St. Ann’s Community Campus in Rochester NY.  It is a 19 story do-decagon (12-sided cylinder).  The Heritage provides care and housing in an apartment-like, community setting.  There are 12 apartments per floor with dining, activity and large lounge areas on the lower floors.  There is also a two-story facility adjacent to the main building providing exam rooms, PT and OT, medication dispensing and meeting rooms.  There is an outdoor courtyard and direct indoor access to the main St. Ann’s area.

The Heritage has its own main entrance and reception area.
There are (3) three elevators and (2) two stairwells which serve the upper floors. There are (5) five “Nursing Pods” or caregiver locations interspersed throughout the building.  The building was erected in the early 1970’s with the main construction materials being concrete and steel. It is a center core design, with the apartments on the perimeter of a circular hallway.

Challenge:
Although the Heritage is an apartment-like setting, it requires a fully functional call system and a reliable resident to staff medical call method.  A traditional Nurse Call System with a centralized annunciator and patient call cords would have been ineffective.  There is no traditional Nurses Station and because of the circular nature of the building, one could not look down the hall for a call light to see which room required assistance. Additionally, the staff was encumbered from traveling freely up and down the floors due to the availability of the elevator car and/or using multiple flights of stairs.  Staff to staff communication was difficult, and nearly non-existent, between floors.  The nature of construction was such that there were no raceways from the apartments to the center core and all penetrations were through extremely thick reinforced concrete. Additionally, there are imbedded steel cross cables, to stabilize the building, which adds to the difficulty of drilling through the concrete.

Prior to Special Care Systems solution, all calls went to the reception desk and would be dispatched to the appropriate caregiver via cell phone.  The challenges came when the call system began to fail; the receptionist went home for the night or on vacation, or when the cell phones were not being answered due to reception or busy calls.  Pagers were tried but range reception was a problem. Residents could only use the call bell when they were in, or near, the bed or from the bathroom.

Solution:
The Heritage, together with the design staff of Special Care Systems of Rochester, NY, put together a three-phased Hybrid Multi Technology Communications Solution. Re-wiring would have been hugely expensive and have resulted in duplication of the existing situation.  Going fully wireless would have eliminated voice communication between residents and caregivers. The three-phased Hybrid Multi Technology Communications Solution eliminated the above undesirable outcomes and accomplished:

1. Collecting resident call information.
2. Communicating to the proper caregiver.
3. Responding to the resident in the appropriate time and manner.

The proposed solution came in the form of Response Care, Response Alert Plus using the RC2200 In-room Communicator which allowed use of the existing wiring connected to a VOIP telephone system.  In addition, the Identifind network covers the entire building wirelessly. Residents are provided with a wearable personal transmitter.  Locators and Repeaters are installed throughout the building able to provide the name of the resident and their location.         

The powerful Response Alert computer connects caregivers directly to residents in their room. Caregivers are equipped with the Medic 9d24 DECT wireless phone system by ASCOM allowing resident to staff, and staff to staff communication.

When a call is placed, it is routed to the caregiver assigned to that resident or the caregiver best able to handle the call.

There are multiple levels of calls capable in the system depending on resident needs and location.  The wearable transmitter, when in the resident room, activates the RC2200 Communicator.

The communicator transmits resident information to the RA Plus Computer via the VOIP system. The computer then routes the call to the assigned caregiver via the Wireless ASCOM phone system.  The resident is identified to the caregiver over the phone and the caregiver responds. If the resident is in bed they can be given a pendant push button much like a standard nurse call that will initiate the same sequence.  The resident also has a permanent bathroom pull cord that communicates activation wirelessly. In room devices are programmed to the communicator as well as the Identifind Locator Network to provide an added layer of protection.  Residents can also place non-emergency calls from their rooms by pushing the Yellow button on the communicator.

Result: Improved communication across the board!

The receptionist no longer fields all calls.  Calls go directly to the assigned caregiver who is best able to handle the call. The caregivers have the ability to communicate directly with residents and to each other. Residents receive care quicker and staff is more in tune with their needs. Administrators and managers can quickly communicate with staff, not only on individual matters but also on emergency and security situations. System logs and reports insure quality and accountability. Residents have freedom of movement and the security of knowing they can get help when ever and where ever they are on campus.