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A tug in the right direction

Robots provide helping “hands” to RNs

Monday August 15, 2011
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Throughout the country, many nurses are receiving a helping hand from Tug robots, which deliver medications, linens, supplies and meals and remove trash and dining trays. The robots save nurses precious time that can be spent with patients. They never tire, become distracted or stray off task, making them a reliable tool.
Geisinger Medical Center’s (Danville, Pa.) various departments use a Tug robot to transport supplies to units. Once it arrives on the unit, the nurse enters a code, and Tug pops open. Facilitating prompt deliveries, Tugs can lead to better patient care.
“I like it,” said Carolyn Devine, RN, CMS, a staff nurse at Geisinger, which deployed the robots several years ago. “It saves a lot of time and a lot of energy for people.”
Providence Hospital in Washington, D.C., added Tugs about six years ago. “We’re pleased with the Tug,” said Juanita A. Hall, RN, BSN, nurse manager for inpatient and outpatient oncology services at Providence. When properly employed, Hall said, “it’s an efficient process to get what we need from various departments.”
Tugs’ efficiencies are clearly illustrated at Providence when a physician orders a new medication. A nurse calls the pharmacy with the order, and the pharmacy sends the drug up via a Tug, which keeps all human hands on deck on the unit. The hospital also uses it for transporting items from materials management or dietary. The robots make about 10 runs a day to Hall’s unit alone.
“The nurses like it,” Hall said. “You can continue to work and take care of patients.”
Aethon of Pittsburgh, creator of the robot, estimates 120 hospitals are using the Tug Automated Robotic Delivery System. The units can be leased for $1,200 to $1,500 per month, according to an article at www.PCmag.com.
“It’s an interesting concept, being a big fan of ‘The Jetsons’,” said Nancy L. Hughes, RN, MS, director of the Center for Occupational and Environmental Health of the American Nurses Association in Silver Spring, Md. “It’s keeping nurses at the bedside and giving them more time there.”

Under lock and key

The R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center in Baltimore installed its first Tug more than seven years ago and recently upgraded its Tugs to include MedEx, automated tracking and chain-of-custody software that allows the robot to deliver controlled substances. To open a Tug a nurse not only has to enter a password, but also has to place a forefinger on the optical reader for identification. Only after these security protocols are followed does a nurse gain access to the Tug’s contents.
Retrieving medications from the Tug requires minimal training, according to Katherine Mulligan, RN, BSN, a senior clinical nurse 1 on the acute care floor at the trauma center. The robot uses the same fingerprint technology as the medication cabinet.
“Before, one nurse had the keys to the narcotic cabinet,” Mulligan said, explaining that in the past the nurse who needed to administer a controlled substance had to track down the nurse with the keys, wait if the other nurse was busy and fill out quite a bit of paperwork when removing the drug. Now, “any nurse, at any time has access,” Mulligan said. “It has streamlined the process.”
Mulligan said the Tugs make their rounds quickly, but the pharmacy still hand-delivers stat medications. While the robots can boost efficiency, they do not replace nursing staff. The University of Maryland Medical Center has not altered nurse-patient ratios on units served by the Tugs.

Safe travels

Each 55-pound Tug can haul up to 500 pounds of supplies, using the hospitals’ existing carts or specially designed cabinets. The robots automatically recharge themselves between deliveries and can move about for 10 continuous hours.
Aethon engineers create a map of the facility, and the Tug is programmed to tool around the hospital on a programmed route, signaling for the elevator, riding up and down between floors, navigating the halls and opening automatic doors. Light whiskers and ultrasonic sonar, infrared and laser sensors keep the Tug from bumping into anyone or anything. “They won’t run you over, but they will come up on you,” Mulligan said.
The Tug talks. “It will say, ‘Please excuse the Tug’ or ‘Tug has arrived’,” said Gretchen Hunt, RN, MSN, ACNS-BC, nursing director for the ICU, PCU and med/surg services at Texas Health Harris Methodist Hospital Southwest Fort Worth. The hospital has programmed its Tug to speak English and Spanish.
The devices have a “stop” button, which anyone can push. Mulligan finds physicians making rounds with residents often will stop the Tug to prevent it from interrupting clinical discussions, which can delay deliveries to other units.
Pharmacy staff can monitor the robot’s location on a Web portal, check what is happening using the on-board camera and intervene if they notice something blocking its path or another problem.

A unique approach

Texas Health Harris Methodist Hospital recently began piloting Tugs to bring food trays and medications to the progressive care unit. Eventually, the Tugs also will transport equipment.
The hospital has taken a unique approach to Tug management, hiring licensed vocational nurses as unit Tug concierges. The pharmacy technician loads the Tug and pages the concierge to let him or her know the Tug is on its way. The concierge receives the robot when it arrives fully loaded from the pharmacy and troubleshoots any problems.
The concierges also help nurses find what they need for patient care and load the Tug with a “dirty” cart containing equipment in need of cleaning. The Tug is sent to the equipment technician, who returns a similar piece of clean equipment to the unit via a clean cart. The Tug concierges can assist nurses in an emergency and perform phlebotomy, but they are not given access to the electronic medical records to avoid having them fall into patient care duties.
“They are an extra set of hands and not an extra nurse,” Hunt said.
The Tug concierges already have identified new uses for the robots, such as hauling trash to environmental services. Hunt adds nurses at the Texas hospital seem to like the devices, and she said, “It helps with efficiency in the hospital.” •


Debra Anscombe Wood, RN, is a freelance writer. Send letters to specialty@nurse.com or post a comment below.