Purpose: Just-in-time training (JITT; also called just-in-time teaching, just-in-time education, or just-in-time learning) is an effective method of providing real-time education to healthcare providers, particularly to reinforce previously learned skills and knowledge that have waned over time (Schuller, DaRosa & Crandall, 2015; Davis, Garcia, Wyckoff, et al., 2012; Wang, Cheng, & Liu, 2015; Branzetti, Adedipe, Gittinger, et al., 2017; Niles, Sutton, Donoghue, et al., 2009; Scholtz, Monachino,, Nishisaki, et al., 2013). Current technology can be leveraged to expand JITT to cover the multitude of high-risk, low-frequency procedures that nurses perform daily, impacting both nursing skills and patient outcomes. Because expanding face-to-face training for a multitude of procedures may be cost prohibitive, quick response (QR) codes are a potential low-cost mechanism for providing JITT via written or video information. These codes are used by manufacturers of hospital-based equipment whereby QR codes are adhered to the equipment, and scanning the code with a mobile device directs users immediately to training videos, or a review of key concepts and instructions. However, few research studies have evaluated the feasibility and usability of QR code readers by healthcare workers in patient care areas (Jamu, Lowi-Jones, & Mitchell, 2016). In an effort to generate research to guide implementation of QR codes in the hospital environment, the aim of this study was to explore the acceptability and usability of a QR code reader for accessing JITT by nurses in a hospital setting.
Methods: We conducted the study on a 24-bed medical/surgical unit in a community hospital, and selected wound vacuum-assisted closure (VAC) dressing changes as the subject of JITT due to the infrequency with which unit nurses performed this procedure. We developed written and video instruction of the dressing changes, placed adhesive QR code links on dressing change packages, and taught the 24 registered nurses how to access information with their personal phone. Nurses completing wound VAC dressing changes during the study period were asked to complete a survey about their use of the QR codes to access the education.
Results: Despite support for the technology, all nurses who performed dressing changes during the study period stated that the QR codes were not used (n=5). The most common reason for not using the codes was that nurses felt familiar with the wound VAC procedure. We conducted a post-hoc survey with all unit nurses and unlicensed assistive personnel to determine which procedures would be most useful with which to utilize this technology; staff reported that utilizing QR codes to access JITT would be most useful for peritoneal dialysis, managing chest tubes, and accessing implanted ports (n=19; 100%, 94%, 94%, respectively).
Conclusion: Hospital patient care providers may utilize QR codes for JITT if they perceive the education to fill a gap in knowledge. Our next step is to expand the QR code implementation study to encompass education of the identified procedures, and resurvey nurses about their use of the technology.
