An Update on Smart IV Pumps and Safety
Here's an update on smart pumps
and meds admin safety via the Premier GPO and their Safety News for
Healthcare. A nice review of recently published research is provided,
with links to abstracts and downloads. The message once again is to pay
attention to the big picture; there's more to meaningful meds safety
improvements than buying a bunch of pumps and a server. Research has
demonstrated real value:
(“near misses”), i.e., potential infusion errors were averted by the
new system. The authors provide an example of the four-fold reduction
in the risk priority score of the FMEA (failure mode and effects
analysis) related to setting IV heparin infusion (from 210 to 56) after
implementation of the IV safety system. The system also provided
continuous quality improvement data for best practice improvement. For
example, identification of the peak times for error warnings occurred
between 3 p.m. and 9 p.m., prompting a review of workload and staffing
patterns.
medication process such as prescribing, dispensing, patient
identification, pump programming, or documentation, there needs to be a
seamless interface of “smart” IV pumps with other technology designed
to reduce MEs.
Another key to improving effectiveness is incorporating IV pump smarts
into more of the clinical workflow. Pump vendors are quickly moving
past annonymous QA databases to patient and user identifiable clinical
transactions. Add alarm notification, which Cardinal's Alaris and
Baxter are providing, with ADT, order entry, and automatic
documentation into the EMR and you've got a closed loop system for
maximum patient safety.
Included are links to Insights from the sharp end of intravenous medications errors: implications for infusion pump technology (full text), in the journal QSHC, and Scanning out medication errors, published in the Pittsburg Business Times.
Implantable Wireless Sensors Developed in UK
Scientists at Imperial College London have developed wireless sensor
technology
that can be implanted in the body. Their current application
is blood glucose monitoring, but they're also targeting respiratory and
cardiac diseases. The sensor communicates with a mobile phone, which
serves as a gateway connecting the patient to their physician. The
system also has the capability to provide self monitoring for the
patient and feed back from the physician. Developers hope to add the
ability to remotely control therapeutic devices.
The sensor, which
includes a Pentium microprocessor just 2mm square, will initially be
implanted in diabetics. Trials will begin by Christmas at St
Mary’s hospital, London. The implant will be programmed to send an
emergency text message via a mobile phone, alerting medical staff to
changes in blood-sugar levels.
Chris Toumazou,
director of the Institute of Biomedical Engineering at Imperial, is
hoping eventually to link the sensor to an insulin pump that can be
operated remotely by a doctor.
Note that the sensor/phone gateway uses SMS
to communicate the data. While wireless IP data is sexier, SMS is the
killer transport for nascent remote monitoring applications. In recent
years carriers have upgraded their SMS services, making them more
reliable and “manageable”. Carrier's SMS messages frequently run
separate from normal voice and data so messages can be transmitted even
when normal circuits are busy. (AT&T Wireless' network worked that
way, I'm not sure how Cingular's network is configured for SMS.)
The advantage for vendors is that GSM/GPRS and SMS are nearly world
wide standards; the same product can be sold into North America and
Europe.
Having worked on a wireless sensor project, I
would guess they are still some way off from a continuous monitoring
capability. I also wonder about the size of the sensor/radio package.
This trial is going to be done with external sensors. I would also speculate that any implantable
device will be closer in size to a pacemaker than a grain of rice.
Oracle is funding the project.
[Hat tip: Wireless Healthcare]
