Infusion pump informatics approach to quantify impact of alerts and alarms on healthcare delivery

2017 ◽  
Vol 61 (1) ◽  
pp. 681-685 ◽  
Author(s):  
Denny Yu ◽  
Kang-Yu Hsu ◽  
Joon Hong Kim ◽  
Poching DeLaurentis
Keyword(s):  
Patient Care ◽  
Medical Devices ◽  
One Health ◽  
Infusion Pump ◽  
Healthcare Delivery ◽  
Health Practitioner ◽  
Contributing Factors ◽  
Infusion Pumps ◽  
Logistic Regressions ◽  
Current Impact

Infusion pumps are medical devices that deliver medication, fluids, and nutrients in a precise and controlled manner that is critical to patient care. This study proposes using infusion pump informatics on all-infusion datasets to understand current impact of alerts and alarms on patient care and health practitioner workflow. All-infusion datasets contain infusion data for both normal and abnormal use, i.e., error states. Ten months of continuous data was collected from one health institution. Analysis of variance with log-transformation and logistic regressions were used to analysis contributing factors for alerts and alarms states. A total 64,511 minutes of alarm activation were observed, where alarms were active prior to being resolved. Mean resolution times for 83% of alarms were one minute or less; however, 3% or alarms required >4 minutes before getting resolved. Risk factors for infusions with alerts included nursing shift variables. Specifically, odds for alerts were 1.3 times higher for infusions that span across shifts than infusions in the day shift.

scholarly journals Kejadian Ekstravasasi Obat Kemoterapi pada Pasien Kanker

2018 ◽  
Vol 11 (3) ◽  
pp. 142
Author(s):  
Marisa Junianti Manik
Keyword(s):  
Cancer Patients ◽  
Medical Devices ◽  
Infusion Pump ◽  
Good Condition ◽  
Chemotherapeutic Agents ◽  
Contributing Factors ◽  
Cross Sectional ◽  
Chemotherapy Drugs ◽  
Cancer Management ◽  
Analytic Design

Chemotherapy is a cancer management with drugs. The complication that can be occurred is extravasation. The objective of this study was to analyze factors such as vein conditions, type of medications/chemotherapeutic agents, volume of chemotherapeutic agents, and their correlation with chemotherapy drugs extravasation incidences. This study used cross-sectional observational analytic design, with purposive sampling. The sample of this study was 70 cancer patients undergoing chemotherapy in hospitals. Inclusive criteria were patients with ages 18-65 in their first to fifth cycle of chemotherapy. The observation form was used as research instrument. The study showed that there were no correlation between vein conditions, type of medications/chemotherapeutic agents, and volume of chemotherapeutic agents with extravasation. Most veins were still in good condition while undergoing chemotherapy. The length of time for administering chemotherapy were mostly <24 hours, which contributed for reducing risk for extravasation, although the type of medication used were irritants and vesicants, and with drugs volume of 100�1000 milliliter. The incidences of extravasation that were immediately can be observed during chemotherapy occurred 7.14% of the time. It was possibly occurred by medical devices used, such as infusion pump that was facilitated the nurses in early anticipate drugs leakage outside the veins tissue. Nurses� roles also contributed to reduced extravasation risks. As conclusion, the results shown there were no correlation statistically; however there might be other contributing factors that need to be explored furthermore.

New Perspectives on Sustainable Healthcare Delivery Through Web of Things

2018 ◽  
pp. 166-187 ◽  
Author(s):  
Cristina Elena Turcu ◽  
Corneliu Octavian Turcu
Keyword(s):  
Social Networks ◽  
Patient Care ◽  
Medical Devices ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Web Based ◽  
Web Of Things ◽  
The Social ◽  
Health Sensors ◽  
The Web

This chapter focuses on examining the adoption of the web of things paradigm in healthcare in order to facilitate the development of new web-based systems in more effective and efficient ways. Nowadays, the increasing number of personal health sensors and medical devices present the opportunity for healthcare providers to interact with patients in entirely new ways. In this context, the WoT paradigm could be closely linked to patient care and has the potential to generate changes in healthcare. WoT could also be applied in the social and insurance fields, etc. The social web of things (SWoT) further extends WoT in order to facilitate continued interaction between physical devices and humans, allowing the integration of smart objects with social networks. Although it opens new social possibilities, it was less applied in the delivery of healthcare. Nevertheless, its successful adoption depends on overcoming some open challenges.

scholarly journals EpiToMe: A Bespoke EHR for Epilepsy Care (Preprint)

2020 ◽  
Author(s):  
Shiqiang Tao ◽  
Samden Lhatoo ◽  
Johnson Hampson ◽  
Licong Cui ◽  
Guo-Qiang Zhang
Keyword(s):  
Patient Care ◽  
Care Management ◽  
Healthcare Delivery ◽  
Data Entry ◽  
General Purpose ◽  
Burden Of Care ◽  
Physician Burnout ◽  
Contributing Factors ◽  
Clinical Workflow ◽  
Redundant Data

BACKGROUND While EHR brings various benefits to healthcare, EHR systems are often criticized as cumbersome to use, failing to fulfill the promise of improved healthcare delivery with little more than a means of meeting regulatory and billing requirements. Besides, EHR systems have been recognized as one of the contributing factors for physician burnout. OBJECTIVE Specialty-specific Electronic Health Records (EHR) systems have been suggested as an alternative approach that can potentially address challenges associated with general-purpose EHRs. We introduce Epilepsy Tracking and optimized Management engine (EpiToMe), an exemplar bespoke EHR system for epilepsy care. EpiToMe uses agile, physician-centered development to optimize clinical workflow and patient care documentation. We also report the initial feedback of EpiToMe on its utility on physician burnout. METHODS Using collaborative, asynchronous data capturing interfaces anchored to a domain ontology, EpiToMe distributes reporting workload among technicians, clinical fellows, and attending physicians. Results of documentation are transmitted to the parent EHR to meet patient care requirements with a push of a button. An HL7 messaging engine exchanges information between EpiToMe and EHR to optimize clinical workflow tasks without redundant data entry. EpiToMe also provides live, interactive patient tracking interfaces to ease the burden of care management. RESULTS Since February 2019, 12,422 electroencephalogram (EEG) reports, 929 Epilepsy Monitoring Unit (EMU) daily reports, and 1,125 EMU phase reports have been completed in EpiToMe for 5,393 unique patients. A ten-question survey was completed by 11 (among 16 invited) senior clinical attendings. Consensus was found that EpiToMe eased the burden of care documentation for patient management, a contributing factor to physician burnout. CONCLUSIONS EpiToMe offers an exemplar bespoke EHR system combining physician-centered design with the latest advances in information technology. The bespoke approach has the potential to ease the burden of care management in epilepsy.

Clinical Cybersecurity Training Through Novel High Fidelity Simulations (Preprint)

2018 ◽  
Author(s):  
Christian Dameff ◽  
Jordan Selzer ◽  
Jonathan Fisher ◽  
James Killeen ◽  
Jeffrey Tully
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Medical Devices ◽  
Healthcare Systems ◽  
High Fidelity ◽  
Protected Health Information ◽  
Patient Harm ◽  
Security Vulnerabilities ◽  
Clinical Simulations ◽  
Medical Infrastructure

BACKGROUND Cybersecurity risks in healthcare systems have traditionally been measured in data breaches of protected health information but compromised medical devices and critical medical infrastructure raises questions about the risks of disrupted patient care. The increasing prevalence of these connected medical devices and systems implies that these risks are growing. OBJECTIVE This paper details the development and execution of three novel high fidelity clinical simulations designed to teach clinicians to recognize, treat, and prevent patient harm from vulnerable medical devices. METHODS Clinical simulations were developed which incorporated patient care scenarios with hacked medical devices based on previously researched security vulnerabilities. RESULTS Clinician participants universally failed to recognize the etiology of their patient’s pathology as being the result of a compromised device. CONCLUSIONS Simulation can be a useful tool in educating clinicians in this new, critically important patient safety space.

Impact of Health Information Technologies on the Quality of Healthcare Deliveries

2021 ◽  
Vol 6 (1) ◽  
pp. 30-44
Author(s):  
Patricia Whitley ◽  
Hossain Shahriar ◽  
Sweta Sneha
Keyword(s):  
Patient Care ◽  
Health Information ◽  
Medical Errors ◽  
Information Technologies ◽  
Healthcare Delivery ◽  
Well Being ◽  
Quality Of Healthcare ◽  
Quality Healthcare ◽  
The Impact

Through a literary review of recent research, this paper examines the mixed impact of health information technology (HIT) on patient care, medical errors, and the quality of healthcare delivery in selected hospital settings such as emergency departments. Specific technologies examined include the electronic health record (EHR), medical devices, artificial intelligence, and robotics. The paper identifies that some healthcare technologies are increasingly valuable in reducing medical errors, improving healthcare quality, and in producing better patient-centered outcomes. It also determines that technologies have complicated the delivery of quality patient care, increased the incidences of clinician burnout, and made receiving quality healthcare in America's hospital systems possibly less sure. The paper concludes with some suggestions for improving HIT's implementations and confirms the need for further evaluation of the impact of HIT in increasing patient safety and clinician well-being.

scholarly journals Spousal Concordance of Physical Frailty in Older Korean Couples

2020 ◽  
Vol 17 (12) ◽  
pp. 4574 ◽  
Author(s):  
Suah Kang ◽  
Miji Kim ◽  
Chang Won Won
Keyword(s):  
Risk Factor ◽  
Married Couples ◽  
Limited Data ◽  
Contributing Factors ◽  
Physical Frailty ◽  
Frailty Phenotype ◽  
Frailty Status ◽  
Spousal Concordance ◽  
Logistic Regressions ◽  
Association Data

Marital status is an important risk factor for physical frailty. However, there are limited data on spousal concordance of physical frailty among married couples. Here, we evaluate the spousal concordance of frailty as defined by the Fried frailty phenotype and specific phenotype components that contribute to this association. Data on 315 married couples (630 individuals) aged between 70 and 84 years were obtained from the Korean Frailty and Aging Cohort Study (KFACS). Multivariate logistic regressions were used for the analysis. After adjusting for covariates (age, body mass index, education, house ownership, comorbidity, cognition, depressive symptoms, cohabitation with adult children for both partners), a husband’s frailty was positively associated with his wife’s frailty (odds ratio (OR) 3.34, 95% confidence interval (CI) 1.04–10.73, p < 0.05), and a wife’s frailty was significantly associated with her husband’s frailty (OR 4.62, 95% CI 1.31–16.33, p < 0.05), indicating a greater effect of the frailty status of the spouse among women than among men. Among the five components of the Fried frailty phenotype, weight loss, slowness, and exhaustion were the main contributing factors to the spousal association for frailty. In conclusion, having a frail spouse is a strong and independent risk factor for frailty among community-living older adults.

scholarly journals Cybersecurity features of digital medical devices: an analysis of FDA product summaries

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e025374 ◽  
Author(s):  
Ariel Dora Stern ◽  
William J Gordon ◽  
Adam B Landman ◽  
Daniel B Kramer
Keyword(s):  
Medical Devices ◽  
Time Trends ◽  
Primary Outcome ◽  
Product Information ◽  
Healthcare Delivery ◽  
Recent Time ◽  
Secondary Outcome ◽  
Regulatory Documents ◽  
Secondary Outcomes ◽  
Premarket Approval

ObjectivesTo more clearly define the landscape of digital medical devices subject to US Food and Drug Administration (FDA) oversight, this analysis leverages publicly available regulatory documents to characterise the prevalence and trends of software and cybersecurity features in regulated medical devices.DesignWe analysed data from publicly available FDA product summaries to understand the frequency and recent time trends of inclusion of software and cybersecurity content in publicly available product information.SettingThe full set of regulated medical devices, approved over the years 2002–2016 included in the FDA’s 510(k) and premarket approval databases.Primary and secondary outcome measuresThe primary outcome was the share of devices containing software that included cybersecurity content in their product summaries. Secondary outcomes were differences in these shares (a) over time and (b) across regulatory areas.ResultsAmong regulated devices, 13.79% were identified as including software. Among these products, only 2.13% had product summaries that included cybersecurity content over the period studied. The overall share of devices including cybersecurity content was higher in recent years, growing from an average of 1.4% in the first decade of our sample to 5.5% in 2015 and 2016, the most recent years included. The share of devices including cybersecurity content also varied across regulatory areas from a low of 0% to a high of 22.2%.ConclusionsTo ensure the safest possible healthcare delivery environment for patients and hospitals, regulators and manufacturers should work together to make the software and cybersecurity content of new medical devices more easily accessible.

Standardized Vasoactive Medications: A Unified System for Every Patient, Everywhere

2005 ◽  
Vol 40 (11) ◽  
pp. 984-993 ◽  
Author(s):  
Kristin Niemi ◽  
Siobhan Geary ◽  
Mark Larrabee ◽  
Kevin R. Brown
Keyword(s):  
Patient Care ◽  
Life Support ◽  
Standard Dose ◽  
Infusion Pump ◽  
Neonatal Resuscitation ◽  
Advanced Life Support ◽  
Tertiary Hospital ◽  
Drug Preparation ◽  
Software Program ◽  
Vasoactive Medications

Providing medications used in emergency cardiovascular care (ECC) in an efficient and consistent manner is a cornerstone for achieving excellent patient care and safety. For neonatal, pediatric, and adult patients who move through different specialty areas in a tertiary hospital, it is essential to have a standardized protocol for these medications that can be followed regardless of location or practitioner. Our institution developed a protocol for intravenous push (IVP) and continuous infusion (CI) medications based on the Neonatal Resuscitation Program (NRP), Pediatric Advanced Life Support (PALS) and Advanced Cardiovascular Life Support (ACLS) guidelines. This protocol incorporates these guidelines into a single reference sheet (Emergency Drug Sheet) based on the patient's weight using a computer software program. The program provides the option for either pediatric (weight-based) or adult (weight-based and standard dose) dosing. The CI section uses a limited number of concentrations, which meets the JCAHO mandate. Commercially available products are used, when possible, in response to USP <797>. It also serves as the standard protocol for vasoactive medications in all patient care settings in conjunction with programmable infusion pump technology. The software program is easy to use; the Emergency Drug Sheet is easy to read; and the program is available everywhere in the hospital. The standard CI protocol used with the Emergency Drug Sheet reduces unclear orders, standardizes drug preparation, and decreases the time to medication delivery. It could serve as a model for community hospitals, as well as tertiary facilities.

scholarly journals The Definition and Scope of Diagnostic Error in the US and How Diagnostic Error is Enabled

2018 ◽  
Vol 3 (1) ◽  
pp. 128-134 ◽  
Author(s):  
Michael Laposata
Keyword(s):  
Patient Outcomes ◽  
Healthcare Delivery ◽  
Quality Of Healthcare ◽  
Developed Countries ◽  
Diagnostic Error ◽  
Cost Of Care ◽  
Contributing Factors ◽  
The Us ◽  
First Time

Abstract Background The quality of healthcare in the US has been progressively addressed by 3 reports from the National Academy of Medicine, the latest of which, entitled “Improving Diagnosis in Health Care,” was issued in 2015 from a 21-member panel (the author of this report was a member). The report is a review of the longstanding problem of diagnostic error. The infrastructure of healthcare delivery in the US has inadvertently made diagnostic error a major contributor to the high cost of care and preventable poor patient outcomes. Content This review describes the failures in US healthcare delivery that have led to the overwhelming number of deaths attributable to diagnostic error. Each failure is associated with recommendations to eliminate it. The review begins with a description of the scope of the diagnostic error problem and then discusses each of the issues that need to be addressed to reduce the number of misdiagnoses. Summary The problem of diagnostic error in the US is a large one. Some the contributing factors to this large problem can be resolved at a small expense and with modest change; others require a major overhaul of aspects of medical practice. For the first time, Americans have a “to-do list” to reduce our diagnostic error problem and be on par with other developed countries that are recognized as providing less costly care with better patient outcomes.

scholarly journals Reducing errors in the administration of medication with infusion pumps in the intensive care department: A lean approach

2019 ◽  
Vol 7 ◽  
pp. 205031211882262
Author(s):  
Alexander F van der Sluijs ◽  
Eline R van Slobbe-Bijlsma ◽  
Astrid Goossens ◽  
Alexander PJ Vlaar ◽  
Dave A Dongelmans
Keyword(s):  
Intensive Care Unit ◽  
Patient Safety ◽  
Intensive Care ◽  
Confidence Interval ◽  
Medication Errors ◽  
Infusion Pump ◽  
Baseline Measurement ◽  
Infusion Pumps ◽  
Improvement Measures ◽  
The Impact

Background: Medication errors occur frequently and may potentially harm patients. Administering medication with infusion pumps carries specific risks, which lead to incidents that affect patient safety. Objective: Since previous attempts to reduce medication errors with infusion pumps failed in our intensive care unit, we chose the Lean approach to accomplish a 50% reduction of administration errors in 6 months. Besides improving quality of care and patient safety, we wanted to determine the effectiveness of Lean in healthcare. Methods: We conducted a before-and-after observational study. After baseline measurement, a value stream map (a detailed process description, used in Lean) was made to identify important underlying causes of medication errors. These causes were discussed with intensive care unit staff during frequent stand-up sessions, resulting in small improvement cycles and bottom-up defined improvement measures. Pre-intervention and post-intervention measurements were performed to determine the impact of the improvement measures. Infusion pump syringes and related administration errors were measured during unannounced sequential audits. Results: Including the baseline measurement, 1748 syringes were examined. The percentage of errors concerning the administration of medication by infusion pumps decreased from 17.7% (95% confidence interval, 13.7–22.4; 55 errors in 310 syringes) to 2.3% (95% confidence interval, 1–4.6; 7 errors in 307 syringes) in 18 months (p < 0.0001). Conclusion and Relevance: The Lean approach proved to be helpful in reducing errors in the administration of medication with infusion pumps in a high complex intensive care environment.

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