Minimally, middleware needs to be able to retrieve episodic data from a medical device and translate it to a standard format. It should also be able to retrieve data at variable speeds to meet the requirements of various clinical operational settings (e.g., operating rooms vs. ICUs vs. medical-surgical units). Because data will be used for real-time intervention, any delay in its delivery can have deleterious effects. As such, it is vitally important to understand the implications of requirements related to data delivery latency, response, and integrity. These include FDA requirements, such as those required for Class II clearance. For a middleware vendor to claim clearance for active patient monitoring, the vendor must have checks and balances to ensure the receipt and delivery of all active patient data for intervention purposes from end to end—from collection point (the medical device) to delivery point (the clinician).
Collaborating on continuous monitoring
Many of the worst-case scenarios associated with failed technology adoption and implementation can be mitigated with adequate planning, training, and collaboration. By listening to, engaging with, and educating direct-care staff, hospitals can dramatically increase their chances of success with continuous monitoring.
How will this new technology impact nurses’ delivery of patient care? What adjustments in workflow and practice need to be made—at go-live and beyond? Starting with these questions can foster buy-in from the staff that will be using this equipment. If end users are not involved in the selection, adoption, and implementation of a technology, they are much less likely to be enthusiastic users of that product.
For example, nursing staff are charged with properly setting the alarms and promptly responding when any of the devices send an alert. As the presence of alarm equipment continues to grow, nurses find that their workflow and ability to engage with patients is disrupted as they chase down hundreds of (often nonactionable) alarms. Without proper education and implementation of alarm devices, it’s all too easy to imagine clinical staff arbitrarily adjusting alarm settings—or even turning them off entirely.
Thus, an expert project team should be formed, ideally comprised of leaders from myriad stakeholders, such as IT networking and facilities, informatics nurses, and direct-care clinical staff. This team will be responsible for every phase of deployment, including goals identification, vendor evaluations, business and clinical requirements, and progress assessments. The project team will also be charged with identifying the departments or units the integration will first impact. Big-bang enterprise integrations are not unprecedented, but a phased rollout allows more time and space for assessments. Designating an executive stakeholder, nursing champion, or empowered super-user at the outset is also recommended.
Finally, avoid minimizing clinical workflow, as this largely defines how data is collected, how it is displayed, and what is displayed. Hospitals should incorporate clinical workflow as early as possible in the process of implementing continuous monitoring.
Both patient-managed and staff-administered pain medication are necessary for patients’ well-being in the hospital. However, the use of these medications presents real risk of respiratory depression, especially for patients with complex chronic conditions and comorbidities. Continuous monitoring can help improve patient safety while keeping patients comfortable, but careful implementation is necessary to avoid a negative impact on the staff and environment patients depend on for care.
Given the rising incidence of in-hospital opioid-related deaths, hospitals should commit—soon—to a strategy for ending them.
Jeanne Venella, DNP, MS, CEN, CPEN, is chief nursing officer at Bernoulli and has spent her career transforming nursing care and improving processes. She is a doctoral-prepared nursing practice expert with extensive experience as an innovative healthcare leader. With her knowledge of day-to-day operations, and as Bernoulli’s primary champion for complex nursing topics, Venella’s strategic objective is to advance evidence-based practice. Her passions are in creating small internal team structures to improve workflow and efficiency processes, including assessment of technical solutions; and implementing systems designed to improve teamwork, patient outcomes, safety, and accuracy.
John Zaleski, PhD, CAP, CPHIMS, is executive vice president and chief informatics officer at Bernoulli. Dr. Zaleski has more than 25 years of experience in researching and ushering to market devices and products to improve healthcare. He has a particular expertise in designing, developing, and implementing clinical and nonclinical point-of-care applications for hospital enterprises. Dr. Zaleski is the named inventor or co-inventor on seven issued patents related to medical device interoperability, and has authored three seminal texts on integrating medical device data with electronic health record systems and using medical device data for real-time clinical decision-making.
Bernoulli. (2016, July). Clinical alarm management & reduction: Eliminating alarm proliferation in hospitals and health systems. Retrieved October 27, 2016, from http://bernoullihealth.com/wp-content/uploads/2016/07/2bwhite-paper-clinical-alarms-mgt-from-word.pdf
Health Devices & ECRI Institute (2016, November). Executive brief: Top 10 health technology hazards for 2017. Retrieved from www.ecri.org/Resources/Whitepapers_and_reports/Haz17.pdf
The Joint Commission (2016). Facts about pain management. Retrieved October 27, 2016, from www.jointcommission.org/pain_management
San Diego Patient Safety Council. (2014, June). Respiratory monitoring of patients outside the ICU: Guidelines of care tool kit. Retrieved October 27, 2016, from www.medtronic.com/content/dam/covidien/library/us/en/product/capnography-monitoring/capnography-protocol-san-diego-patient-safety-council.pdf
Williams, J. S. (2014, November). Opioid safety & patient monitoring conference compendium. AAMI Foundation. Retrieved October 27, 2016, from http://s3.amazonaws.com/rdcms-aami/files/production/public/Libraries/Opioids/Opioid_Compendium_2015.pdf
Wong, M., Mabuyi, A., & Gonzalez, B. (2013). First national survey of patient-controlled analgesia practices. A Promise to Amanda Foundation and the Physician-Patient Alliance for Health & Safety. Retrieved from www.premiersafetyinstitute.org/wp-content/uploads/PPAHS-national-survey-patient-controlled-analgesia.pdf
Zaleski, J. R. (2014, October 4). Alarm fatigue? What a nuisance! [Blog post]. Retrieved from www.medicinfotech.com/2014/10/mathematical-techniques-mitigating-alarm-fatigue