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George Gray is CTO and vice president of software development at Ivenix, a vendor of infusion management system software. In this Q&A with SearchHealthIT, Gray discusses how technology can improve the medical device safety of connected infusion pumps used to deliver drugs to hospital patients.
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How big is the problem of medical device safety and errors in infusion pump administration, and what kind of damage is it causing?
George Gray: It's actually a pretty large problem in terms of dollars. It's estimated to be costing the healthcare system about $2 billion a year. It could be extending the length of stay of the patient because you've done harm, or it could be tied to other issues because the patient died. It involves the cost of extending care and increasing the amount of care because of problems with the pumps.
You're delivering medications, and medications are inherently dangerous. If you're using a machine to do that, it's so easy to be off by a zero or a decimal point, and if you're off by a decimal point, you're going to, at a minimum, create harm to the patient.
What kind of technology is needed to manage large volume infusion pump delivery, while ensuring medical device safety?
Gray: Well, when drug libraries were introduced, that did help to a certain extent because you were placing what would be typically very high and very low limits, and you were restricting how much drug the machine could deliver. So you could say a rate can't go any higher than this or any lower than that.
The technology that really needs to bring us to the next level is just to try to simplify the user interface. There are a lot of mistakes that are made because people make mistakes.
The pumps today are complicated; they have little tiny user interfaces. We're all used to phones having apps on them that are very simple, but the infusion pump technologies today aren't like that. They're like old VCRs, with little displays and lots of buttons on them.
It's like 20 years ago type of technologies. So the first thing you need to do is improve the graphical interface and how you interact with the machine, and you simplify things. You take the distractions away, like alarms going off when they don't need to go off, get rid of that.
Number two is to come up with ways to really provide better guidance. Today, we have drug libraries that say if you're trying to set an upper and lower limit for every individual that will be in the ICU; those limits have to be pretty broad.
The next step is to use some of the patient data to set the limits better. For example, if I know the patient's blood glucose, I can advise the nurse on what an appropriate insulin level would be, or if I'm going to give insulin again.
What are some other directions technology needs to go in to improve medical device safety?
Gray: In the infusion business, if you go to an ICU, someone can easily have three or four or five infusions -- sometimes even more -- running into them, and they don't interact with one another.
Because the devices don't intercommunicate, they don't notify each another, and there's no warning back to the clinician. For example, and this is common to have a situation on the first shift, you have a nurse who might deliver an order for Heparin. And then the nurse comes in on the second shift and sees that she has an order for Heparin, and she goes and she delivers it. But the first round of Heparin isn't done, and she doesn't realize that it's actually still being delivered. So they basically deliver a double dose.
Getting these devices to become aware of one another, and to share information around, you know, what's going on with the patient, is really, in my mind, the next thing.
What's the best way to manage medical device alarm fatigue?
Gray: When you talk about how you manage an alarm fatigue, you always start with this premise that no one wants to turn the alarms off because they see the value of them. But the fact that there's just so many coming at them, that's where you get the fatigue.
Many of the alarms are going off because your settings are incorrect. The way to manage them is to build an ability in your systems to collect data and find out when alarms occur, why they occur and how long it takes a user to respond to the alarm. It's about using data, passing that data back in and making the right decisions.
What's the role of a central dashboard in managing all the infusion pumps on a hospital floor?
Gray: The way to get really efficient delivery of infusions and to manage patients is to put that central station in their pockets. So they can have a tablet; they can have a phone. They can also put it up at the central station. The browser can be anywhere. It could be integrated into an Epic system.
What are smart pumps, and why are they not enough to prevent serious medical device safety errors from continually occurring?
Gray: The definition of a smart pump today is a pump that has a drug library. The drug library has brought the industry a long way. But, basically, it's not patient-specific. It's setting limits that are broad. It has the value of not letting you go off the rails, but it has no notion of who the patient is and what their condition is or what the particular needs of this patient are.
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