New Patient Monitoring Device

[atkinite]

Hi all,

I am currently involved in a research dealing with a new Patient monitoring device that is targeted towards providing constant vigilance on patient vitals in general wards. The device has the ability to detect declining health patterns (based on patient vitals) extremely quickly and accurately (reducing false alarms) and can remotely notify nurses and doctors when such events occur.

just wanted to get a feel from the nursing community about this:

1. Do you think that introducing such a device would increase patient safety ?

2. Do you think that the general ward patients are the people most in need of such devices ? Is it suited to some others ?

3. Do you think the device should be a decision support system (conducts a complete diagnosis on the patient and suggests remedies) or should it remain a monitoring/alarming system ?

4. If this device was available, what is the one feature you would need to see in this device to deem it useful?

(e.g. Form factor should be small, format of results on monitor, rate of false alarms etc.)

Thanks !!

[nerdtonurse?, BSN, RN]

I work on a tele unit, and we've gone thru 2 vendors the last 10 months. The problem with a constant monitor is that you've got 2 criteria that can be difficult to achieve:

1--you've got to have patients who will keep the monitor on and not keep yanking it off (I had an Alz. pt's who thought the monitor and wires was a big spider and she actually beat the thing against the floor until it broke before we could get down there. Even if the pt's A/O, it's hard to balance an adhesive strong enough to keep the EKG pads on but not so strong it causes skin tears in the frail. I'd be happier with a system that didn't call everything it couldn't figure out "Vtach", too.

2-- you've got to have someone sitting there monitoring the system who knows what they're doing, isn't distracted by 50 other things, and can get you in a split second if something goes wrong. That's a harder combo to get that you'd think. The idiots managing our department put our tele techs in a room (making it easier for them to concentrate) but without any way to get us without calling the nursing station and having the US call us over the com. And since these same brain cases didn't schedule for a US to be at the desk, half the time we've had the tele tech come to the door and scream "GO TO 4!" when someone starts tanking. Just waiting for JC to see that in action...

Also, do some research on what's already been done. Auburn or UAB did some work years back in having automatic meds dispensed based off the monitoring, and found a lot of problems with implementation.

[canoehead, BSN, RN]

How does your idea differ from the moniters we have already?

[atkinite]

Thank you very much, nerdtonurse? for that insight! We'll keep that in mind.

What we're working on is a device that's not too sensitive i.e. reducing the number of false alarms, because that way the device loses credibility. Moreover, our device is designed to have a wireless feature that will notify nurses on their terminals and raise red flags whenever a patient is crashing. We know that that might result in a havoc of bells and whistles but (a) we're trying to increase the accuracy (reducing false positives) (b) transmit concise messages to nurse terminals or common status screens of what patients need attention along with a urgency level (like "yellow" or "red").

@canoehead: Thanks for your interest. The way we're different from devices like GE Dash 3000 and Hoana's Life-Bed is that (a) the embedded algorithm is faster and more complex so that it can detect declining health patterns extremely quickly and accurately (b) the device is meant for patients who are mobile in general words and not necessarily bed-ridden; thus its light and portable © it's cost-effective; can't give a price figure right now but it's definitely not in the order of thousands as other devices are (d) it's meant to take a limited set of physiological inputs. we talked to medical directors and they suggested that constant vigilance on heart rate, respiration rate, pulse ox and NIBP can be quite useful to detect how the patient is faring.

Please do let me know if you have any other suggestions and featuers you would like to see in such a device. What level of detail in messaging (to nurse terminals) would you like ? Do you believe that early detection of patient distress is a big problem in hospitals these days ? What are the alternatives to this device that are currently in practice where work ?

[bagladyrn, RN]

Will the device you are designing have adjustable parameters (at the "consumer" end, that is)? I find that much false alarming in the equipment we use now is d/t patient "norms" that fall outside the standards - for example patients on a med that has the side effect of increasing the pulse rate - expected, but causing constant alarms from the monitor, or a med that lowers BP for a theraputic reason, but below the machine standards. Even changes in altitude of the facility can change the standards, for instance of acceptable pulse oximetry.

[atkinite]

I think that's an excellent point , bagladyrn, thank you for raising that. I completely agree with you on the point that every patient's circumstance is different and just like you mentioned, parameters might be biased because of some med being given to them, the result of which is an 'expected change' to patient's vitals which is being interpreted by the device as a red flag.

For that purpose, we are planning to introduce sensitivity controls on the device to tweak the thresholds of when the device needs to start raising alarms. However, we're still trying to figure out what would be the unit of measure to represent such sensitivity and the various risks associated with it (e.g. patient might tamper with controls, wrong thresholds were set by the nurse etc.) Nevertheless, that's a good point and we will definitely take that in consideration. Thank you !

[atkinite]

Hi guys,

Can you please fill this survey out ? I'd really appreciate it ! It won't take more than 5 minutes.

http://www.surveymonkey.com/s.aspx?sm=dAx4TwejKUwDrKKbsLNfIw_3d_3d

Thanks a lot !!