Looking Back Before Looking Forward

By Dave Harrington, PhD

One of the top—if not top—problems over the years has been with patient monitor alarms—particularly heart rate alarms.

Over 40 years ago, a company called Electrodyne solved that problem, however, by offering a circuit to count “R” waves called a slew rate detector. This technology measured the height, width, and rise time of the wave—and it worked great, with almost no false alarms on those systems.

It’s beyond me why all the others in the industry continued using the basic Schmitt trigger, which counts pulse rate by the height of the wave and allows for count-based errors. A solution is available, however; the manufacturers just have to install it on their new designs. So push your vendors to make the corrections.

Another potential solution is to turn off the heart rate alarm—which reacts too quickly—and to turn on the pulse oximeter alarm. After all, the oximeter waveform shows the rhythm of the heartbeats and the level of oxygen in the blood. For someone living with atrial fibrillation like me, their heart rate can vary widely—and a pulse oximeter indicates problems better than the simple heart rate monitor does.

Discuss using a pulse oximeter at your next critical-care meeting and gauge the response among your peers. I bet you will get two responses: one that it’s worth a test trial and the second that it’s a crazy idea and “We’re not sure what you are smoking, but we want some.”

Seeking Better Solutions

Going back to Electrodyne: They offered a blood pressure module that had 18 controls on the front panel. That was overkill, and now blood pressure monitoring is much less common and cumbersome as pulse oximeters have replaced that module in many monitoring systems. It’s also important to remember that direct and indirect blood pressure are generally not the same thing: The wrong size blood pressure cuff will give you bad readings; too small will show higher pressure while too big will show lower pressure.

Next, you need to examine all the data that you’ve generated on devices over the years and try to determine how many problems were due to equipment failures and how many were user-related. If your hospital is like most others in the world, the user problems vastly outnumber the technical ones. Even so, user problems become technical problems for your department and demand solutions.

Such solutions should involve the education office—not just the nursing office—as well as all other training functions in the hospital. IT, however, should be left out of the equation since they are never wrong. (If you believe that one, I have a great piece of waterfront property for sale; you just have to water the front twice a day.)

One of the bigger consumers of our time and efforts are infusion pumps. And infusion pumps often have serious problems that we need to solve. Many of the problems are mechanical, ranging from casters, to pole clamps, to damaged power cords—all of which indicate less-than-ideal treatment by the users. One time, in fact, we had a new administrator come to the hospital and put down rugs on all the patient floors. We spent weeks changing casters on IV pole stands (and everything that rolled!) because the administrator wanted the hospital to look more like a hotel.

Another time, we had a series of complaints about the pumps not delivering at the rate selected. We did all of the standard testing, but it didn’t lead us to the problem. But after remembering an old 24×7 article about putting pressure on the patient side of the pump head and looking for bubbles entering the drip chamber, we found the problem: The pressure limit on the pump was set too low. We then worked with the vendor and were able to correct the problem by modifying our PM procedures to include the back-pressure test. All the complaints ceased. So looking back made us look good.

It’s important to watch and listen to the users of the equipment you’re keeping running— often well beyond its expected life—as they may have good suggestions on what is needed in the purchase of new equipment. The mnemonic “KISS”— “Keep It Simple Stupid”—is also helpful in improving patient care and possibly lowering costs. (And if Congress follows suit, we will be in great shape moving forward.)

One last item to consider: Please start writing and presenting at industry meetings. That way, you will have lots of good ideas to share with others.

Dave Harrington, PhD, is a healthcare consultant in Medway, Mass. For more information, contact chief editor Keri Forsythe-Stephens at[email protected].