Physicians Implore Healthcare Technology Community to Step Up to Two Major Challenges

Posted June 5, 2016

Making a clear connection between the promise of technology and the reality of a patient’s well being, two highly respected physicians exhorted the healthcare technology community on Sunday to do more to make greater headway on two daunting challenges: infusion system safety and the monitoring of patients receiving opioids.

While the nature of the two challenges was distinct, the physicians highlighted a common thread: a need to appreciate the systemic nature of modern healthcare in which clinical decisions are made in an environment that is increasingly interconnected and complex.

Nathaniel Sims, MD, a cardiac anesthesiologist and physician advisor to biomedical engineering at Massachusetts General Hospital in Boston, and Frank J. Overdyk, MSEE, MD, an anesthesiologist for Roper St. Francis Health System in South Carolina, presented this year’s Dwight E. Harken Memorial Lecture at the AAMI 2016 Conference & Expo in Tampa, FL. This annual lecture honors the substantial contributions Harken, a pioneer in cardiac surgery and a driving force in the founding of AAMI, made to medical science and technology.

Sims led the team that developed and implemented the first smart drug infusion pumps as a way to “embed clinical practice into the device.” While reducing medication administration errors wasn’t the primary object of this invention, Sims revealed, it was a fortuitous side effect. Now all patients have the benefit of dose-error reduction systems and drug libraries that protect against potentially harmful mistakes.

Although these features have helped healthcare delivery organizations refine and disseminate evidence-based best clinical practice, “a new era of innovation is emerging,” according to Sims. This innovation has seven distinct areas of focus:

  • More intense local monitoring of postmarket surveillance signals
  • User-developed online device safety education for clinicians
  • Drug concentrations standardized by the Food and Drug Administration and the American Society of Health-System Pharmacists
  • Intravenous clinical integration
  • Physiological measurement integration, ranging from basic oximetry to advanced brain state monitoring that could eventually lead to autotitration
  • Care quality indicators
  • New infusion pump platforms

During the second half of the lecture, Overdyk focused on another major patient safety issue that has been emerging over the past few decades: the monitoring of patients receiving opioids While awareness of the “opioid epidemic” in the United States has increased, far fewer in the general public are aware of the dangers of being found “dead in bed” as a result of opioid administration in a hospital.

Patients receiving opioid medications to control their pain are nearly twice as likely to suffer from an in-hospital cardiac arrest as those not prescribed opioids, based on a study Overdyk published at the beginning of the year in PLoS One. For those receiving an opioid and a sedative, this risk increases to nearly 3.5%.

Current best practice in most healthcare delivery organizations is a spot check of vital signs every four hours, which Overdyk described as “room-service monitoring.” To powerfully illustrate the dangers of such an approach, Overdyk shared photos and stories of several patients who died in their hospital beds while being treated with opioids. All of these patients had entered the hospital for seemingly routine procedures.

“We don’t have a failure to rescue,” Overdyk said. “We have a failure to recognize.”

To combat this trend, Overdyk advocated for the continuous electronic monitoring of all patients receiving opioids. Based on his research, vital signs such as respiratory rate are strong predictors of patient decline. “Physiology doesn’t lie,” he said.

Both of these issues are being tackled by AAMI Foundation, so healthcare delivery organizations don’t need to feel overwhelmed, according to Marilyn Neder Flack, senior vice president of patient safety initiatives and executive director of the AAMI Foundation.

“Both infusion therapy safety and the continuous monitoring of patients on opioids are initiatives being pursued by the AAMI Foundation,” Flack said. “Through our National Coalition for Infusion Therapy Safety and our National Coalition to Promote Continuous Monitoring of Patients on Opioids, we are developing the tools and rationale needed to educate and encourage hospitals to make technological and clinical changes that can have a significant impact on patient outcomes and safety.”