Non-Invasive Hemodynamic Monitoring System

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by dpuli013
Last updated 5 years ago

Health & Fitness

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Non-Invasive Hemodynamic Monitoring System

WorkflowAnalysisBefore and After

Introduction and Organizational DescriptionSepsis is the main cause of death among non-cardiac ICU patients and the 10th leading cause of death in the United States overall. Timely and appropiate recognicion and treatment are critical to improve patient's outocmes and survival (Mayr, Yende, & Angus, 2014). Monitoring intravascular fluid status and volume responsiveness is crucial to guide clinical desicions in the treatment of sepsis (Marik, Monnet & Teboul, 2011). Currently this is accomplished with invasive and minimally invasive devices that place patients at risk for iatrogenic complications. Being able to obtain hemodynamic parameters and anticipate fluid responsiveness is possible with the use of innovative technologies. The setting for the implementation of this innovation is a 4-unit-32 bed multispecialy critical care center, with a 2:1 RN to patient ratio. All ICU rooms are equipped with telehealth technology (E-ICU - see video).

Non-Invasive Hemodynamic Monitoring byDiana Pulido & Dafney Santana

SolutionThe use of a 100% non-invaise monitoring system coupled with the telemedecine technology currently available at our hospital has the potential to improve patient outcomes by decreasing exposure to nosocomial complications. Two innovative technologies that offer non-invasive hemodynamic monitoring are: Bioreactance and bioimpendance.Research has shown that with bioimpendance body habitus and factors such as temperatue and humidity affect the accuracy of hemodynamic readings. Additionally, variations in sensor location on the patient's body, movement, and electrical interference from other devices (i.e. EKG leads) impede accurate signal interpretation by the machine (Marik, 2013). Bioreactance on the other hand is not affected by the above mention factors and its accuracy has been correlated with that of the PAC or doppler thechnology (Marik, 2013).

Organizational ReadinessThe organization has demonstrated a commitment to enhancing patient safety and quality of care, therefore accessibility of resources does not comprise a concern. Intensive care units pertaining to this organization are equipped with telehealth technology (see video). Echoing on the diffusion of innovations theory, the NICOM technology presents certain traits that are meaningful in the adoption of a new technology (Robinson, 2009): It postulates advantages over and is comparable with current practices, it can be tried through pilot testing before making a purchase commitment, research studies have demonstrated its accuracy against well-established systems (Squarra et al., 2007, & Waldron et al, 2014), and because of its ease of use it should be well accepted by the end users. Training for this innovation will consist of four weeks (two weeks for the pilot study and two weeks for training). Computer and didactic training will be implemented for bedside and eICU staff.

StakeholdersStakeholders for the unification of this innovation with telehealth will be the patient, clinical staff, and administration. Prevention of iatrogenic risks (i.e. nosocomial infections) will improve patient safety and be cost effective for all stakeholders involved. The end users of this innovation will be the bedside RN and eICU RN’s. In respect to the diffusion of innovation theory, the authors of this work along with nursing administration will encompass the category of early adopters, who embrace innovations that are compatible with their needs, disseminate information to other adopters, and influence how other groups under the bell curve welcome the innovation (Gerard, n.d).

Functional RequirementsFor the incorporation of NICOM hemodynamic monitoring into eICU telehealth the following functional requirements have been identified: •Audible alarms•NICOM machine with accuracy of hemodynamic parameters•Aesthetically pleasing interface•Easy to use•Simple color and font•Provides guidance and protection of errors through set up as well as status updates

Planning & ImplementationGo-lives will start rolling out once all ICU and E-ICU staff have been trained in the use of the device, which will be accomplished over a period of 4 weeks. For every shift there will be a super-user available, and a representative from the manufacturing company will be available 24/7 by phone. Risks associated with implementing this monitoring solution include: · Inadvertent skin injury from direct contact with the electrode pads· Entry of incorrect patient data at the time of set up can cause inaccurate readings leading to inadequate therapeutic management. Simulations and mock codes will be carried out during training sessions to allow end users time to interact and become familiar with the device prior to pilot testing (Rice, 2014). Additional education will include assessment and documentation of skin integrity, and ways to prevent device related skin break down (Pittman et al., 2015).

TestingA pilot test will be carried out in on of the four ICU units with the aim to identify the correct order of directed tasks to ensure a realistic workflow, adjust how to collect data to ensure completeness and accuracy, and idenfify device interface limitations (Wiklund, Kendler, Strochlic, 2010, p 244). Usability of the device will be tested by observing end users interacting with the NICOM, to identify problems with the system's interface. For example: RN unable to find a trend graph due to poor menu option wording, or misread parameter due to small numbers, screen glare of poor background to text contrast (Wiklund, Kendler, Strochlic, 2010, p 250).


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