The incessant beeping, chirping, whirring, flashing and whooping of any number of patient monitors continues to be a top hazard in hospitals, as bedside providers either struggle to prioritize the noisy demands of the machines, or tune them out completely.
That's according to a study, Top 10 Health Technology Hazards for 2012, from the nonprofit ECRI Institute. The organization is designated an Evidence-Based Practice Center by the U.S. Agency for Healthcare Research and Quality.
The report notes that bedside providers increasingly are showing signs of "alarm fatigue" as they deal with the constant demands of ventilators, infusion pumps, physiologic monitors, dialysis units, and other technology.
Repeated exposure to the alarms, the report says, can desensitize providers, which can lead to missed alarms or delayed responses, or a failure to make distinctions between the levels of urgency. In addition, the report suggests that some providers improperly adjust monitors to limit alarms, or simply turn down the volume so that the alarms can no longer be heard.
Among its recommendations, ECRI says that healthcare providers should establish institution-wide alarm management programs that examine all equipment being used, and establish protocols for alarm-system settings and notifications.
ECRI's annual report ranks hazards by the harmful impact they could have on patients, how often the hazards occur, how widespread the hazards appear to be, and whether or not the hazards are considered "high-profile" problems that have been covered in the news media, or that providers are pressured to correct.
Here's a brief synopsis of the remaining Top 10 Healthcare Technology Hazards for 2012.
2. Exposure hazards from radiation therapy and CT scans
Radiation exposure, the top healthcare technology hazard in 2011, continues to be a top threat to patient safety. "It isn't clear how many patients are affected by radiation therapy errors – for one thing, there isn't an unambiguous definition of a reportable event – and there is a good chance that incidents are being significantly underreported," the report warns.
With CT scans, the report notes, higher dose levels improve image quality which creates "a natural tendency to use higher doses." In addition, most healthcare facilities do not audit CT doses, so there is a wide variation in the dosages used for the same treatments.
ECRI says there are no simple solutions to correcting the problem, but they recommended in general terms that healthcare providers: ensure proper staffing; install and verify quality control measures; and acquire national accreditation for their radiology an CT services.
3. Medication administration errors using infusion pumps.
While infusion pump technology has improved over the years with the introduction of "smart" pumps, preventable errors continue to occur, and the entire infusion process should be examined, the report says.
Typical problems include illegible orders, incorrectly prepared drugs and solutions, and medication given to the wrong patient. ECRI recommends that providers consider infusion pumps as part of the overall medication delivery system, and determine the compatibility with other safety systems already in place.
Providers should develop drug libraries for clinical areas that use infusion pumps to create standardized concentrations of commonly used drugs and solutions, ECRI recommends.
4. Cross-contamination from flexible endoscopes
The report notes that when endoscope reprocessing problems surface, they can create great anxiety among patients who are told that they may have been exposed, and they can be highly damaging to a healthcare facility's reputation. "At worst, they can lead to life-threatening infections. Such incidents are almost always associated either with failure to follow established cleaning and disinfection/sterilization guidelines and instructions, or with the use of damaged or malfunctioning equipment," the report says.
"Flexible endoscope reprocessing requires consistent adherence to a multi-step procedure. Failure to properly perform any step, including some necessary manual tasks, could compromise the integrity of the process."
ECRI recommends that healthcare facilities; have strict and detailed reprocessing protocols for every model of flexible endoscope in their inventory; periodically review those protocols; and make sure the protocols are readily available to employees who are responsible for the reprocessing.
5. Inattention to change management for medical device connectivity
Problems are arising with the growing interrelationship between medical technology and IT, and the potential for incompatibility. "A key reason problems arise is the failure to implement adequate change management policies and procedures that accommodate both IT and medical technology needs," the report says.
"Because medical devices and health IT are becoming so interconnected, healthcare facilities must be aware of a possible domino effect wherein changes to one component of the system affect the operation of another." ECRI recommends that healthcare facilities evaluate policies and procedures around change management to ensure that issues around healthcare IT and convergence are addressed, with particular care taken to determine how technology decisions involving medical devises and IT networks can impact operations and patient care.
6. Enteral feeding misconnections
Misconnections usually take one of two forms: nutrients intended for the gastrointestinal tract are delivered elsewhere; and inappropriate fluids are delivered to the GI tract. The first problem is the more serious because it can result in death by embolism or sepsis, the report said.
ECRI recommends that enteral pumps be used for enteral feeding only, and that color-coded feeding lines and connectors be traced from end to end when making initial connections. The report also recommends that the standard Luer syringe never be used for oral medications or enteral feedings, and that IV or feeding devices never be adapted for other purposes.
7. Surgical fires
ECRI said it continues to receive reports of one or two surgical fires each week, and the institute estimates that there are about 600 surgical fires each year nationally. "Not all surgical fires result in patient injury, but when they do, the consequences can be severe, including potentially fatal airway burns and horrible facial disfigurement," the report says.
"Virtually all surgical fires can be avoided. But doing so requires that each member of the surgical team clearly understands the role played by oxidizers, ignition sources, and fuels in the operating room." ECRI recommends that hospitals implement surgical fire prevention and management programs; that include familiarization with risks posed by oxygen-enriched air.
The report also recommends discontinuing the traditional practice of open delivery of 100% oxygen during head, face, neck, and upper chest surgery.
8. Needlesticks and other sharps injuries
Needlesticks and other sharps injuries continue to pose a threat of exposing healthcare workers to bloodborne pathogens such as HIV and hepatitis. "Most hospitals have ongoing programs to address sharps safety. But these programs may have been established some time ago and may no longer be receiving adequate attention or achieving their expected level of effectiveness," the report says.
"Continuing injuries are a signal that additional attention is needed; it could be that clinicians are using poor technique, that the safety devices being used should be replaced with more effective models, or that gaps exist in the facility's sharps safety program."
ECRI recommends that healthcare facilities; conduct annual reviews of their sharps safety programs that include assessments of injuries and current practices; and develop action plans that identify and categorize injuries and include remediation plans.
9. Anesthesia hazards due to incomplete pre-use inspection
The report notes that thorough pre-use inspection of anesthesia units has long been accepted as standard procedure. "However, in actual practice, such inspections can be inconsistent and incomplete. Hospital staff sometimes conducts pre-use checks using obsolete procedures or procedures designed for anesthesia units other than the one being used."
Staff may also skip some parts of the inspection because they don't understand its importance or mistakenly believe that the step is being performed by another person, or the unit's semi-automated self-check. ECRI recommends that full inspections of anesthesia units be undertaken every day before the first case of the day, and that subsequent checks throughout the day include the manufacture's prescribed abbreviated check for that model anesthesia unit.
ECRI also recommends that facility policy should clearly state which staff members are responsible for performing the checks, that the check list be readily available to staff, that the findings are documented, and that the checks are expanded to include airway suctioning equipment and manual resuscitators.
10. Poor usability of home-sue medical devices
More people are receiving care in their homes. That limits supervision of caregivers and equipment. "Often, devices that are used in the home are not designed with the lay user in mind," the report says. "They are frequently very difficult to use or very complex, and in fact may sometimes be identical to devices used in the hospital by clinicians."
ECRI recommends that homebound patients, their families, and their caregivers first be evaluated to determine their technical competency before prescribing medical equipment for the home. ECRI also recommends that patients and their families be given educational materials about their medical equipment, and contact information with the provider should problems arise.
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John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.