Patient Safety: Surveillance, Cyber ​​Awareness, and Action

Regulatory requirements, such as The Joint Commission and the Occupational Safety and Health Administration, require that safety inspections be conducted at regular intervals to ensure patient safety. The Nursing Practice Act also requires nurses to safely operate all equipment and use medical devices appropriately during patient care. When new equipment is introduced into a patient care area, a proficiency check of the responsible personnel who will be using the equipment should be performed. This proficiency check is generally kept in the employee’s personnel file for future reference if necessary.

Nurses are taught at some point during their training to always look at the electrical cords of all equipment because a frayed cord is a potential fire hazard. This is still true. The temperature of the solutions used to heat and cool pads or blankets can also pose a risk of injury to the patient if the liquid is too hot or too cold. Burns are the result of improper temperature regulation associated with a variety of patient care treatment devices. Crazy as it may sound, a simple non-invasive blood pressure cuff has caused patient harm. The device was inflated to extreme pressures intermittently for a period of time that ultimately caused permanent nerve damage to the patient’s arm, resulting in a clawed hand. A list of equipment that is frequently involved in patient care issues includes, but is not limited to, the following: volumetric infusion pumps, patient controlled pain pumps, blood glucose testing devices, heating pads, cooling blankets / warming, non-invasive blood pressure cuffs, nasal cannula tubes, leg immobilizers, patient lifts, and continuous positive airway pressure machines. An injury that exposed an older person’s Achilles tendon was the result of a leg immobilizer. The patient’s skin was not checked regularly and as ordered by the doctor for possible damage.

Cyber ​​risk

It seems obvious that inspecting medical equipment and / or devices at regular and periodic intervals is a patient safety concern. Inspection or evaluation of the proper functioning of medical equipment should be an additional consideration at the time of a rapid response event or immediately thereafter. We live in a world where amazing cyber technology exists, therefore healthcare providers must now consider the possibility that technical equipment has malfunctioned, which may have originated from a cyber source. This possibility would never have been considered before. Hacking Healthcare IT in 2016 was published by the Institute for Critical Infrastructure outlining how devices that are Bluetooth compatible and have Internet access, such as implantable cardioverter defibrillator, cardioverter defibrillator and pacemaker, analgesic pumps controlled by the patient and insulin pumps. for being hacked or reprogrammed.

To take action:

1. Be hyper-vigilant and open to the possibilities of contributing factors never before considered.

2. Conduct an in-room equipment inspection at the time of the event and carefully inspect it as soon as possible after a Rapid Response or Code situation. In case of doubt, remove the equipment from circulation; send it to biomedical engineering for inspection and record your action in an incident report, occurrence report, or variance report (whatever your institution may call the form). Let trained biomedical engineering professionals determine when to return the equipment in question to on-hand inventory.

3. Recheck the medication rates programmed into the infusion pumps. Sometimes the scheduling is wrong and guess who’s going to be held accountable? That’s you! Check the bombs by calculating the math yourself.

4. Record the temperature on any equipment or device that displays the temperature. For example: fluid warmers, blanket / pad warmers, warming / cooling blankets, crib warmers, etc. When the temperature is recorded, the medical record conveys that the healthcare provider was paying attention to details that will support their clinical competence should it be questioned.