Get connected
4 Dec 2008 by Evoluted New Media
The development of electronic connectivity has improved the flow of information in many areas of life. Increasingly, the application of this technology is being introduced in healthcare systems around the world to support patient care
The development of electronic connectivity has improved the flow of information in many areas of life. Increasingly, the application of this technology is being introduced in healthcare systems around the world to support patient care
DESPITE initial concerns regarding the security of sensitive information, these problems have been addressed so that connectivity is now appropriate for use in hospitals to update, input or view information from anywhere in the facility, helping to maintain accurate patient records, increasing the speed and quality of care, improving accuracy and improving the audit of patient pathways. In fact, connectivity is encouraged in the NHS to reduce errors and to improve staff compliance1.
Connectivity can be achieved in a number of ways:
• via a docking station to a Local Area Network (LAN)
• via a USB connection to a personal computer
• via wireless transmission
The first two options can be achieved easily in any hospital. Wireless technology is however the most exciting development and is expected to increase due to the savings in workflow and improvement to patient safety that can be achieved. Already, in the USA, more than 90% of medium and large hospitals either currently use wireless technology or have plans to adopt it in the future2.
Laboratory information management systems (LIMS) have shown how rapid access to diagnostic results can improve patient care. As diagnostic technology has evolved to allow certain tests to be performed outside the laboratory, at the point of care (POC), further time savings can be achieved, but the accurate recording and sharing of these results is essential.
Hospitals need technology that will help them to reduce errors, whilst taking into consideration regulatory requirements and issues such as ease-of-use, cost effectiveness and infection control.
With the introduction of wireless technology, mobile data collection has become a reality, so that test results from POC devices can now be transmitted to a centralised database from the patient’s bedside, increasing accuracy, raising the visibility of data and, thus, improving patient care.
One test that is increasingly performed at the point of care is the measurement of blood glucose levels. Blood glucose measurements are often recorded manually, which increases the risk of transcription errors and omissions from the patient record3. Hospitals are under pressure to ensure that blood glucose testing is properly documented and monitored through quality control checks. This is a growing challenge for POC coordinators and medical staff as the number of glucose tests performed in hospitals increases.
The world is facing a growing epidemic of diabetes, which is expected to affect more than 360 million people worldwide by 20304. In the UK, in 2006, there was estimated to be 2.4 million people with diagnosed diabetes (and another 500 000 undiagnosed), and as much as 10% of in-patient spend used in the care of people with diabetes5.
Diabetes is characterised by persistent hyperglycaemia, and so it is important to
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| An ICU nurse using the Accu-Chek Informa II |
In addition to this, blood glucose levels are also monitored in intensive care units (ICUs) in critically ill patients with a glucose imbalance caused by, for example, major organ failure or septicaemia3. The implementation of tight glycaemic control (TGC) protocols during the stabilisation of these patients, involving frequent blood glucose monitoring, has also increased the number of blood glucose tests performed in hospitals. Intensive insulin therapy to maintain near normal blood glucose levels reduces the morbidity and mortality of patients6 and shortens the duration of stay in the ICU7.
Until recently, blood glucose results had to be recorded manually or were transmitted to the hospital information system (HIS) by returning the hand held blood glucose meter to a static docking station. Now, however, it is possible to transmit the result wirelessly from the patient’s bedside - improving accurate documentation, saving valuable time in the recording of results and providing immediate access to the information by authorised personnel.
This year, the world’s first wireless hospital blood glucose meter became available in the UK. Based on proven diagnostic technology, the Accu-Chek Inform II blood glucose monitoring system from Roche Diagnostics is designed for accurate and efficient POC testing, and incorporates several important elements.
The hand held meter allows the glucose test to be performed at the patient’s bedside and improves the mobility of staff from room to room and patient to patient. For each test it automatically stores patient identification, operator identification and test strip lot data (entered manually or by scanning bar codes), in addition to the time and date of the test and any relevant comments, which are displayed and reported with the test result.
For ‘at risk’ patients, it is also possible to use a dedicated meter. The bedside result improves workflow, minimising the need for dedicated staff to move around the department and allowing them to respond to the result immediately with appropriate delivery of care.
The system utilises the Accu-Chek Performa test strips, provide results in 5 seconds. The strips require a small sample volume (just 0.6µl), improving patient comfort. Under-dosing is detected, ensuring that adequate blood is applied before a result is given. Performa strips are versatile, allowing blood glucose levels to be determined in venous, capillary, arterial and neonatal (including cord) whole blood samples.
The connectivity options of the meter are flexible in order to meet the requirements of individual facilities. It can be achieved at the meter’s docking station, which can be free standing or wall mounted in a convenient location, which can be connected via a USB cable or hard-wired directly to the Ethernet network. Alternatively, the system is easily upgraded to provide wireless communication from the hand held meter (via a RF card) for facilities with a WiFi infrastructure. With this capability, the meter need only be returned to the docking device for recharging or for communication with the HIS if the WiFi signal is weak or interrupted. The information that is transmitted to the HIS includes test and control results, operator and patient details, consumable details, configuration information and comments. As recommended, communication is bi-directional8, allowing firmware updates and additional information from the HIS to be sent remotely to the meters.
A browser-based data management system, cobas IT 1000, enables the electronic capture of data from POC tests (from both Roche and non-Roche instruments) and transfer of results to the HIS. It permits patient validation, operator recognition and material lot tracking, enhancing regulatory and facility documentation requirements.
The data management package allows data to be accessed by authorised personnel from any location in the hospital network, helping staff to better manage and treat patients’ clinical glucose needs. In addition POC coordinators can obtain a summary of systems and their connectivity status at a glance, from a central location, and can view warning messages for instant identification of problems.
Quality control (QC) for POC devices is often the responsibility of the hospital laboratory, and so it is important that QC data can also be viewed from a remote location.
The Accu-Chek Informa II blood glucose monitoring system is supplied with glucose control solutions and requires glucose control tests to be performed at intervals determined by individual facilities. The system can be configured to require in-range glucose control results before patient testing is allowed and a warning is displayed when control tests are required. Control tests results and control solution details are stored and transferred automatically to the HIS.
In addition, it is important that healthcare professionals are trained and certified to perform POC tests. Operator identification ensures that only trained personnel can carry out the blood glucose test. Furthermore, a password protection option ensures that only authorised personnel can make changes to the system set up.
The wireless capability of the meter is designed to improve hospital quality management by helping POC coordinators to track what tests are being done when, on whom and by whom, ensuring that the right patient receives the right test at the right time and thus improving patient care and safety. The system conforms to Wireless Local Area Network (WLAN) standards.
The continuous access to data enabled by a wireless POC blood glucose testing allows POC coordinators to better demonstrate regulatory compliance, providing real-time management of operator training and meter QC, and enhancing quality assurance by collecting, storing and transferring information about the meter, test strips, glucose control solutions and test results.
In addition, the speed and convenience of the POC blood glucose test, combined with automated recording and rapid access of results, helps to save valuable staff time, improving workflow and efficiency, and enhancing the care of the patient. Furthermore, it has been identified that staff time contributes to the majority of the cost of a blood glucose test and so any feature that saves staff time will also result in significant cost savings3.
