Background:
Indwelling vascular and urinary catheters are critical in the care of hospitalized patients. However, they can also lead to potentially life‐threatening infectious and non‐infectious complications, such as bloodstream and urinary infections and thromboembolism. A key strategy in preventing these adverse outcomes is early removal of catheters that are clinically unnecessary. Yet, recent studies show that physicians often are unaware of the presence of vascular or urinary catheters in their patients. These patterns suggest that solutions to inform providers of device presence are needed in order to align practice with safe outcomes.
Purpose:
Partnering with biomedical engineers, we set out to design an “Intelligent Safety Intervention System (ISIS)” to track and alert providers to catheter presence. Conceptually, we envisioned a device that would visibly alert providers to the presence of an indwelling catheter while tracking and displaying duration of catheter use. We recognized that patients, physicians and nurses are key stakeholders in the success of this device and arranged informal focus groups to develop value agendas and mission statements for each of these constituents. We specifically engaged patients to use patient activation as “sentinels of safety” regarding device awareness in providers. These considerations were formalized in a device specification protocol and used to develop an ISIS prototype.
Description:
In the summer of 2012, we used off‐the‐shelf components to build and debut an ISI prototype. ISIS was specifically designed to alert healthcare providers and patients, accommodate multiple catheter types, and track device presence/catheter dwell time in days using a universal light scheme. The device was designed so as to be safe (no electromagnetic interference or cross‐talk with other medical devices/computers), highly usable (minimal training to understand features) and pragmatic (lightweight, durable, and reliable). The ISIS prototype uses radiofrequency technology (RFID) to detect and display catheter presence. RFID antennas built into the device sense tags placed on urine collection bags and hubs of central venous catheters to detect and track device presence. In pilot testing, ISIS detected 100% of devices it was exposed to and was able to track multiple devices (urinary catheters and PICCs) with 100% reliability (no failures or dropouts) when placed at the head of the patient’s bed. In addition, user feedback from stakeholders was incorporated to create flexible design features such as variable display colors and visuo‐spatial details including such details as where best to situate the device, automatic dimming at night hours, etc. Field‐tests for interference, visibility, alarm scheme, and power‐failures were also conducted and passed 100%.
Conclusions:
ISIS technology has the ability to alert providers to catheter presence, track catheter days, and visually display catheter dwell times. Further refinements to the technology and studies that measure its impact on infectious and non‐infectious outcomes are next steps. In addition, networking ISIS across a hospital and EMR so as to create central “device dashboards” and preserve device history despite patient movement from one area to another are important next steps. The potential for ISIS to improve tracking, measurement, and reporting of device‐use while improving patient safety is promising.
