Patient Safety: Vigilance, Cyber Awareness, and Action
Regulatory requirements, such as the Joint Commission and the Occupational Safety and Health Administration, mandate 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 correctly during patient care. When new equipment is introduced into a patient care area, a competency check of the responsible personnel who will use 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 in heating and cooling pads or blankets can also pose a risk of injury to the patient if the liquid is too hot or too cold. Burns have been the result of inadequate temperature regulation associated with a variety of patient care treatment devices. As crazy as it sounds, a simple non-invasive blood pressure cuff has caused harm to the patient. The device was inflated to extreme pressures intermittently over a period of time which ultimately caused permanent nerve damage in the patient’s arm, resulting in a clawed hand. A list of equipment 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/ heaters, non-invasive blood pressure cuffs, nasal cannula tubes, leg immobilizers, patient lifts, and continuous positive airway pressure machines. An injury that exposed the Achilles tendon of an elderly person resulted from a leg immobilizer. The patient’s skin was not checked regularly and as ordered by the doctor for damage.
Cyber Risk
It seems obvious that inspecting medical equipment and/or devices at regular periodic intervals is a patient safety issue. Inspection or evaluation of the proper functioning of medical equipment should be an additional consideration at the time of or immediately after a rapid response event. We live in a world where incredible cyber technology exists, therefore healthcare providers must now consider the possibility that technical equipment is malfunctioning and originated from a cyber source. This possibility would never have been considered before. Hacking Healthcare IT in 2016 was published by the Critical Infrastructure Institute describing how devices that are Bluetooth-enabled and have Internet access, such as implantable cardioverter-defibrillators and pacemakers, patient-controlled pain pumps, and insulin pumps are at risk. for having been hacked or reprogrammed.
To take action:
1. Be hypervigilant and open to possibilities of contributing factors never before considered.
2. Conduct an inspection of the equipment in the room at the time of the event, and carefully inspect as soon as possible after a quick response or code situation. If in doubt, take the equipment out of circulation; send it to biomedical engineering for inspection and record your action on an incident report, occurrence report, or variance report (whatever your institution calls the form). Let trained biomedical engineering professionals determine when to return the equipment in question to available inventory.
3. Recheck the medication rates programmed into the infusion pumps. Sometimes the schedule isn’t right and guess who’s going to be held accountable? So are you! Recheck the bombs by calculating the math yourself.
4. Record the temperature on any equipment or device that displays a temperature. For example: liquid warmers, blanket/pad warmers, heating/cooling blankets, crib warmers, etc. When the temperature is recorded, the medical record conveys that the health care provider was paying attention to details that will support their clinical competence should it be called into question.