The Mechanical IV Pump: Keeping Patients at Home
Given the choice, few patients choose to stay any longer than required at a hospital or long-term care facility. A growing number of patients choose home as the place to not only live but also the place to heal. The reasons are many, with comfort usually being the first. Home care can reduce costs for both the hospital and the patient. Home care often also reduces the risk of patients contracting infectious diseases. Home care does not, however, come without its challenges.
Spectrum Health Visiting Nurse Association (VNA) has been providing home care services for more than 100 years. Nurses working at the VNA visit patients in their home environment and assist in their adjustment to continuing their health care at home. A common part of home care involves using an IV, or intravenous therapy, to administer medication. According to the Medicare Payment Advisory Commission, 136,000 Medicare beneficiaries used home infusion in 2009 with more than $1 billion in costs for drugs, supplies, and equipment. “Home services are fast growing into the business model of future health care,” says Julie Hill, RN, nursing supervisor, Spectrum Health Visiting Nurse Association. “And it’s working well—except for one aspect. Patients often need to be able to use a complicated device, the IV, which is designed for trained clinicians, not patients, to use.”
The Problem: A Do-It-Yourself Project
Julie Hill has long observed the problems patients receiving home care services have when using an IV to self-administer medication. When things go wrong with home infusions, patients often must be readmitted to hospitals. They may also suffer from poor wound healing, longer treatment periods, or, at best, require more of the nurse’s or caregiver’s time to administer medications. Clogged PICC lines in the pump are another common problem. In some cases, when medications are not properly administered, it can even lead to death.
Hill got her chance to talk about the problems she saw with patients using IVs at home when two members of the Spectrum Health Innovations (SHI) team joined her on a ride-along one day. Scott Daigger, manager, innovation and entrepreneurship, and Eric Van Middendorp, MSE, engineer, came to the VNA and asked if they might watch her work throughout the day to see what problems might arise and what they might help solve. It’s what the Innovations team does. “I didn’t even know SHI existed until I met Scott and Eric,” Hill says. “It was such great fortune to have them job shadow me that day.”
For the elderly and other home-bound patients, administering their own medications with this complicated machinery is intimidating and difficult, Hill explained to her teammates for the day. The dexterity needed to set up an IV can be hard for aging hands. The steps involved, too, can be complicated for patients who may not be fully physically and/or mentally competent. For the 50 to 60 patients that the visiting nurses check on each and every day, a much simpler and more foolproof device was needed.
The Challenge: Untying the SASH
Julie Hill describes the procedure VNA nurses must teach their home care patients: “SASH is a process we teach patients to follow when administering medication with an IV. That stands for Saline, Administration, Saline, Heparin, and it is meant to help them remember all the steps necessary. The patients are responsible for performing the SASH procedure by themselves and with separate syringes.” The medication bag must be spiked and hung from a stand, the drip chamber and tubing primed and an adjustment roller used to get the correct flow rate. To calculate that rate, the patient must then count a drip rate in the drip chamber and calculate the rate mathematically. The patient must receive another flush of saline, followed by a flush of heparin, to prevent clotting. Lost yet? “Scott and Eric saw the problem right away, and they jumped right in to come up with a solution,” Hill says.
The Spectrum Health Innovations Solution: Safe and Simple as 1-2-3
Daigger and Van Middendorp brought Kristina Emery, BSN, RN, clinical specialist, Spectrum Health Innovations, onto their team. They invited a group of students from Grand Valley State University (GVSU) to bring their fresh ideas in engineering and design to the table. “We shouldn’t expect patients to grasp what trained clinicians do,” Emery says. “So we asked the students to come up with an idea that is easy and self-contained. And it has to be on wheels so even Grandma can move it around without effort.”
The GVSU students put their minds and skill sets to the task. The result was a series of prototypes that resemble a briefcase. Inside the case are all the parts of an infusion system needed, contained in one. A small pump replaces the former drip requiring gravity. The flushing of saline and heparin that patients had to perform manually is now an automatic process. “With all the many elements that need to be tested, we will have to work on this prototype for a long time yet,” Hill says. “The students are currently working on making the mechanical IV pump lighter, easier to carry. When designing this for our patients, the students have to consider in factors of age, literacy, physical ability, medical literacy, cost, good vision, and fine motor skills. A lot goes into this, but we want something so foolproof that even a patient in the early stages of dementia can use it.”
The prototype of a mechanical IV pump is seeing early success: the students presented it at the MWest Challenge, West Michigan’s regional business competition, and won a $5,000 prize to continue their work.
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