Patient Monitoring

Medical instrumentation used for patient monitoring has be­come quite sophisticated. This microprocessor-controlled equipment provides multiphysiological parameter monitoring with alarm generation and recording capability. It incorpo­rates telemetry, S—T segment analysis, and full physiological parameter disclosure capability (which stores selected wave­forms for recall), allowing clinical study of abnormalities. It also includes automatic arrhythmia detection at the bedside, which until a few years ago required a large stand-alone com­puter housed in a specially cooled room. Using individual per­sonal computers, patient data can also be collected and ar­chived for additional statistical studies.

The patient’s physiological parameters are viewed on bed­side monitors as well as on remote slave displays. Parameters monitored include ECG, heart rate, respiration rate, cardiac output, noninvasive blood pressure, invasive blood pressures (arterial, pulmonary artery, central venous, etc.), oxygen sat­uration (SAO2), pulse rate, end-tidal carbon dioxide (ET CO2), and temperature.

In critical care areas, the bedside monitors are hard-wire connected to central nursing stations allowing centralized

Figure 7. Central nursing station. Physiologi­cal monitoring has grown quite sophisticated. Patient information gathered at the bedside is routed to a central nursing station providing clinical staff with a comprehensive viewing area. Each central station monitor typically shows waveforms and parameters for four dif­ferent patients and has the ability to zoom in on a specific patient to show all monitored pa­rameters. Recorders provide documented printouts of alarm conditions including de­tected arrythmias. Closed circuit TVs visually monitor patient isolation rooms as well. Clini­cal engineering is involved with the entire life cycle of such equipment from prepurchase se­lection through acceptance testing, PM, repair, and eventual obsolescence retirement.

viewing at one location (Fig. 7). Nursing stations may be con­nected together via local area ethernet-type networks, allowing remote patient viewing between nursing stations and sharing of full disclosure equipment. Telemetry informa­tion is likewise routed to a nursing station for centralized viewing of ambulatory patients. In this case, the telemetry transmitter takes the place of the bedside monitor, transmit­ting a signal to an antenna system that routes it to a receiver and display unit.

Equipment Classification; Nomenclatures

Equipment classification nomenclature systems bring order to the vast array of medical equipment presently in use. These systems simplify the gathering and distribution of data relat­ing to medical devices. Complete nomenclature listings are found in ECRI’s Health Devices Sourcebook (28), and the Med­ical Device Register (29). Another nomenclature system was developed by the U. S. Food and Drug Administration (FDA) as part of its regulatory responsibilities for medical devices. ECRI and the FDA are presently attempting to standardize their two systems.

In the sample nomenclature listing below, note the two ways of listing an ECG monitor.

Cart, resuscitation Pacemaker, cardiac Heart rate monitor, ECG ECG monitor Diathermy unit

Equipment Inventory List

To be effective an equipment management program requires maintenance of an up-to-date, complete inventory of medical equipment used in the health-care institution. This equip­ment inventory list helps identify equipment for product re­call and hazard alerts, as well as to locate equipment due for

PM. As much information as possible should be included for each piece of equipment in the list (30), such as the following:

Unique identification number, which could be a property control asset number, but is usually assigned by clinical engineering and is generally not the serial number Equipment manufacturer, model, serial number, and de­scription (nomenclature)

Equipment location Purchase order number Departmental owner

Service organization responsible for the equipment (in­house, contract, etc.)

Acceptance date, when approved for clinical usage Warranty expiration date Equipment acquisition cost

PM frequency and PM procedure number to be used Additional information the organization believes useful for proper equipment management

Equipment Records

Equipment history files are maintained to provide informa­tion for equipment management and technology assessment purposes, as well as to satisfy regulatory requirements. When equipment is taken out of service and is disposed of, its his­tory file should be maintained for a minimum of three addi­tional years (31), or longer if an institution’s legal council or risk manager deems it necessary. This will offer the institu­tion some protection in the event that a patient incident law­suit is initiated at the time of equipment disposal, of which clinical engineering or risk management is unaware. Records for equipment involved in patient incidents are usually se­questered by the risk manager so as to avoid possible tam­pering.

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