New Coalition Focuses on Continuous Patient Monitoring

Matt Whitman, a retired Michigan state trooper, strode to the lectern at the front of the room in downtown Chicago and made a startling announcement: “On April 17, 2003, I died.”

Whitman then related his dramatic account of a hospitalization gone scarily awry. His neck surgery—precipitated by a drunk driver hitting his squad car years earlier—had gone fine, but in the recovery room, a new danger emerged. He was placed on a morphine pump for the pain, but without any electronic monitoring. That night, he stopped breathing: a case of respiratory failure induced by the opioids he was on. Were it not for a nurse passing by his room to look for an item for another patient, Whitman believes he would be dead. “I heard you take your last breath,” Whitman recalled the nurse telling him. The nurse called a Code Blue, and a team of doctors resuscitated Whitman. When he came to, a priest was holding his hand.

“I became so angry that there was something that could have been done to prevent the terror that I went through,” Whitman told the audience. That “something” would be continuous electronic monitoring, and Whitman was speaking to a crowd who shared his conviction.

The Nov. 14 inaugural meeting of the National Coalition to Promote Continuous Monitoring of Patients on Opioids focused on the issue stated so clearly in its name: using technology to eliminate the silent and potentially deadly danger of patients succumbing to respiratory failure while on these powerful painkillers.

“From my perspective, continuous monitoring of patients on opioids is a no-brainer,” said Eyal Zimlichman, MD, with Sheba Medical Center in Israel.

The coalition was organized by the AAMI Foundation’s Healthcare Technology Safety Institute. The ambitious campaign marks the latest effort by the institute to address a patient safety issue in the world of healthcare technology. The work of the coalition is being supported by several industry partners, including CareFusion, Connexall, Covidien, Early Sense, Masimo, PMD Solutions, Respiratory Motion, the San Diego Patient Safety Council, Smiths Medical, and Sotera Wireless.

Additionally, there were 17 co-convening organizations, including these pioneering groups which have worked for many years on this issue: the Institute for Safe Medication Practices (ISMP), the Anesthesia Patient Safety Foundation (APSF), the San Diego Patient Safety Council, and The Joint Commission. The federal Centers for Medicare & Medicaid Services (CMS) has also been active on this front.

The day-long meeting featured both heartbreak and hope. The heartbreak was supplied by families whose hospitalized loved ones died while on opioids—and without the benefit of continuous electronic monitoring. “She wasn’t perfect, but she was our girl,” said Cindy Abbiehl, who with her husband Brian, talked about their daughter Amanda, who died at the age of 18 while hospitalized for a throat infection. The hope came from the experts in the room who said that technology—coupled with the proper education and training—could eliminate the danger of respiratory failure.

Making the Business Case

One crucial aspect of the day’s proceedings—attended by an invited group of doctors, nurses, industry executives, patient safety advocates, and regulators—was a focus on making the business case for continuous electronic monitoring. Several speakers noted that it was simply a fact of modern healthcare that the “money question” must be confronted and answered head on for the campaign to gain traction.

“You’re going to need help with your finance department and you’re going to need to work closely with them,” advised George Blike, MD, chief quality and value officer at Dartmouth Hitchcock Medical Center in Lebanon, NH. His facility has won accolades for its introduction of patient surveillance monitoring into more units.

At a separate session, Jim Welch, executive vice president of product development and customer fulfillment at Sotera Wireless, said the business case for surveillance monitoring could be compared to the argument one might make for a restaurant: bolstering the turnover, so that you have more paying customers. In the case of healthcare facilities, continuous monitoring could lead to fewer adverse events and fewer return trips (or longer stays) in the intensive care unit (ICU). That means hospitals could schedule more surgeries with new patients, generating more revenue.

Changing federal reimbursement models also are increasing the pressure on all healthcare facilities to rethink the delivery of healthcare. Federal regulations are placing a new emphasis on the quality of care, not the number of tasks completed, noted Frank Overdyk, MD, executive director for research at North American Partners in Anesthesia, based in Melville, NY. He also is a professor of anesthesiology at Hofstra North Shore-LIJ School of Medicine. Overdyk served as moderator of the kick-off meeting, along with Tim Vanderveen, MS, vice president of the Center for Safety and Clinical Excellence at CareFusion, a healthcare technology company headquartered in San Diego.

‘No One Answer’

Another theme that emerged throughout the day was the need to take a wide, integrated view of the problem. While impressive, surveillance technology alone—with its increasing array of sophisticated sensors and monitors—won’t solve the problem of adverse events involving patients on opioids, several speakers emphasized. Education, training, transparency, and a cultural shift are also important elements.

“There is no one answer here,” cautioned Maureen Cooney, an RN at Westchester Medical Center in New York. Technology can certainly help, she said, but she stressed that it has to be useful and practical for nurses.

“Whatever we do with the technology,” Cooney emphasized, “we have to do it in a way to make sure the data is meaningful.”

Another concern noted by several attendees is the prospect of more technology introducing a greater number of sounds into the healthcare environment. That cacophony of beeps and alerts from a multitude of medical devices has led to a condition known as “alarm fatigue” in which clinicians become desensitized to the sounds. The introduction of more electronic continuous monitoring, nurses urged, must be done so in a way that recognizes that danger.

The families of loved ones kept the day’s proceedings grounded in very personal ways. Brian Abbiehl said he was both encouraged and frustrated by what he heard: encouraged to hear so many different healthcare and medical industry professionals sound the call for continuous electronic monitoring of patients on opioids, but frustrated that more hospitals have not yet taken that step.

Asked his wife, Cindy: “If you have a safety net, why not use it?”