By Melissa Hagstrom, contributor
February 7, 2014 - “Do no harm.” It’s the longstanding mantra of nurses, physicians and other health care professionals and a cornerstone of clinical practice. So what happens when the health devices and techniques being used to care for and heal patients are actually causing harm?
The annual Top 10 Health Technology Hazards list, developed by ECRI Institute and published this past November, highlights safety issues that the nonprofit group believes warrant particular attention for the coming year. Pediatric-related hazards turned up twice on this year’s list, representing problems that can be avoided or risks that can be minimized through the careful management of technologies.
Rob Schluth, senior project officer, ECRI Institute, said nurses can help mitigate risks by being aware, proactive and acting as patient advocates.
“The general issue is that it’s not so much that the technology is harmful to children, so much that the technology may not have been designed with the specific needs of children in mind,” said Rob Schluth, senior project officer, health devices group, ECRI Institute. “That’s really where the issue comes in.”
It’s not as easy for device suppliers and other key players in the market to design products that are focused on treating or diagnosing a child, Schluth explained. “This means that health care workers are left with a situation of having to use devices that maybe have not been optimized for the treatment of children. It’s that lack of optimization that I think would open up avenues for harm.”
The crux of the issue is that children are different than adults: they are smaller, they weigh less, their bodies are developing at different rates, they are susceptible to different conditions and they metabolize medications differently.
“When you are using a technology that is not geared toward children, you could run into issues,” Schluth said.
Thus, it is important for nurses and other clinicians to be aware and proactive when dealing with adult technologies and health care techniques with the pediatric patient population.
For example, a medication dose that is appropriate for an adult may harm a child, or a blood pressure cuff that fits snugly on an adult’s arm may be too loose to get an accurate reading on a child.
Erin Sparnon, engineering manager, ECRI Institute, encourages nurses to play a key role in choosing the health devices and technologies used in their facilities.
Erin Sparnon, engineering manager, health devices group, ECRI Institute, said this issue is especially timely given the prevalence of electronic health and medical record systems. Although they are helpful in many ways, electronic health records (EHRs) and related systems can bring some additional challenges for pediatric care.
“[A] confounding challenge with EHRs when you get to pediatrics is that normative values tend to come in big long tables instead of just a plain value. For example, for an adult, we all know that our blood pressure is supposed to be within a certain range. Now, for pediatric patients it really depends on how old you are and how big you are. [A health care provider has] to look up both the patient’s age and weight before you can find a normative value for things like blood pressure, heart rate and even medication dosage,” Sparnon said.
“Pediatricians are used to looking at height and weight on a percentile chart. Some EHRs will show you height on one screen and then you have to click a few places to find weight normative values. If you can’t see those two transposed against one another, physicians lose a really quick and important way of assessing whether that child is doing well or not.”
The third item on ECRI’s Top 10 list for 2014 was CT radiation exposures in pediatric patients, and the report cites mounting evidence that exposure to ionizing radiation from diagnostic imaging at a young age can increase a person’s risk of developing cancer later in life. The recommendation is to take steps to minimize a child’s exposure to high doses of ionizing radiation.
“CT scan parameters that are intended for an adult may unnecessarily expose more of a child’s anatomy to the ionizing radiation,” Schluth said. “Anytime you can minimize the dose of a CT scan, you want to do that.”
Nurses, parents and caregivers can act as advocates on behalf of pediatric patients and ask if a CT scan is absolutely necessary. Or, if a child recently received one at another facility, tracking down those records may allow the patient to avoid another scan.
Both Schluth and Sparnon agreed that one of the most important steps nurses can take to minimize risk is to get involved in the device and technology selection process at their facility. “The information that frontline caregivers can provide to people making device selection really can be key in choosing technologies that ultimately will improve patient care,” Schluth said.
One of the things we advocated for in this year’s list was establishing a pediatric technology coordinator, Sparnon said. “One thing that nurses can do is try to advocate within their facility to have this position established. If the position is already there, they should use it as a resource to ensure the right equipment is present for each pediatric patient.”
“Nurses should do what nurses do; that is, care for the patients and continue to advocate for their good care,” Schluth concluded. “Verify the appropriate pediatric supplies are in stock in your unit. In a general hospital, maybe sometimes children rarely come in, and as a nurse you can keep an eye out that your unit has the appropriate supplies in place. It takes some extra steps and care to really watch out for your patients.”
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