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The problem is the viscosity of different drugs used. With the gloppy stuff(drugs knowhow) they use on CCU and ITU there is a need for them to up the occlusion. Also when a bolus is administered.

If a way could be found that this would all be taken into account with the drug database versus size versus rate calculation then by all means the occlusion could be removed. One less button for them to break.

We call them mckinley T34 here. If you are looking at these make sure you have a look at the price of the parts. You can not just change the LCD here it is full front. If you have the older type as we do you have to get the back aswell as the new front doesnt fit the old case. Circuits are different.

bcarlise
Im based in a 16 bed ICU we have set the max occlusion at 500mmhg for our syringe pumps and 750mmhg for infusion pumps the pump has a programed bolus that allows for higher occlusion for the duration of the bolus this iset on all pumps in the hospital (360 syringe 450 infusion approx ) and have had no problems

How do these databases get updated as new drugs become available? Will we still be able to update in (say) ten or twenty years time?

As an aside:- for the first time in my sheltered existence, I have just opened up a Baxter Colleague. Interesting pump mechanism ("shuttle"?), but not so easy to open up the unit. That is, a bit "fiddly" with the various connectors. No doubt I'll get the knack!

Both our infusions and syringes are unlocked. Staff have hopefully been trained to use the lowest occlusion setting to achieve their aim.

We set them when they leave here at midrange (approx 500mmHg).

Billy

For those interested in this thread it's World Usability Day (WUD). Yes, yes there seems to be a day for everything nowadays but more seriously this gives people interested in making usable technology a chance to promote their field and discuss important HCI issues. The theme for this year is communication, and at UCLIC we are lucky enough to be able to showcase a great piece of communication by our MSc students on UCL TV.

2min film: "Why buttons go bad" shows the importance of user-centred design. The film and its relation to patient safety can be found in this blog post http://chi-med.posterous.com/an-amusing-short-film-illustrating-the-import

Please consider sharing this to inspire people to think more about the tools, technologies and interfaces around them; those that are user-friendly and those that are less so.

Two usability issues from recent discussions:

1) PCA - as I understand it patients have a button that they can press to administer pain relief. However, there are controls as to how much drug the pump will deliver no matter how much the patient presses the button, e.g. it ignores the extra button presses beyond a limit. Does anyone know what sort of feedback, if any, these devices give the patient and clinical staff?? Does it just ignore the patient with no feedback? Does it make a dull sound to show it cannot comply? Does the nurse have access to how many times the patient has requested a dose?
These different configurations could have important implications for the patient's own management of dosing/pain and the awareness of patient comfort by clinical staff.

2) ECG monitors. I heard ECG machines are commonly reported broken when actually the wrong paper has been used or it has been put in upside down. Apparently this is a persistent and annoying problem. Do other's agree this is persistent? Any good ideas on alleviating this issue?

Thanks

How about this for item 2):- always make a note of which way round the old paper fitted, before trying to replace it.

Hint:- could this be why so many healthcare professionals have university degrees these days?

As far as PCA goes, I only have experience of the ubiquitous Graseby 3300s (never got my hands on an Omnifuse PCS sadly) - other pumps may do things slightly differently.

With the 3300, you get the same beep from every button press, I guess just so the patient knows it was acknowleged and doesn't lie there pressing the button harder and harder. And yes it does record how many requests, and how many were actually given.

As for ECG, the main problem I get is phantom lead faults. Incorrect / upside down paper is annoying, but not what I would call persistent (of course, larger hospitals may be more prone to it simply due to there being more equipment, therefore more opportunity for it to happen).

However, since you're asking specifically about that;
The incorrect paper seems to stem from the fact that while most units take (or can accommodate) the same size of paper, the page markers vary - it might be a hole, it might be a small black patch, positions may vary. Now, if manufacturers would agree a standard, that would be ideal, but that won't happen. They want you to buy their paper, after all.
Besides, it would take years for that to trickle down and replace all the older machines with their many different ways of determining where the next page starts.

Standardising on one model within a hospital would help, although obviously it can't prevent the wrong paper being ordered. But equipment replacement is piecemeal at the best of times, and is often dictated by who will give you the best deal, so you end up with a smorgasbord of stuff.

As for upside down paper, to me that's a training thing. If the machine doesn't immediately give the expected result, the operator should maybe check one or two things before picking up the phone. Maybe that's a rather optimistic viewpoint though...

Hello

Yes the Graseby beeps, from memory it displays how long to the next available bolous and it definitively records how many successful and unsuccessful doses it gives, i have seen cases where the patient has pressed the button unsuccessfully hundreds of times. Whilst the patient is still under the after effects of sedation and in pain they often keep pressing the button until the pain stops, obviously from pressing the button to actually receiving the pain relief takes time.

On the ECGs you can add the problem of staff ordering the wrong size American/English paper to Gordovan's list especially when the same model can be set up for different paper. Most of the problems I’ve seen stem from lack of or poor training regarding the taking ECGs, but I’ve also seen way to many paper loading problems over the years.

Lee