8 ms·
Excuse my ignorance, but what systems are needed for CPR?
by dwatson92 2y ago
Excuse my ignorance, but what systems are needed for CPR?
- pksebben 2y agoMy guess is the system that notifies the next caretaker in the chain that someone is currently receiving CPR. if it works, there's a lot more to be done to get the patient to stable.
- SamuelAdams 2y agoI used to work in healthcare IT. Running a code is not always only CPR. Different medications may be pushed (injected into the patient) to help stabilize them. These medications are recorded via a bar code and added to the patients chart in Epic. Epic is the source of truth for the current state of the patient. So if that is suddenly unavailable that is a big problem.
- dwatson92 2y agoMakes sense, thank you for the explanation.
- 627467 2y agoOkay,not having historical data avaliable to make decision on what to put into a patient is understandable - but maybe also print critical stuff per patient once a day? - but not being able to log an action in realtime should not be a critical problem.
- adolph 2y ago> maybe also print critical stuff per patient once a day? Yep, the business continuity boxes are basically minimally connected PDF archives of patient records "printed" multiple times a day.
- pas 2y agomaybe non-volatile e-paper, which can be updated easily if things are up, and if the system is down it still works as well as the printouts
- anonymous8888 2y agoupdatable e-paper is going to be very expensive
- rbanffy 2y agoA small printer connected to the scanner should do.
- pas 2y agoCompared to managing thousands of printers? And then the resulting printouts? Buying ink, changing the cartridges? Technologically it seems doable. Big enough order brings down the costs. https://soldered.com/product/soldered-inkplate-5-5-2%e2%80%b3-e-paper-board/ https://soldered.com/product/soldered-inkplate-5-5-2%e2%80%b... Of course the real backup plan should be designed based on the actual needs, perhaps the whole system needs an "offline mode" switch. I assume they already run things locally, in case the big cable seeker machine arrives in the neighborhood.
- jacurtis 2y agoI don't think it is historical data required to make a decision, it is required to store the action for historical purposes in the future. This is ultimately to bill you and to track that a doctor isn't stealing medication, improperly treating the patient, and to track it for legal purposes. Some hospitals require you to input this in order to even get physical access to the medications. Although a crash cart would normally have common things necessary to save someone in an emergency, so I would think that if someone was truly dying they could get them what they needed. But of course there are going to be exceptions and a system being down will only make the process harder.
- efitz 2y agoThis. Anyone involved in designing and/or deploying a system where an application outage threatens life safety, should be charged with criminal negligence. A receipt printer in every patient room seems like a reasonable investment.
- jmcgough 2y agoI don't think you understand the scale of this problem. Computers were not up to print from. Our Epic cluster was down for placing and receiving orders. Our lab was down and unable to process bloodwork - should we bring out the mortar and pestle and start doing medicine the old fashioned way? Should we be charged with "criminal negligence" for not having a jar of leeches on hand for when all else fails?
- efitz 2y agoI was advocating for a paper fall back. That means that WHILE the computers are running, you must create a paper record, eg “medication x administered at time y”, etc., hence the receipt printers, which are cheap and low-dependency. The grandparent indicated that the problem was that when all tow computers went down, they couldn’t look up what had already been done for the patient. I suggested a simple solution for that - receipt printers. After the computers fail you tape the receipt to the wall and fall pack to pen and paper until the computers come back up. I completely understand the scale of the outage today. I am saying that it was a stupid decision and possibly criminally negligent to make a life critical process dependent on the availability of a distributed IT application not specifically designed for life critical availability. I strongly stand by that POV.
- jmcgough 2y agoThis would be a disaster from a HIPAA perspective, and an unimaginable amount of paperwork.
- galangalalgol 2y agoThis approach is also what popped in my head. I've seen people use white boards for this already so it must be ok from a hipaa standpoint.
- anonymous8888 2y agoin this case, it's the entire operating system going down on all computers, so I don't think the printers are working either
- gtvwill 2y agoMost printers in these facilities run standalone on an embedded Linux variant.They actually can host whole folders of.data for reproduction "offline". Actually all scan/print/fax multi function machines can generally do that these days. If the IT onsite is good though the usb ports an storage on devices should be locked down.
- CydeWeys 2y agoIt is a critical problem if your entire record of life-saving drugs you've given them in the past 24 hours suddenly goes down. You have to start relying on people's memories, and it's made worse by shift turn-overs so the relevant information may not even be reachable once the previous shift has gone home. There are plenty of drugs that can only be given in certain quantities over a certain period of time, and if you go beyond that, it makes the patient worse not better. Similarly there are plenty of bad drug interactions where whether you take a given course of action now is directly dependent on which drugs that patient has already been given. And of course you need to monitor the patient's progress over time to know if the treatments have been working and how to adjust them, so if you suddenly lose the record of all dosages given and all records of their vital signs, you've lost all the information you need to treat them well. Imagine being dropped off in the middle of nowhere, randomly, without a GPS.
- czl 2y ago> It is a critical problem if your entire record of life-saving drugs you've given them in the past 24 hours suddenly goes down. Will outages like this motivate a backup paper process? The automated process should save enough information on paper so a switch over to paper process at any time is feasible. Similar to elections.
- dogmatism 2y agono money for that there are backup paper processes, but they start fresh when the systems go down If it was printing paper in case of downtime 24/7, it would be massive wasteage for the 99% of time system is up
- grugagag 2y agoA good system is resilient. Paper process could take over when system is down. Form my understanding healthcare systems undergo recurrent outages for various reasons.
- dopylitty 2y agoMaybe if all the profit seeking entities were removed from healthcare that money could instead go to the development of useful offline systems. Maybe a handheld device for scanning in drugs or entering procedure information that stores the data locally which can then be synced with a larger device with more storage somewhere that is also 100% local and immutable which then can sync to online systems if that is needed.
- rbanffy 2y agoLooks like a small scanner + printer running a small minimalistic RTOS would be a good solution.
- ta988 2y agoOk now you have a park of 200 of those devices to handle. And now you move a patient across a service or to another hospital and then.... Reality is complex.
- rbanffy 2y agoOh yes. This would be a contingency measure, just to keep the record in a human readable form while requiring little manual labor. Printed codes could be scanned later into Epic and, if you need to transfer the patient, tear the paper and send it with them.
- monkmartinez 2y agoYou need to document everything during a code arrest. All interventions, vitals and other pertinent information must be logged for various reasons. Paper and pen work but they are very difficult to audit and/or keep track of. Electronic reporting is the standard and deviating from the standard is generally a recipe for a myriad of problems.
- devilbunny 2y agoWe chart all codes on paper first and then transfer to computer when it's done. There's a nurse whose entire job is to stay in one place and document times while the rest of us work. You don't make the documenter do anything else because it's a lot of work. And that's in the OR, where vitals are automatically captured. There just aren't enough computers to do real-time electronic documentation, and even if there were there wouldn't be enough space.
- monkmartinez 2y agoI chart codes on my EPCR, in the PT's house, almost everyday with one hand. Not joking about the one hand either. Its easier, faster, and more accurate than writing in my experience. We have a page solely dedicated to codes and the most common interventions. Got IO? I press a button and its documented with timestamp. Pushing EPI, button press with timestamp. Dropping an I-Gel or Intubating, button press... you get the idea. The details of the interventions can be documented later along with the narrative, but the bulk of the work was captured real-time. We can also sync with our monitors and show depth of compressions, rate of compressions and rhythms associated with the continuous chest compression style CPR we do for my agency. Going back to paper for codes would be ludicrous for my department. The data would be shit for a start. Hand writing is often shit and made worse under the stress of screaming bystanders. Depending on whether we achieved ROSC or not would increase the likelihood of losing paper in the shuffle
- czl 2y agoThe idea is to have the current system create a backup paper trail from which you practice resuming from for when computers go down. Nothing about current process for you need change only that you be familiar with falling back to paper backups when computers are down.
- davycro 2y agoYou can do CPR without a computer system, but changing systems in the middle of resuscitation where a delay of seconds can mean the difference between survival and death is absolutely not ideal. CPR in the hospital is a coordinated team response and if one person can’t do their job without a computer then the whole thing breaks down.
- SoftTalker 2y agoIf you're so close to death that you're depending on a few seconds give or take, you're in God's hands. I would not blame or credit anyone or any system for the outcome, either way.
- singleshot_ 2y agoI’m sure you meant “the physicians’ hands.”
- SoftTalker 2y agoNo. The physician will be running a standard ER code protocol, following a memorized flow chart.
- dreamcompiler 2y agoJudgement is always part of the process, but yeah running a routine code is pretty easy to train for. It's one of the easiest procedures in medicine. There are a small number of things that can go wrong that cause quick death, and for each a small number of ways to fix them. You can learn all that in a 150 hour EMT class.
- xyst 2y agoprobably the system used to pull and record medication uses in a hospital. It's been awhile, but "Pyxis" used to be the standard where I shadowed. Nurses hated it.
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