Disaster Preparedness and Medication Administration- CaseStudy

When the lights go out, so does critical IV infusion equipment.

Prepping for Power Failure

In 2012, Tropical Storm Sandy created a widespread outage covering Lower Manhattan and leaving over 250,000 people without power. During the outrage, two high volume Manhattan hospitals, NYU Langonw Medical Center and Bellevue Hospital, experienced back-up generator failures that forced the evacuation of nearly 1,000 patients. Nearly five years later, Houston’s Ben Taub Hospital and Florida Hospital at Connerton in Pasco County, FL experienced similar generator failures after hurricanes Harvey and Irma.

Back-up generators are a key component of power loss prevention in many Emergency Operations Plans set by FEMA and other regulators. However, as the incidents described above demonstrate, managing and regulating generators to ensure reliability for emergencies remains a persistent challenge.

– In 2011, the Joint Commission’s Environment of Care standard associated with emergency power systems was found to be among the top ten standards cited for noncompliance during critical access hospital surveys.

– A 2014 Consumer Reports examination of emergency backup generators found that many backup generators are 50 or more years old and housed in basements without flood protection.

It’s time to think beyond generators and become imaginative and detail-oriented in our disaster preparedness approaches. In addressing the problems with generators, adding more regulations isn’t the only approach. An alternative is to adapt current practices that reduce reliance on generators so power failure does not leave patients, clinicians, and facilities vulnerable to disaster.

Not just filling gaps: Creating new solutions

Sometimes new solutions for challenges faced during disasters borrow from tried and true healthcare practices. Intravenous (IV) infusion therapy is one of the most common healthcare practices in any setting, and it is used to deliver everything from fluids and antibiotics to chemotherapy. In many U.S care settings, powered infusion pumps are used to control the doses of medications administered to patients. While many of these pumps have battery backups for power outrages, the backup systems typically only last a handful of hours, leaving clinicians without a tool to safely administer IV medications during prolonged power outages.

When power is limited or unavailable, clinicians can use gravity-fed infusion techniques to provide medications. Gravity infusions are more commonly used in home care settings or non-US hospital settings without readily available pumps. When unmonitored, gravity infusions are vulnerable to error and unintended flow rate changes from factors such as patient venous pressure. Setting an accurate dose using a gravity infusion also requires complicated calculations and frequent hand-counting of rates – practices that 50 years ago were taught as essential to safe and accurate infusion but are often no longer included in contemporary nursing programs. A study conducted in 2008 found of 50 subjects receiving gravity infusion only 1 in 5 was receiving an infusion that was withing 20% of the charted rate, a staggering statistic demonstrating the risk unmonitored gravity infusions pose to patient safety.

Flow regulators, such as Dial-A-Flo, are a tool sometimes used to help improve accuracy when gravity infusion is used. They allow the clinician to set a rate between a range of 20 to 250 ml/hr. However, their accuracy rates fluctuate between -10% to +20% (according to manufacturer’s label), requiring constant monitoring.

Monitored gravity infusions are an approach that can bridge the gap of accuracy and electricity reliance. This can be achieved with tools like the DripAssist Infusion Rate Monitor, a new type of battery-operated tool that attaches to any standard IV drip set to eliminate dosage guesswork and ensure continuous monitoring. The device uses an infrared sensor to precisely detect and count drops in real time with 99% accuracy.

DripAssist is a lightweight and portable tool powered by a single AA battery that allows for 360 hours of continual use. It provides an accurate measure of infusion flow rate and total volume, replacing the need for manual calculations. Additionally, an optional alarm function alerts a clinician if flow rate changes from the set rate. DripAssist is currently used in U.S. clinics, pre-hospital settings, as well as in resource-constrained global settings that face challenges with training, electricity, supply chains, or infrastructure. If flooding causes a hospital to go without power, or field hospitals are set up after a devastating earthquake, DripAssist can be depended on to reliably ensure accuracy for any IV procedure.

While infusion is just one procedure of the countless done every day at a hospital, examining how to increase the preparedness of each procedure is an important part of detail oriented planning. The scope of disasters cannot always be predicted and even when proper protocol is followed generators can fail. Preparedness goes beyond backup generators; it is having tools in place to respond to a crisis when all systems fail. Innovative tools such as DripAssist are the ‘imaginative’ approach to planning that creates resilient hospitals and can save lives.

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