McGill prof offers hospitals tips to avoid wireless snafus

TORONTO — There’s no magic cure for medical errors, which are estimated to cause anywhere from 40,000 to 100,000 deaths a year in the U.S. alone.

But the establishment of wireless infrastructures in hospitals is one preventive treatment that would go a long way to reducing the number of such

tragedies, the audience at Canada’s second annual summit on wireless healthcare technology heard Thursday.

“”Wireless solutions are required to minimize mobile medical errors,”” said Bernard Segal, an associate professor in McGill University’s department of otolaryngology. At the same time, though, he added, “”you cannot allow wireless radio waves to cause interference — you don’t want to replace one trouble with another.””

Segal said that in the U.S. the Federal Drug Administration (FDA) has proposed the use of patient and medication barcoding by 2006. Wireless, he said, is what will help hospitals take full advantage of barcoding. But there are two major obstacles to widespread rollout of wireless: electromagnetic interference (EMI) issues, and privacy and security concerns.

“”When I was planning to establish a wireless operation at a hospital in Montreal I was told I could not do it because the Quebec government will not allow wireless to be connected to its Internet system, so there are things that have to be resolved,”” said Segal.

EMI is a concern because it can cause medical devices to fail – and often doctors and hospital staff don’t know enough about the problem to recognize it, he said.

“”There was a case in Montreal where there was a medical device that was malfunctioning in a hospital for months and no one recognized it,”” he said. “”The physicians and medical staff didn’t have it in their mindset that a medical device could malfunction due to EMI. Once you tell people about it you’ll have the right framework to start in on wireless health care.””

Segal outlined the steps hospitals have to take before introducing a wireless system into their environments.

First, he said, decide where it’s going to be used, whether throughout a ward or in another area. “”The rest you will establish as a non-wireless zone.””

Next, work on your in-hospital wireless policy.

“”Already you’ve got a problem because most hospitals in the country do not have a wireless policy,”” he said.

Once you have the policy in hand, he said, it’s time to gather together the necessary expertise – also a huge challenge for hospitals, many of which have experienced major cutbacks over the last few years.

“”Efforts have to be made to pool resources,”” he said. “”There’s not local expertise and this has to be recognized at the highest level. If you don’t have that there has to be a mechanism to ensure support by co-operation among hospitals, perhaps on a provincial and national level.””

To ensure that wireless devices can operate safely without causing medical devices to break down, Segal said a hospital needs to establish wireless zone procedures.

“”Decide on all the wireless sources you want to use there, such as 802.11, cell phones, walkie-talkies and the devices, and what equipment you and your patients need,”” he advised. “”Try to choose sources that have as little radio frequency power as possible.””

That will exclude walkie talkies, he added, due to the amount of RF power they radiate.

Segal referred to one EMI test in which 55 to 75 per cent of medical devices exposed to walkie-talkies malfunctioned.

That’s cause for concern when a security guard with a walkie-talkie thinks he’s far enough away from, say, the intensive care unit, but in fact isn’t, he said.

“”This is something that makes a risk manager sit up and take note.””

Hospitals planning on wireless rollouts will need to conduct ad-hoc testing to simulate what happens when an RF source and a medical device will be in close proximity.

“”Look for serious, repeatable malfunctions where the device operated out of specification with or without alarming,”” he said.

Before starting an implementation, Segal advises that hospitals invest in a copy of the Association for the Advancement of Medical Instrumentation’s T1R 18 update.

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