PEER REVIEW THE DUTCH ASSOCIATION OF TECHNOLOGY IN HEALTHCARE (NVTG), THE NETHERLANDS
Technology embraces healthcare amid crisis
The Dutch Association of Technology in Healthcare (NVTG) conducted a peer review with NVTG members on coming together to help reduce COVID infections in hospitals.
The healthcare sector has been hit hard by the COVID-19 outbreak. An amended way of working and tightened measures were imposed on all fronts. It is clear that, when (re)structuring a cohort department or other form of special spaces, a crisis team needs to be able to take decisions fast. This involves the rapid screening by medical and nursing staff, but we must not lose sight of technical risks. The capacity of the intensive care departments had to optimised at all times. Healthcare organisations have carried out major internal reviews of the corona period. The Dutch Association of Technology in Healthcare (NVTG) has taken the initiative to set up a working group with NVTG members who all work in hospitals to share knowledge and experience, and to make recommendations. This review zooms in on how we could best contribute proactively to the prevention of incidents in hospitals during a pandemic. What are the consequences of deploying medical equipment and of the presence and use of existing technical systems and which standards and work protocols are relevant?
Experience, greater awareness, and
pragmatic solutions for levelling risks were shared in relation to mechanical and electrical engineering infrastructure for medical equipment outside the high-tech intensive care environment. We also looked at how to deal with alarm systems for malfunctioning medical equipment during power outages or the deployment of medical equipment in other spaces than those for which it was evaluated originally. Many members recognised these scenarios, but they also provided additional insights into action taken by medical and technical staff during a crisis. A survey of NVTG members revealed that there is an urgent need for peer review and that NVTG could facilitate this as a platform for sharing knowledge.
Project leads Victor Pastor, NVTG board member, Arcadis; Janet Vissinga, chair of peer review meetings, external project manager of the working group.
IFHE DIGEST 2023
Rationale We have seen everywhere how Intensive Care Units (ICU) came under intense pressure due to the pandemic. In various hospitals in The Netherlands, capacity was increased by temporarily deploying regular departments for the treatment of patients with, for example, respiratory insufficiency owing to a COVID-19 respiratory infection. This allowed patients to leave the ICU more quickly, thus freeing up beds. The technical facilities in a regular patient room differ from an intensive care environment. In the working group, we asked ourselves how we could best continue to provide safe care in such a situation and identified various practical situations. In May 2021, we were shocked by an incident at the Maastricht University Medical Center+ in The Netherlands. A power failure caused medical equipment administering supplemental oxygen to fail and unfortunately two patients died. This was a serious warning for the NVTG healthcare institution members to look at the way of working within their hospitals. With this document, the working group is not only creating a sense of urgency, but also stating that measures must be taken to prevent such incidents from occurring in the future. l Argument based on medical treatment: Many NVTG healthcare institution members emphasised that in the recent crisis situation, we often responded reactively instead of proactively. Healthcare staff – specialists and the core teams around them – are occupied with their primary task: caring for patients. And that is understandable. Making the right choices in the risk profile of a treatment strategy requires more than just a trigger from the medical staff. Can I justify what I am doing from the point of view of patient safety? What technical facilities are needed and how can patient safety be better ensured? This includes involving the whole circle of domain responsibilities. Whether it concerns the use of equipment or a medical procedure you are performing.
l Argument based on technology: Reverse reasoning is also a method. In this document, we want to map out the work processes: the procedures and protocols on how we use medical equipment are perfectly in place. Yet we see things coming in through the back door that we cannot control. We are not involved or we skip a cog somewhere: then that chain is not set in motion.
Knowledge sharing and best practices In five peer review meetings, ten NVTG healthcare institution members shared knowledge and exchanged best practices. Examples of failures that have occurred are given below:
Risk management in the event of power outages l In the cases discussed – which were anonymised – the risks were recognised in time at the hospital concerned.
l To minimise recurrence, a power outage detector was placed between medical equipment and the 230V power outlet, which gives a loud alarm for one hour if the power is cut. It must be reset on site.
l In many cases, no battery pack (UPS) was used, as this is seen as an additional link, which also creates a risk. Nevertheless, opinions are divided on this.
l One recommendation to consider is to provide departments where specific equipment is deployed, with WCDs connected to a preferred electrical group powered by an Uninterruptible Power Supply (UPS).
l According to Dutch Standard NEN 1010 (Electrical installations for low voltage, Dutch implementation of the HD-IEC 60364 series) part 7 chapter 710 about medical room classification (based on NEN-EN-IEC 60601:2006, 3.8), this medical equipment will probably not have to be placed after an isolating transformer because the equipment is placed on the skin and has no galvanic contact with the bloodstream.
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