Nurses are the primary users of medical devices during patients care and are confronted daily with devices used for diagnostic testing for illnesses, surgical and therapeutic instruments, and telemedicine. The majority of the uses are for monitoring the patients. Unfortunately using medical devices can sometimes lead to fatal outcomes. There are ways to prevent this from happening by informing our nurses with the most up to date technologies so that they can operate these devices appropriately. While new technologies are often beneficial for the patients, Nurses often encounter difficulties in using devices associated with these technologies, since there might be misinterpretation of the device that can harm the patients. The Board of Nursing should come up with a plan that can get these nurses to be as ready as they can be using these devices. Critical-care equipment can be utilized more fully, cost-effectively and safely if a formal and regular training program is implemented among all the entering nurses as well as the higher level nurses. Since technologies are constantly changing, nurse should always be up to date with the latest devices. The new entering nurse should have their own specific training on all of the medical devices that is used in their field of study, whether if it is in a clinic or hospital. Safety procedures and regular checkups on the devices are also mandatory.
Key words: Medical devices, medical device adverse event, Medical Devices Agency (MDA) death, injury, trial and error, patients, manufacturer, misinterpret, consequences
A Patient's Life, The Nurse's Responsibility
Over time, technologies have become increasingly sophisticated and complex especially in the medical field, reshaping the delivery of healthcare both in the hospital and at home but subsequently become more challenging for the nurses. Not only do the nurses have to care for the patients but they have to use special devices, which can be overwhelming. Although physicians are responsible for the treatment, it is often the nurses who are the primary users of such medical devices. It is not only important to have the nurses learn all about the devices but it is mandatory to do so.
A medical device refers to any item used to diagnose, treat, or prevent disease, injury or any other condition that is not a drug, biologic or food. (Swayze & Rich,2012) The devices range from items as simple as tongue depressors to more complicated devices, such as x ray machines. They represent the most innovated technologies for the medical field, but no matter how high tech it is; there are still flaws. These devices often lead to a medical device adverse event where a medical device may cause or contributed to a death or serious injury of the patients. (Swayze & Rich,2012) Last year, the Medical Devices Agency (MDA) received 7,249 adverse incident reports, of which 824 involved serious injury or fatality. (Murray, 2001) The consequences can be devastating to the patients and their families as well as the medical professionals who were involved. In one study, 323 registered nurses were surveyed to determine what and how they initially learned about the medical devices use, the study found that the most frequently identified methods of initial learning were trial and error and reading the user instruction manual. (Dankelman, 2010) This can be a huge issue since the patients are not a variable in an experiment where they can be tested on. Reading only the instruction manual can often lead to misunderstanding of the context. Furthermore, 87.1% of respondents stated that they had received instructions about the device from another staff member or another registered nurse. (Dankelman, 2010) However, the other staff or registered nurse might or might not have the knowledge of operating the devices properly so there might some misinterpretations. This will be another chance that the patients will suffer from injuries. It is important that the nurses clearly understand the instructions manual which accompany the medical devices. If they misinterpret the instructions, it could lead to improper use of the devices, the device will not function how it should be and result in injuring the patients. In two reports on the use of critical care equipment by nursing staff, 19% and 12.3% of nurses, respectively, indicated that they had used equipment improperly, which had consequently harmed a patient. There were incidents reported to MDA where children were being injured, even killed, through the improper use of devices. Sometimes the devices might seem to be simple and harmless but if it is used incorrectly, it can be extremely dangerous.
It is not always the nurses' fault since some devices might have defects or flaws. However if a device failure occurs, it is the nurses' responsibility to remove the device from service immediately, tag it with a label describing the problem, and report the incident to the appropriate department within their facility so it can be evaluated and returned to the manufacturer.(Swayze & Rich, 2012) There have been incidents where devices that were supposed to be discarded were used again because of the nurse's failure to follow the appropriate procedures.
Nurse need to be familiar with the devices before they actually use it on patients. As nurses move from one unit or hospital to another, the potential for error increases since there might be some similarity in the devices. This happens because devices may have similar designs that nursing will not recognize the difference. Therefore, it is important that nurses knows how to operate each individual device they use. There should be a training session by an expert on that certain device provided to the nurses before they begin using it. The instructions for using the devices should be explained thoroughly so that the nurses have a better understanding of it. Especially, the newly registered nurses with first experiences with medical devices should be thoroughly trained; since it might be overwhelming for them, they might take longer to comprehend. By giving them this session, the nurses will feel more confidence and less stress when they operate these devices. It might take time and effort but rather it be safe than sorry. Of course there is such an enormous range of medical devices, so it would be impossible to adequately train the nurses to use them all. The MDA has published comprehensive guidance on rationalizing a number of different devices (MDA, 1998a), and encourages limiting the number of devices used (Murray, 2001); so that the nurse won't be too overwhelmed with the amount of information.
It is also important for the nurse to record documents of the different devices. Records should be identify the devices and provide evidence that the device is kept in good condition. Which includes recording the device's identification details, for example, manufacturer, model and serial number. Keeping records of the devices is essential because if a device has a factory defect, there is some type of information that can be display to the manufacture so they can figure the problem.
Another issue that nurses should pay attention to is the fact that they are still responsible when the patients no longer need the device. They will need to know the proper procedures to dispose the device. Also, nurses should have the knowledge of what devices should be reuse or single used. There are many cases where nurse attempt to reuse a single-use without considering the serious consequences.
Conclusion
Medical device technology will continue to advance and challenge nurses each and every day. Nurses are encouraged to seek for assistant from different organizations such as the MDA to further assist them in what they need to know about medical technologies. All nurses are also encouraged to share important medical device adverse events with the MDA. By doing this, they will corporate with all the staff to find the root causes of problems encountered and to improve patients' as well as the nurses' safety. The Board of Nursing should take action and provide all newly registered nurses a training session for the devices being used by the nurses. This will give the nurse a chance to familiarize themselves with the devices before they are being used on the patients. Also, the families of these patients will feel at ease knowing that the nurses are well educated. There are many advantages of doing this. First and for most, it will decrease the injuries and deaths caused by improper use of medical devices. Second, it will reduce the costs of having to replace the devices if they are properly used they will last longer. Lastly, it takes less stress and burden off the nurses because will not have to the trial and error method anymore.
