Chapter 50. Patient Care Technology and Safety

The general public believes that technology will improve health care efficiency, quality, safety, and cost. However, few people consider that these same technologies may also introduce errors and adverse events. Given that nearly 5,000 types of medical devices are used by millions of health care providers around the world, device-related problems are inevitable. While technology holds much promise, the benefits of a specific technology may not be realized due to four common pitfalls: (1) poor technology design that does not adhere to human factors and ergonomic principles, (2) poor technology interface with the patient or environment, (3) inadequate plan for implementing a new technology into practice, and (4) inadequate maintenance plan. Patient care technology has become increasingly complex, transforming the way nursing care is conceptualized and delivered. Before extensive application of technology, nurses relied heavily on their senses of sight, touch, smell, and hearing to monitor patient status and to detect changes. Over time, the nurses’ unaided senses were replaced with technology designed to detect physical changes in patient conditions. Consider the case of pulse oxymetry. Before its widespread use, nurses relied on subtle changes in mental status and skin color to detect early changes in oxygen saturation, and they used arterial blood gasses to confirm their suspicions. Now pulse oxymetry allows nurses to identify decreased oxygenation before clinical symptoms appear, and thus more promptly diagnose and treat underlying causes. While technology has the potential to improve care, it is not without risks. Technology has been described as both part of the problem and part of the solution for safer health care, and some observers warned of the introduction of yet-to-be errors after the adoption of new technologies. For example, nurses and other health care providers can be so focused on data from monitors that they fail to detect potentially important subtle changes in clinical status. Problems may emerge based on the sheer volume of new devices, the complexity of the devices, the poor interface between multiple technologies at the bedside, and the haphazard introduction of new devices at the bedside. Despite the billions of dollars spent each year on an everincreasing array of medical devices and equipment, the nursing profession has paid little attention to the implementation of technology and its integration with other aspects of the health care environment. Patient care technologies of interest to nurses range from relatively simple devices, such as catheters and syringes, to highly complex devices, such as barcode medication administration systems and electronic health records. Technology can be broadly defined to include clinical protocols and other “paper” based tools, but for the purpose of this chapter, we will focus more on equipment and devices that nurses are likely to encounter in delivering direct care to patients. The purpose of this chapter is to provide a conceptual model for technologies that nurses are likely to encounter and to delineate strategies for promoting their effective and safe use.