By Michael Wong, JD (Founder/Executive Director, Physician-Patient Alliance for Health & Safety)
This week marks the 8th anniversary of Amanda Abbiehl’s tragic death. Her story continues to remind us of the need for continuous electronic monitoring for all patients receiving opioids and more generally of the need for the adoption of new technologies and practices to improve patient safety.
Amanda was 18-years-old when she was admitted to hospital for a severe case of strep throat. To help her manage the pain, she was placed on a patient-controlled analgesia (PCA) pump. The next morning, she was found unresponsive and died. Though PCA pumps are designed to deliver an exact dosage of opioid – in Amanda’s case, hydromorphone – getting the ‘right’ dosage is not a simple task. Too high a dosage can lead to respiratory depression, sometimes in minutes. Read more about Amanda’s story, and how you can prevent opioid-related respiratory depression, by visiting the Promise to Amanda site here.
For me, her death marks both the beginning of the Physician-Patient Alliance for Health & Safety, as well as the need to continue to advocate for the use of continuous patient monitoring. Yet, when I promised Amanda’s parent, Cindy and Brian Abbiehl, that I would do what I could to prevent another death like Amanda’s, little did I know that, eight years later, I would still be shouting about the need for continuous patient monitoring.
But, why after eight years is it still necessary for me to advocate for change? Why is there such a long adoption time for new technology?
Historically, healthcare has been slow to adopt new technologies. As a lawyer, I understand this well. The “medical standard of care” is typically defined as the level and type of care that a reasonably competent and skilled health care professional, with a similar background and in the same medical community, would have provided under the circumstances that led to the alleged malpractice. By using this as a way to determine whether a particular clinician is negligent of malpractice (not practicing in accordance with what his/her peers) prevents the use of new technologies and techniques, because these may deviate from what other clinicians in the area are doing and potentially invite a finding that a particular clinician’s practice does not meet the standard of care.
And, yet, the practice of medicine has changed over time and has incorporated new technologies and practices. This begs the question – how does a standard evolve if it’s based on doing what everyone has done in the past?
The current standard of care is for a nurse to check on patient every few hours. This method of intermittent spot checks has been shown to be insufficient to detect the signs of opioid-related respiratory depression in time to intervene.
Does the medical standard change when a respected organization advocates for the need for change? For example, undetected opioid-induced respiratory depression has remained in ECRI’s Top 10 Health Technology Hazards for years. This year, ECRI identified in its Top 10 Patient Safety Concerns the need to detect changes in a patient’s condition, saying:
“Failure to detect changes in a patient’s condition is an ongoing patient safety concern across the continuum of care … Technology can alert caregivers to a patient’s changing condition, but it must be used appropriately. Staff must be trained in how to operate the equipment and understand the organization’s policies and their responsibilities for responding to alarms.”
Or, does it change when a body of experts comes together and recommends the use of continuous patient monitoring? For example, with the goal of helping to reduce adverse events and deaths with PCA pumps, the Physician-Patient Alliance for Health & Safety released a safety checklist that reminds caregivers of the essential steps needed to be taken to initiate PCA with a patient, and to continue to assess that patient’s use of PCA. The checklist was developed after consultation with a group of 19 renowned health experts.
However, a Harvard Business Review/Verizon study found that “although few healthcare organizations view first-adopter status as a business advantage, those that more quickly implement new technologies do reap valuable returns on these investments.”
In short, a conservative lawyer may counsel sticking with the tried and true. However, the shrewd business person may advocate for the adoption of new technologies and practices. Whose counsel would you follow?