ECRI names top 10 health tech hazards for 2020

The ECRI Institute has ranked the top safety issues confronting healthcare facilities when it comes to the use of medical devices and systems.

The Top 10 Health Technology Hazards list for 2020 identifies the “potential sources of danger” that ECRI believes “warrant the greatest attention for the coming year” and the risks that “should receive priority now” from organizations.

“All the items on our list represent problems that can be avoided or risks that can be minimized through the careful management of technologies,” advises ECRI. “Not all hazards on the list will apply at all healthcare facilities.”

The list of health tech hazards for next year include:

1. Misuse of surgical staplers.
2. Adoption of point-of-care ultrasound (POCUS) Is outpacing safeguards.
3. Infection risks from sterile processing errors in medical and dental offices.
4. Hemodialysis risks with central venous catheters, and how the push toward home dialysis may Increase the risks.
5. Unproven surgical robotic procedures may put patients at risk.
6. Alarm, alert and notification overload.
7. Cybersecurity risks in the connected home healthcare environment.
8. Missing implant data can delay or add danger to MRI scans.
9. Medication errors from dose timing discrepancies in EHRs.
10. Loose nuts and bolts can lead to catastrophic device failures and severe injury.

When it comes to point-of-care ultrasound (number two), ECRI warns that safeguards for ensuring that users of the technology have the necessary training, experience and skill have not kept pace with the speed of adoption.

“Patient safety concerns include POCUS not being used when warranted, misdiagnoses, inappropriate use of the modality and overreliance on POCUS when a more comprehensive exam by an imaging specialist is indicated,” states the report. “Policies and procedures should address institution-wide concerns, including user training and credentialing, exam documentation and data archiving. And they should address specialty-specific issues, such as developing exam protocols that conform to established guidelines and recommendations.”

According to ECRI, the problem with surgical robotics (number five) is that the systems have significant limitations and cause adverse patient events.

“In some cases, complications from a robotic procedure may not appear for years,” notes ECRI, adding that a 2019 FDA safety communication noted the potential for late-developing complications associated with surgical robot use for certain cancer-related surgeries. “Healthcare facilities need robust processes for approving the application of surgical robots in new procedures, as well as comprehensive programs for training, credentialing and privileging surgeons and OR staff for those procedures.”

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ECRI’s list recognizes that healthcare facilities are very noisy environments for clinicians to work in, with medical device alarms constantly going off—many of them false positives. As a result, providers experience “alarm, alert and notification overload” (number six).

To address the problem, ECRI recommends a “global approach” to “prevent the kind of cognitive overload that can distract or desensitize clinicians or prompt them to use improper notification settings, all of which can lead to missed notifications and patient harm.” The report recommends that healthcare facilities “support activities that help clinical staff develop the critical thinking skills needed to mitigate cognitive overload.”

Another problem area identified by ECRI are cybersecurity risks in the connected home healthcare environment (number seven).

“Challenges include: the deployment may rely on the patient’s home network, which the provider doesn’t control; physical access to the device is limited, which can complicate troubleshooting and installing updates; and patient compliance can be difficult to sustain, particularly if the patient lacks proficiency using the device or has unwarranted fears about cybersecurity risks,” the report states. “Recommendations include assessing system security during device procurement and addressing security considerations during installation, both at the patient’s home and on the provider’s network.”

Another hazard cited by ECRI involves medication errors from dose timing discrepancies in electronic health records (number nine) which can have significant clinical consequences.

“A combination of configuration and usability issues within the electronic health record can contribute to such discrepancies,” contends the report. “Dose timing errors can be made less likely if an EHR order-entry system prominently displays the scheduled medication administration time, allows prescribers to easily modify that time, and includes a ‘now’ option for medications that need to be administered as soon as possible.”

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