This is a bundle of software applications that can be used to monitor patients in the Intensive Care Unit (ICU). It is composed of: i) a program that can be used to track patients on a ventilator, ii) a program to calculate dosage of medications, and iii) a program to obtain the cardiopulmonary profile of a patient. These applications are convenient to operate with user-friendly interfaces. They can be integrated into existing ICU software or may be used independently.
Roughly 10 percent of all US hospital beds are located in intensive care units, where it has been estimated that as much as 40 percent of care time for ICU patients is devoted to the task of manually recording monitor information. As a result, there is a pressing need for ICU software that will enable hospitals to make their monitoring systems more cost efficient, comprehensive, and accurate. The global market for patient-monitoring systems is forecast to grow from about $7 billion in 2008 to more than $8 billion in 2015, and it is likely that ICU-related software expenditures will represent a significant portion of that growth.
It is designed to allow the user to complete the IHI ventilator-associated pneumonia (VAP) 4-element bundle. It is to be used for tracking ventilated patients in the ICU.
The user completes four elements each morning:
- Has the patient been put on a sedation vacation?
- Is the patient on peptic ulcer disease (PUD) prophylaxis?
- Is the patient receiving DVT (deep vein thrombosis) prophylaxis?
- Is the head of bed (HOB) elevated?
In the afternoon the last question is again asked of the user.
The four questions (as well as sub questions) are answered Yes or No. If ’No’ is recorded for any of the questions, a drop-down list of the reasons why any of the questions would be answered negatively appears.
DVT prophylaxis has been subdivided to include: a) DVT prophylaxis medication, b) DVT prophylaxis sequential compression boots, and c) information about whether an IVC filter was inserted.
The program has “canned” reports that track ventilator patient days and responses to the questions. The program is written in Access VBA. Currently the program is linked to the ICU data set, which transfers all ICU patients (names, MRNs) to the VAP opening encounter form. Further upgrades would allow the user to input the names of the patients in the ICU to allow it to be a fully standalone program.
This is a standalone, Web-browser-based application that allows the user to input patient name, room number, MRN, and weight. A drop-down list appears containing approximately 50 ICU drugs used for continuous infusions. The background spreadsheet includes:
- names of the drugs
- units that the drug is administered in
- formulas to convert the units to ml/hr
- minimal and maximal dose ranges
- recommendations for loading
- dilution (quantity of drug and quantity of diluent are preprogram defaulted)
The program then calculates a dosing range.
All default values can be changed. Special instructions are provided both on the screenshot and on the printout.
This is a standalone, Web-browser-based application that allows the user to input patient identification (name, MRN, bed number, height, and weight), as well as hemodynamic and pulmonary artery catheter variables determined at the ICU bedside. These variables then are used to calculate a cardiopulmonary profile.
The program has canned reports that are available in long or short form, and the user can select the profiles to view.
The program includes a glossary of all acronyms used as well as the mathematical calculations that the program uses.
Currently being used in the Intensive Care Unit at Memorial Sloan Kettering Cancer Center’s Memorial Hospital; ready for implementation with existing ICU software packages elsewhere
Patient monitoring in ICU
Neil Halpern, MD, FCCM, FCCP, FACP, Chief, Critical Care Medicine Service, Medical Director, Respiratory Therapy, Memorial Sloan Kettering