Wireless Cardiac Device Monitoring

Presented by:Ashley D. Solomon, RN

Nursing 457: Nursing InformaticsFall 2009

Objectives:

Define wireless cardiac device monitoring (WCDM).

Describe and evaluate the hardware and software used in WCDM.

Describe and evaluate the different types of information systems used with WCDM.

Objectives: (Cont.)

Depict the function of nursing informatics when working with different WCDM systems in the inpatient and outpatient settings.

Discuss the advantages and disadvantages of WCDM from the perspective of a professional nurse.

What is Wireless Cardiac Device Monitoring?

Implanted Cardiac Devices

*Monitor cardiac rate

*Monitor cardiac rhythm

*Diagnose problems

*Change device settings if necessary

*Follow up can even be performed from the patients own home!

What is Wireless Cardiac Device Monitoring? (cont)

• Medtronic

• Boston Scientific

What is a Pacemaker?

Pacemaker ~ Electrodes placed during surgical procedure Electrodes deliver electrical shock when indicated Regulates beating of the cardiac muscle

What is an Implantable Cardioverter-Defibrillator (ICD)?

Implantable Cardioverter-Defibrillator ~ Battery-powered electrical impulse generator Device connected to leads inside of the heart or on

the surface of the heart Detects ventricular tachycardia or fibrillation and

delivers shock

Equipment Requirements:

Implanted Device Portable Wireless

Transmitter Home Computer

What Hardware is used?

Pacemaker

Implantable cardioverter-defibrillator

What Hardware is used? (Cont.)

Wireless Transmitter Device• Wirelessly transmits data from ICD

• Information sent to healthcare provider via secure server

Secure Server• Secure internet connection

• Transfer information to healthcare provider wirelessly

Computer• Stores, calculates, relays data wirelessly

What Hardware is Required?

Patient Implanted Cardiac Device (Pacemaker, ICD, etc.) Wireless Transmitter Device

Healthcare Provider Computer Secure Server Pager

What Software is Required?

Application Software• Software required to interpret and display cardiac rhythm,

rate, and waveform

System Software• Secure server is required to transmit the patients cardiac

information to the physicians office

Programming Software• Security and anti-virus software is required to maintain

patient privacy

Usability of the software:

Minimal technology is required for the patient.

Provides portability for patients and healthcare providers.

Real-time monitoring capability during all hours of the day or night.

Privacy of the patients own home.

WCDM as a Clinical Information System (CIS)

Clinical Information System (CIS)

Used by physicians, cardiologists, nurses and patients

Functionality Diagnosis of arrhythmias Documentation of patients rhythm at any date/time

Point of Care Testing, Work Station, Local Area Network

Data Standards for WCDM

American Society for Testing & Material International Standards Organization

International Statistical and Classification of Diseases and Related Health Problems (ICD-9 or ICD-10 used for disease classification.

Recommend WCDM systems? The many advantages to WCDM outweigh the

disadvantages. Advantages:

Minimal Technology is required Provides portability for all users (physicians and patients) Increasing portability for patients causes greater

compliance Real-time monitoring capability 24/7

Disadvantages: Cost for technology Possible breach of confidentiality

Legal & Ethical Concerns

Possibility for breach of confidential information,

security, and privacy Patient’s may view this

technology as a substitute for regularly

scheduled check-up’s with their physician

Possibility of equipment error and failure

Informatics Competencies

Computer Based Learning Modules

Yearly competency training and continuous technology

upgrade demonstration Up to date nursing license

Function of Informatics Nurse Guide the patient in properly plugging into the computer system

for interpretation Provide further guidance related to emergency situations

(example: Contacting 911) Provide call-backs to the patient on any possible changes needed to

be made to the ICD/pacemaker Communicate with the attending physician regarding the patient’s

care and current condition Stay up to date on the most current upgrades and trends in WCMD

systems Provide patient education

Summary

Advantages of wireless cardiac monitoring far outweigh the disadvantages

New technology that is continuously improving

Convenience and safety for the patient and healthcare staff

Greater ease of use and portability will increase patient compliance

References:

Medtronic. Published April 22, 2009. Defibrillators (Implantable). Retrieved September 20, 2009. http://www.medtronic.com/our-therapies/defibrillators/index.html.

WebMD. “Abnormal Heart Rhythms and Pacemakers”.

Retrieved October 11, 2009. http://www.webmd.com/heart-disease/abnormal-rhythyms-pacemaker.

.

References: (Cont.)

Cardiac Device Clinic at The Carle Heart Center. February 2009. “Follow up care for patients with pacemakers and ICD’s”. Retrieved October 11, 2009. http://www.carle-clinic.com/Heart/Documents/EHTC1208_CardiacDeviceClinicBro09.pdf.

Boston Scientific. 2009. “ICD Systems and Leads from Boston Scientific CRM”. Retrieved October 11, 2009. http://www.bostonscientific.com/Device.bsci?page=ResourceDetail&navRelId=1000.1003&method=DevDetailHCP&id=10106021&resource_type_category_id=1&resource_type_id=91&pageDisclaimer=Disclaimer.ProductPage.

References: (Cont.)

My Life Stages. “Sutter North Launches New Wireless Cardiac Monitoring System.” Published 2008. Retrieved November 21, 2009. https://mylifestages.org/sites/MyLifeStages/featuredar

ticle/2009/feb/0209_snmf2_wireless.page.