Adverse drug reactions, or ADRs, are unintended and undesirable reactions to medicines. ADRs are a common cause of hospitalizations leading to serious health complications and even death. In fact, ADRs are the fourth leading cause of death in the developed world.
While India does have an ADR reporting system in place, underreporting is a major problem. Some studies have reported a 16% rate of moderate ADRs and 1.6% rate of serious ADRs. Although adverse drug reactions are not predictable, they are preventable.
In fact, a review of studies that included more than 24,000 inpatients revealed that 45% ADRs were preventable.
Consider the cases of adverse reactions to opioid pain relievers, a common medicine that has come to the fore in the last decade. A careful analysis of these cases, many of which led to fatality, show a common underlying feature: respiratory failure. Following pain treatment with opioids, undetected respiratory failure was the most commonly reported patient complication. The keyword here is “undetected.” How could the hospital staff miss signs of their deteriorating conditions?
As discussed in our other article, over 50% of patient deaths happen in areas outside of the ICU. Many of these deaths are linked to rising incidence of ADRs across the hospital. These ADRs can be attributed to complicated reasons: new complex pharmaceuticals, drug to drug interactions, and the patient’s response to a drug or drug combination. Thus, hospitals are challenged to detect these complex ADRs and prevent fatal events in even their “safe” unmonitored population.
Why Signs of Deterioration go “Undetected”
A hospital often segregates patients into “acutely ill” and “safe.” This helps them prioritize patient’s care. Clinical teams can predict that an adverse event may be eminent for the acutely ill patients. These patients are kept in the hospital’s Intensive Care Units, or ICUs. ICUs monitor vital signs of patients continuously. Because the ICU set up is closed and properly staffed, it is easy for the nursing staff to personally keep track of the patient’s health. Should anything be found amiss, they can immediately intervene and rescue.
On the other hand, patients who are apparently healthy and have no signs of complications are usually kept in private rooms and general wards. In general wards or private rooms, the patient is usually alone or with a member of the family. Vital signs are measured manually by nursing staff at regular intervals, often once in six hours. The lack of continuous information leads to adverse events going unnoticed sufficiently long for a patient to be beyond rescue.
Often, preventing hospital deaths depend on early recognition of patient deterioration
ICUs are equipped with state-of-the-art technology required for continuous monitoring of a patient’s vital signs and provide 1-to-1 nursing care. When the monitors detect an anomaly, they set off an alarm that can call the nursing staff into action.
Outside of the ICU, it is often too late if nurses and clinicians rely on alarms to intervene and rescue the patient. Continuous monitoring in such scenarios allows healthcare providers to spot patient deterioration early, such as a disturbing trend in one or multiple vital signs well before they trigger alarms.
The human body always gives subtle hints of its gradual decline of wellness.
It is these hints that, if properly identified, predict a full-blown adverse event before it occurs.
Proactive Patient Management through Vitals Trends
Technological advancements have made affordable continuous monitoring a reality. However, continuous monitoring systems that focus on alarming will not provide the necessary trending information for preventing an adverse event.
Trend-based continuous monitoring is fast becoming an imperative for patient care. Automatic trending systems eliminate manual measurements by nurses which prevents human errors, documentation errors, and loss of nursing productivity. Cloud connected trending systems specialize in central data collation, thereby opening the door for trend-based analysis and proactive patient management.
Trends also help identify ADRs long before a patient crashes. When clinical care in the ward focuses on vitals trending rather than alarm management, a return on investment is simple.
The future holds exciting potential as clinicians realize the value of patient vital sign trends and incorporate them in their clinical decision-making to create safe, holistic, and most importantly, proactive patient care.
Vice President -Sales and Marketing
Dr. Roheet Rao leads Sales and Marketing at Stasis. He was previously a Consultant with Ernst and Young, India. He trained as a doctor and holds a PhD in Oncology from the University of Cambridge. His belief that the yawning healthcare gap in India can be bridged by technology drives his passion to provide universal access to affordable healthcare through technology.