Friday, 7 September 2012

Patients' perceptions of infusion devices

Having recently had two friends-and-relations in hospitals on infusion pumps (and one on a syringe driver too), I have become even more aware of the need to take patients' experiences into account when thinking about the design of devices. To the best of my knowledge, there have been no situated studies of patients' perceptions of infusion devices. I should emphasise that this is not a formal study: just an account of two articulate people's experiences of having glucose, saline and insulin administered via infusion devices.

Alf (not his real name) felt imprisoned in his bed by the fact that the devices were plugged in to the wall. He hated being confined to bed, and would have been perfectly capable of making it to the bathroom if he hadn't felt attached to the wall. He didn't like to ask the staff whether the devices could run on battery for a while so that he could move around.

This contrasts with stories that others have told us: of patients being seen out with their infusion devices having a smoke outside the hospital, chatting up a fellow patient in the sunshine, and even going to Tesco's to do some shopping with drip stand in tow. I suspect this reflects people's amount of experience of receiving medication via infusion devices.

It also contrasts with some of our observations in situated studies, where we have found that devices are run on battery for extended periods of time because there are too few sockets available, or simply to allow the patient to move around more freely.

Manufacturers generally take the view that devices should remain on mains power except for very short periods, which is a position somewhere between Alf's sense of imprisonment and some other observations. As pumps get smaller and more portable, it should be possible for patients to feel less imprisoned by their devices, but this creates new challenges of improving battery life, adapting the physical form of stands to make them easier to move around with, and making sure that batteries get re-charged reliably (which depends on there being sufficient power sockets as well as good notifications of when charge is getting low).

Bert has a cannula in the crook of his elbow, and almost every time he moves his arm it sets off the occlusion alarm. He has learned to silence it, but it only stays silent for a short period and then alarms again (he hasn't worked out how to restart the pump). In a previous informal observation, we noted the same problem; because patients are not meant to touch their own device controls, nurses are understandably reluctant to tell patients how to restart them; in the previous observation, we found that knowledge of how to restart the pump was passed around the ward by the patients who had been in there for a while to the more recent arrivals. Some pumps will automatically detect that the occlusion has been cleared and restart themselves.

However, Bert hates having this happen while he's eating, and would really like to be able to suspend the infusion while he eats, then restart it again afterwards. In our observations, we have noted pump operation being suspended while the patient has a shower: nursing staff are able to achieve this effect, but the patient himself is not. Bert feels capable of taking responsibility for more of his own care than he is being permitted to, and finds that frustrating.

The one-size-fits-all approach to infusion device design, which removes both power and responsibility from the patient (who often has the time and the intelligence to take a more active role in their own care) may improve safety by reducing variability. However,  it may also reduce resilience and it definitely degrades the quality of the patient experience by concentrating
it all on busy, multi-tasking clinical staff.

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