The IoT in Healthcare – improving lives in care homes. Part 1
How can the IoT improve the lives of clients and staff in care homes?
As I mentioned in my last blog featuring the IoT in hospitals, I am not a care home expert. In this two-part blog, my aim is to attempt to seed some ideas that could go some way to improving our lives in the near and long term future.
Medication management
Although there is less risk of medicine errors in a care home environment, there is still a risk. As I mentioned in the last blog, if highly qualified and experienced nurses make mistakes with medicine administration, anyone can. An IoT coded medicine containers combined with a patient’s biometric verified IoT tag could significantly reduce the risk. Simply by offering the medicine bottle to the patients tag staff could be presented with the exact dose from that specific bottle for that specific patient. If this level of automation is a step too far, then a simple scan process using a hand held device could achieve the same results. It would certainly reduce the risk of giving someone an incorrect does of medicine and potentially reduce staff stress.
Karen had one of her medications reduced and then removed during the initial stages of her rehabilitation. The changes to Karen’s condition were subtle but vitally important and they were becoming more significant as the says went on. I was unaware of the medication changes but having noticed some changes in Karen’s state I mentioned it to Karen’s doctor. The doctor was very thorough in wanting to understand when I had noticed the changes and the effect this was having on Karen. She was very quick to associate the change with the particular medication change and arranged for a gradual restoration of the medication. None of the staff were with Karen long enough to notice the change. By this time, I was visiting for four hours a day during the week and eight hours at weekends so although I wasn’t with Karen 24 x 7 I was with her long enough to notice any changes. As a result, the doctor caught the problem early and was able to deal with it.
When I discussed this with the doctor I discovered the reason for removing the medication had been taken because the reason for administering the medication at the outset was unclear and did not agree with the rehabilitation consultant’s assessment. This was not the only example of a lack of detail in the medical notes. Another medication was administered during Karen’s time in the acute hospital but the date and time was not recorded and the details could not be found.
In both of these examples, an IoT based medication monitoring process would have automatically recorded the changes to medication. In the first example the symptoms Karen suffered during this brief spell tied in exactly what the need for the medication. If all of the healthcare professionals were aware of the signs they too may have been able to spot the changes in Karen. Not all patients have daily visitors, some have none. The potential effects of changes in medication could be made aware to all staff through a local communications portal automatically triggered by the change. How many times do these changes in medication go unnoticed causing the patient unnecessary distress?
Patient baseline
Care home staff typically get more time to get to know their clients so maybe this is less of an issue. However, if assistive technologies using IoT technologies and based on standards were used throughout the healthcare industry creating a joined up care package for people throughout their healthcare journey this would be truly transformational. Any transition from hospital is traumatic whether the transfer is to another hospital, a rehabilitation centre, care home or home. The patient is going into the unknown and staff or outreach workers are facing the unknown with a new patient or client coming into their care. When my daughter transferred from the acute hospital to the rehabilitation hospital she was distraught. This made her upset and aggressive and this was the first impression the staff at her rehabilitation hospital saw of her.
Fortunately, the amazing team at the Royal Hospital for Neuro-disability had a strategy to deal with this. They had already sent a member of the team to carry out a thorough assessment of Karen while she was in the acute hospital. When we arrived on a Friday afternoon the multi-disciplinary team engaged across the board. Nursing staff, physiotherapists, occupational therapists, speech and language therapists, psychologists and doctors all within the first afternoon. They worked together with some input from me to come up with a tailored care package to ensure Karen got the best from her rehabilitation. This included some specific training for the healthcare staff on how to deal with Karen’s anxieties resulting from her Autism.
Karen was being considered by three rehabilitation hospitals. When the assessor from the RHN arrived she was already well prepared and had read through Karen’s notes in detail. I was very reassured by her approach and the tests she ran through with Karen and the time she took to get to know her. The consummate professional. She worked with Karen’s physiotherapists to understand Karen’s capabilities and how she interacted with the physiotherapists team. I am convinced that when she reported back to her team at the RHN she would have conveyed a very accurate description of Karen and her needs. It was no surprise that the admission process at the RHN was so effective and Karen was settled within a couple of days.
I was far less enamoured with the experience of the assessments from the other rehabilitation units. One simply didn’t show up and the other arrived two hours late and treated Karen like a three-year old, testing her with some shoddy hand drawn sketches on paper. Based on their assessment, I would not have trusted them with a pet hamster. That may be an extremely unfair statement, but this was a life affecting decision for Karen and I took it extremely seriously. The other two rehabilitation units were probably more than capable of taking Karen through the next stage of her recovery (I discovered later one of them has a very good reputation) but in my opinion the effectiveness of the transition depended on far more than the contents of the medical notes. Karen suffered as a result of some serious shortcomings when handed over from one medical team to another within the same hospital, I was not going to let this happen during this next transition.
What can be done to improve this? One biometrically verified IoT tag could be linked to patient baseline information and updated by the healthcare professionals and care staff whenever they take their observations and carry out procedures. This may not need to be as detailed as needed in hospital but it could include food and fluid ingress and egress, medication side effects, mood changes, personal preferences, mobility, language capabilities and much more.
Healthcare monitoring and management
Getting emergency care can be a challenging a traumatic time for anyone. Notices and posters plastered everywhere tell us casualty cannot cure a cold. They tell us not to waste the time of the emergency services and healthcare services to deal with minor injuries but to wait and arrange a visit to your GP instead. I agree with this wholeheartedly, it is just selfish to take up the time of these professionals working under extreme pressure with minor ailments, potentially preventing someone with real need getting the urgent attention they need. I am not a frequent visitor to casualty as I have only had the need to go to casualty twice in the past three years, both times were life and death situations for my daughter and on both occasions casualty resembled a war zone. I couldn’t help thinking of MASH while waiting patiently. While my daughter was in the acute hospital I passed through casualty several times and it was always very busy. Either the poster campaign is not working or the casualty department was simply not geared up for the size of the population. But that’s another subject!
A couple of days ago a ‘celebrity’ doctor on radio two said we should go to see our doctor as soon as we are feeling slightly unwell. When we book an appointment with our local doctor you can wait a week for an appointment. This obviously defeats the object of trying to get in to see the doctor early. As challenging as it can be to get medical attention, the majority of us are able to make a decision as to whether we really do need casualty to see a doctor within hours, or to opt for an appointment with our GP in several days. However, care staff looking after elderly disoriented clients or clients with special needs are often in a position of having to make that decision for their client. Establishing whether their client can wait to see the GP or really does need casualty can be an extremely tough judgement call. Even more so when the client lacks mobility or has limited communication.
Medication can add another layer of complexity. Speaking from experience, if the client is prescribed pain relief medication on a regular basis, the medication can mask underlying symptoms of a new and developing problem. Other medication may create a euphoric effect which again can mask underlying symptoms until the problem has really taken hold. Having spent a long time in hospital alongside experienced healthcare professionals, I witnessed first-hand how some medication can make it very difficult for the experts to spot a developing problem. There were a couple of occasions when my daughter came close to being moved back into an acute hospital but due to the brilliant skill of the ward doctor she was spared the trip by a ‘just in time’ diagnosis and treatment regime.
So, what can the IoT do to improve this situation? I am going to throw in a few ideas here, nothing particularly joined up other than where the information is gathered. If carers were trained to capture data using a range of devices and sensors, the data could be automatically logged in the Cloud. Data could then be analysed in near real time with alarms and alerts set for any deviation from a health baseline. The results can be associated to the client through the use of IoT tags on the client and on the measuring equipment, thus removing the risk of errors in collection and recording. The alerts would serve as an early warning system to ensure the person in care gets the intervention they need, when they need it. The results are also available in the Cloud for any healthcare professional responsible for ongoing management of the client’s health.
The results collected could include temperature, blood pressure, blood oxygen, hydration, glucose monitoring, International Normalised Ration (INR), ECG heart monitoring and more. Some of these tests may be introduced for specific periods of time such as following medical procedure or medication change and others may be ongoing. Early intervention has the potential to significantly reduce costs so why would we not do this?
Useful links…
Dail Mail – Dementia Care Lottery Exposed
Andrew Gunn – Inexcusable, a lack of digital innovation in healthcare provision