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KSR Publishing, Inc.
Copyright © 2016

         Clinical intelligence for supply chain leadership



August 2013

Products & Services

New Technology

Urine test can diagnose, predict kidney transplant rejection

Analysis of three biomarkers in the urine of kidney transplant recipients can diagnose — and even predict — transplant rejection, according to results from a clinical trial sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. This test for biomarkers — molecules that indicate the effect or progress of a disease — offers an accurate, noninvasive alternative to the standard kidney biopsy, in which doctors remove a small piece of kidney tissue to look for rejection-associated damage. The findings appeared in the New England Journal of Medicine.

"The development of a noninvasive test to monitor kidney transplant rejection status is an important advance that will allow doctors to intervene early to prevent rejection and the kidney injury it causes, which should improve long-term outcomes for transplant recipients," said NIAID Director Anthony S. Fauci, M.D.

Following a kidney transplant, patients receive therapy to prevent their immune systems from rejecting the organ. Even with this immunosuppressive therapy, approximately 10 to 15 percent of kidney recipients experience rejection within one year after transplantation.

Typically, a biopsy is performed only after a transplant recipient shows signs of kidney injury. Although the procedure seldom causes serious complications, it carries some risks, such as bleeding and pain. In addition, biopsy samples sometimes do not give doctors an accurate impression of the overall state of the kidney because the samples are small and may not contain any injured tissue.

"Potentially, a noninvasive test for rejection would allow physicians to more accurately and routinely monitor kidney transplant recipients," said Daniel Rotrosen, M.D., director of NIAID’s Division of Allergy, Immunology and Transplantation."By tracking a transplant recipient’s rejection status over time, doctors may be able to modulate doses of immunosuppressive drugs to extend the survival of the transplanted kidney."

In the study, part of the NIH-funded Clinical Trials in Organ Transplantation, investigators at five clinical sites collected urine samples from 485 kidney transplant recipients from three days to approximately one year after transplantation. Researchers led by Manikkam Suthanthiran, M.D., of Weill Cornell Medical College in New York and Abraham Shaked, M.D., Ph.D., of the University of Pennsylvania School of Medicine, assessed the urinary cell levels of several biomarkers that previously have been associated with rejection.

To determine whether the urine test also could predict future rejection, the scientists analyzed trends in the diagnostic signature in urine samples taken in the weeks before an episode of rejection. The values for patients who experienced rejection increased slowly but steadily leading up to the event, with a characteristic sharp rise occurring approximately 20 days before biopsy-confirmed rejection had occurred. In contrast, the values for patients who did not show any clinical signs of rejection remained relatively constant and under the threshold for rejection. These findings suggest that it might be possible to treat impending rejection before substantial kidney damage occurs.


Carts, workstations morph in meaningfully
useful ways

by Jeannie Akridge

Carstens LinkT

The basic form and function of the medical supply cart continues to serve as a "toolbox" of sorts, bringing medications and supplies to the point of care. But as patient care becomes increasingly digitized, workstations must offer more specialized functionalities and play more active roles in care delivery, particularly to help facilities implement electronic medical records and/or meet Meaningful Use standards set forth by the Centers for Medicare and Medicaid Services.

Mobile carts, workstations on wheels, and wall-mounted workstations have evolved to become highly secure medication administration vehicles as well as computing systems that allow caregivers to capture patient data, often in real time, for entry into the EMR and hospital information systems. 

"Point of care charting can increase quality of patient care, reduce errors, improve efficiency, and enhance workflow," said Kim Krisik, CDW Healthcare Business Development Manager. Carts, workstations and mobile devices can greatly enhance patient safety — especially at the point of care, said Krisik, and can also contribute to improved patient satisfaction.

Mobile carts and computing devices can "enable quick, accurate decision making thanks to immediate access to data; reduce errors and enhance documentation accuracy as paper charting is eliminated; and provide access to patient data for all members of the circle of care, preventing duplicate efforts and providing accurate communication and a clear care plan," Krisik reasoned.

Flexible solutions that fit, not fight, existing workflows will be key to facilitating EMR integration. A strategic combination of mobile carts and wall-mounted workstations can help meet the goal of ensuring convenient access to the EMR throughout the continuum of care.

"A successful implementation of mobile carts and devices requires symmetry between the healthcare facility’s goals and the technology solutions that it adopts," added Krisik. "The ability to understand workflow is very important in this process."

The transition to an electronic system of maintaining patient records will likely uncover the complexities of EHR/EMR implementation, including issues with user adoption, asserted John Pierson, Director of Strategic Business Development, Carstens. "How do you get clinicians to use the system, and more importantly, how do you do it while increasing efficiency and improving workflow?"

With the goal of better equipping clinicians to give outstanding care to their patients, said Pierson, "the way to do this is to ensure the point of data entry is also at or near the point-of-care. This addresses several things: it improves the level of patient/caregiver communication while improving workflow."

Pierson proposed that the use of Carstens mobile and wall-mounted workstations "can help improve all-important HCAP scores by improving the patient experience through increased face-to-face interaction between patients and their clinicians."

LogiQuip QT Quiet
Treatment/Procedure cart

Carstens’ LinkT is an ergonomically designed workstation equipped with a stool that can be stowed when not in use. "The LinkT is so intuitive in how it moves with the body that you really feel as though it is an extension of yourself," Pierson described. "The work surface slides out of the way when you need it to with just a gentle nudge and the entire cart can easily move around the room with you. Our [wall-mounted] Wallaroos have various options for articulating arms, laptop and tablet mounts that allow you to always keep eye contact with the patient."

Designed to help improve patient satisfaction by aiding noise reduction initiatives, QT Quiet Treatment/Procedure carts from LogiQuip feature a soft return, silent closing drawers, silent hospital grade casters, quiet innovative eLock system and an easy pull-out work surface. "Studies show that a quieter environment for patients 1) shortens patient recovery times; 2) fosters a calmer healing environment; and 3) improves patient satisfaction scores and HCAHPS survey results," said Eric Schuldt, Vice President Sales and Marketing, LogiQuip.

Carts and workstations with ergonomic design and functionality can also encourage user adoption and satisfaction as well as prevent caregiver injury and strain. 

"There are a number of features that are critical for facilities when implementing EMR and e-MAR systems. First and foremost, the workstation must be designed with ergonomics in mind to provide a comfortable and convenient user experience for caregivers," said Rob Sobie, Vice President, Metro, adding that the new Metro AccessPoint Mobile Computing System was designed from the ground up to meet Cornell ANSI/HFES 100-2007 Human Factors Engineering of Computer Workstations ergonomic standards.

Rubbermaid CareLink

Alissa Kubera, Senior Product Manager, Rubbermaid Healthcare, emphasized flexibility and maneuverability. "Making the carts easy to move is crucial for any organization implementing EMR or e-MAR systems. Workflows and facility configurations are highly variable, even within the same building, so a cart that is easy to move and adaptable for any size space is very helpful."

Rubbermaid Healthcare’s new CareLink Mobile Nurse Station is equipped with large 5-inch casters to help cross thresholds and maneuver over carpet. "New to this workstation, our proprietary N-Stride steering control allows users to easily navigate halls and turn corners without unnecessary strain by switching the front casters from multi- to single-direction with the click of a trigger," said Kubera.

CareLink features a 7-inch integrated glass touchscreen that allows for messaging capabilities, customized user settings, and interactive tools designed to streamline care delivery, allowing clinicians to remain with the patient while performing their duties. "They can send and receive messages to and from other areas of the hospital, including IT, pharmacy and housekeeping, directly on the touchscreen computer without disrupting their EMR session," said Kubera. "This increases response times and minimizes disruption to patient care. It also allows the caregiver to be more productive and efficient with each encounter."

Midmark CareExchange workstations with adjustable height keyboards

Michael Couch, Marketing Manager, Midmark Corp., highlighted how the Midmark Care Exchange Workstation family of products enables caregivers to easily bring digital information to the point of care. "Many workstations adjust in height, while tilt and rotation features for monitor options allow caregivers to maintain a proper working position without sacrificing eye contact with the patient," said Couch. Low rolling resistance casters offer ease of movement, and the workstations feature a small footprint on the floor or on the wall without hindering workflow efficiency.

Stinger Medical’s integriti Vitals is an integrated vitals software that acquires, modifies and files, in near time, vital signs and patient modifiers (such as pain intensity, respiration, level of consciousness, etc.) directly to the EMR from the bedside. Noted Todd Jackson, Executive VP Sales, "By automating the documentation process, integriti Vitals reduces manual transcription errors, charting omissions and delays. In a workflow study, clinicians saved on average one hour and 23 minutes each per day using integriti Vitals."

"When facilities add vital signs data capture devices onto mobile computing workstations, clinicians have the flexibility to check vital signs and document care in the electronic medical record during each patient visit," said Sobie. "The result is efficient, accurate data collection and documentation that supports better medical decisions and ensures faster response to changes in a patient’s condition."  

As facilities look to meet meaningful use requirements they might also look at overhauling their fleet of carts and workstations to facilitate workflows and provide more automation at the point of care.

Krisik described the complex list of requirements when considering point of care and mobile devices/carts for meaningful use applications.

• You must order 30 percent of all medications via computerized physician order entry (CPOE). You can do this at the point of care via the EMR on the mobile device placed on the cart

• Clinical Decision Support (CDS) is a requirement for meaningful use. CDS at the point of care is realized through the utilization of a mobile device and cart

• You must submit 40 percent of clinical lab results through the EMR. You can do this with mobile devices leveraged by everyone in the circle of care

• You must enable drug-drug and drug-allergy checks. When you use a medication cart along with a barcode scanning solution, the medication is scanned into the EMR before it is administered to the patient. If there are errors, the system will automatically make the provider aware. This reduces errors and improves patient safety

• You must record and chart changes in vitals for 50 percent of unique patients. This can occur at the bedside, for example, by having a blood pressure cuff connected to a mobile device and stationed on the cart

Emphasizing the criticality of a robust power system for mobile workstations used for EMR applications, Patrick Ney, Vice-President, Anton/Bauer MPS, said, "When a hospital does not incorporate a reliable system to power its fleet of mobile medical carts and other electronic devices, the equipment may be in jeopardy of not working properly, therefore leaving caregivers frustrated and/or unable to perform their responsibilities, including the electronic capturing of a patient’s medical information." 

"With the medical industry focused intently on meeting Meaningful Use requirements," Ney commented, "hospitals and other facilities continue to spend $100,000’s to $1,000,000’s on equipment that will support the meaningful use of Electronic Health Records (EHR.) Unfortunately, hospital decision-makers often overlook the importance that a mobile power system plays in ensuring those devices work properly. More than just a battery, when the power system does not meet workflow requirements, the major investment in the EHR system is compromised."

He added that many inexpensive, low-quality batteries will perform well for a few months but then fail quickly. "The inexpensive options typically cost much more over the life of the product versus investing in higher quality upfront."

Metro AccessPoint

Ease of maintenance and flexibility in configuration, for example to accommodate future upgrades, is another key component to enable EMRs and will be critically important as facilities move through the various stages of adoption, said Sobie. "Because the needs of a facility are likely to change as they progress through the HIMSS EMR adoption mode, Metro AccessPoint was designed to be field-upgradeable for any application. The flexibility to add medication storage and a barcode scanner to support BCMA or dual monitors for PACS allows a facility to maximize the return on their mobile computing investment."

Scalability to adapt to future needs is perhaps one of the most important criteria for any solution intended to integrate EMRs into patient care, Pierson agreed. "I have seen quite a few facilities that have opted to construct fixed workstations in the corridors only to discover months or years later that even more workstations are needed." Modular wall-mounted solutions and carts from Carstens are scalable as facility needs grow, and new carts on the horizon from Carstens in coming months will aim to give customers "the ultimate in design flexibility," he said.

Carts with auto locking drawers can help facilities meet security needs related to medication administration and a wireless programming component offers distinct advantages.

Armstrong Premier Aluminum Wireless
Auto Locking Cart

The new wireless Armstrong Electronic Auto Locking Controlled Access carts allows control over who accesses the cart and when along with an added option that requires a dual credential access into a controlled substance drawer, explained John Figel, Sales Manager, Armstrong Medical. "Our New WEL Cart with controlled substance drawer option creates better accountability and security for controlled substance at point of care where many facilities are vulnerable right now," Figel remarked.

With the ability to set the auto locking timer so the carts will lock themselves in a set time frame, along with audit trail reporting for cart access, the auto locking carts help bolster the security of cart contents and improve compliance with accreditation authorities, he said.

The programming feature of the Armstrong Wireless Auto Lock makes it easy to manage users and data. "It is time consuming to have to connect to each cart to make changes," said Figel. "The new wireless cart option we offer now allows for the changes to be made at a central location having these changes sent to the carts wirelessly through the hospital’s network. This saves many hours of staff time."

He added that compared to older, heavy steel carts in use Armstrong’s lightweight aluminum cart line offers ease of maneuverability and reduced injury potential.


Blue Bell Wireless Autolock Cart

Blue Bell Bio-Medical
recently introduced its new Wireless Autolock Cart. Susan Saam, Regional Manager, explained, "It allows user updates and lock settings to be managed from the convenience of an administrator’s office by utilizing the facility’s wi-fi network. Make the update once and it’s done, even for carts located at satellite facilities. No more docking to each cart."

The keyless entry feature of the Blue Bell Wireless Autolock Cart allows for multiple individual user codes and activity reporting. Proximity or Magstripe card readers may be added and optional independently-accessed drawers for increased security of controlled substances or other valuables is also available. 

Blue Bell has also added an Extra-Wide Cart that offers maximum mobile storage space for endoscopy, anesthesia, or case cart supplies, features 30" of configurable drawer space and is available with choice of five lock options.

Highlighting the flexibility and adaptability of Blue Bell’s cart offerings, including customization options, Saam noted that the use of a "Sure Clamp" mounting system allows for easy accessory changes. Blue Bell’s "Design-A-Cart" configurator walks the user through each step of building a customized cart as he or she selects the details and watches it being "built" from cart size to color to accessories, Saam explained. "The 3-D model can be viewed from all angles so you can really see what your cart will look like." 

CartWrite TC/Tablet Cart

For a convenient way to quickly deploy mobile technology on the front lines of patient care, CartWrite’s new TC/Tablet Cart ships fully-assembled, power-ready and immediately useable with laptops, notebooks, tablets and more. CartWrite TC products are available in two different finishes and are made in the U.S. with American-sourced, recyclable materials. Double-compartment cushioned drawers are standard, while CartWrite interiors can be quickly customized to user needs. Featuring tangle-free storage, access for power and cord management is simple and neatly contained within the unit.

Andrea Bradshaw, CDW Senior Director and General Manager, Mobility Solutions, commented on challenges related to striking a balance between use of mobile computing solutions and healthcare’s unique security requirements. "Research tells us that security and mobile device management (MDM) are the biggest concerns keeping healthcare IT managers awake at night. In particular, the ability to offer staff, patients, and visitors the freedom to use the devices and apps that make caregivers productive — all while upholding HIPAA requirements mandating that all patient data is secured at all times."  

"Adding to the challenge is the growing trend of bring-your-own-device (BYOD) in healthcare, which makes implementing MDM a tough pill for many practitioners to swallow, as they are at risk of having their device(s) wiped clean if suspicious app use or activity is detected," Bradshaw continued. "Because healthcare professionals need the flexibility to efficiently coordinate care at any time — and on any device — BYOD policies are critical. (For example, a policy that outlines which apps a user can download to his or her device and/or access through the Web.)"

CDW’s Total Mobility Management helps organizations determine and define their ideal mobile strategy, and choose which devices and apps would best support its workforce. "We can guide IT managers to the right solution to protect the organization’s data — most importantly, its patient data," said Bradshaw. "Through our Mobility Management Portal, we can integrate day-to-day IT operations into one screen and provide real time views and alerts of usage, expenses, device location, non-compliant activity, and other activity deemed important. For BYOD users, we offer 24/7 support through a help desk and self-service portal. CDW will customize the optimal Total Mobility Management solution and services for each specific healthcare environment, because we know that the right clinical mobility solution can improve quality of care, communication, and convenience."

Bradshaw added, "Implementing a robust mobility solution establishes a first level of defense against harmful hacker attempts, and improves compliance with HIPAA and other regulations tied to critical patient information." 

Powered for uninterrupted care

It could be said that a mobile workstation is only as good as the battery that powers it — especially if caregivers are constantly struggling with an insufficient power system to meet their workflow demands.

"Battery life comes into play in any mobility project, and recognizing the battery life of these units is key," said Krisik, CDW. "Can you charge the units during off peak times? Can you set up specific charging stations that are easily accessible to decrease issues?" 

"One of the most important factors to consider is whether or not the power management system is compatible with a hospital’s current or newly-purchased fleet of mobile carts and other electronic devices," said Ney, Anton/Bauer. "Having reliable power supporting this equipment, throughout a facility ensures consistent care."

Anton/Bauer MPS SmartSwap

"Another consideration to keep in mind," said Ney, "is whether the power system will be compatible with any future technological upgrades. Equipment needs to be changed often, so having a flexible; forward-compatible power solution can save time and money. For example, a new Anton/Bauer MPS battery purchased today can be used on an Anton/Bauer MPS charging system that was bought 10 years ago. Further, any necessary charger updates can easily be made with firmware updates, without having to purchase an entirely new system, further maximizing a hospital’s ROI."

"Anton/Bauer MPS incorporates patented technologies within its products that increase overall battery life and runtimes," described Ney. "The company specializes in both swappable and conventional base-mounted models in a wide range of configurations, size and chemistries to match any hospital’s needs for capacity, runtime and other features. Therefore, no mobile medical device should ever be inoperable."

Anton/Bauer’s HotSwap and SmartSwap mobile power systems consisting of Anton/Bauer batteries, chargers and Gold Mounts provide users with nearly 100 percent uptime, as Anton/Bauer batteries can be swapped in and out without having to shut down the equipment being powered. "This consistent power supply enables users to continuously use the cart with one charged set of batteries, while the other set of depleted batteries recharge," said Ney. The SmartSwap is also a hybrid-charging system that can be plugged in to charge when stationary or while in use, enabling the batteries to be "swapped" out. "Once the caregiver engages the SmartSwap by turning on whatever mobile workstation or other medical device he or she is using it with, the system’s power charger also operates as a D/C power supply that will continue to power the device and any peripheral devices being used, while the depleted batteries charge."

An LED Fuel Gauge offers visual alerts to battery runtime, and Anton/Bauer Battery Management Software monitors battery capacity and overall health, displaying the remaining runtime as well as providing further diagnostic information, if needed, for troubleshooting.

Built specifically for hospital mobile devices and designed as a retrofit solution to power any brand of mobile cart, Stinger Medical’s Mobius Power Swappable Power System can help eliminate downtime due to battery recharging. Mobius Power is supported by Stinger’s CAST mobile fleet surveillance and remote diagnostic tool.

In addition to Lithium Nano chemistry that features runtimes up to 13 hours and lasts over 5,000 cycles, noted Sobie, Metro also offers an Anton/Bauer professional grade swappable power solution to provide continuous 24 hour runtimes. A new fanless charging mode on the Metro AccessPoint reduces the circulation of dust, debris and other harmful contaminants while quietly recharging the system in 3 hours. "This is ideal for isolation areas or when you do not want to disturb a patient," he said, adding that the fan-aided fast charge mode can replenish a depleted power supply in as little as 2 hours.

The new 451 Hybrid Power Management System from Hoffman Engineered Systems (HES) accepts any battery technology and converts the battery’s DC power into AC and DC outputs, thus allowing the system to efficiently operate electronic devices without converters, inverters or adapters. To accelerate battery charging, the 451 system provides 450 watts of power to rapidly charge any size battery with 25 amps of output, optimizing run times and extending battery life.

Sensible mobile storage

High density mobile storage systems can offer ultimate flexibility in supply organization as well as cost savings.

DSI’s U.S.-made Modumax can increase the storage capacity in a given space from 15% to as much as 50%, said Peter Lane, President, DSI Inc., and can also serve as a Kanban (twin bin) system. "Modumax has been shown to dramatically reduce Supply Chain inventory and labor costs in hospitals."

Once installed, Modumax units can be completely reconfigured without tools in minimal time, Lane explained. Originally designed to help hospitals meet the new Joint Commission standard prohibiting stacking of sterile wrapped packs and kits, Modumax allows users to incorporate a variety of shelving selections, he added.

LogiCell carts from LogiQuip offer increased storage capacity along with more generous sized components. Featuring LogiQuip’s next generation Cell System, the LogiCell carts allow components to be positioned horizontally or at a 30-degree angle for easier access and viewing. Flexible components range from storage for short hanging catheters to long boxed catheters, to small supplies and IV solutions.

Akro-Mils’ new TiltView Stack Cart offers the convenience of tilt-bin storage with a mobile work center that is shipped fully assembled, explained Scott Wiley, Industrial Product Line Manager. "This cart combines clear tilting bins, which allow for maximum visibility, easy item recognition and optimized efficiency, while the cart itself uses space that might otherwise be wasted and can travel from location to location."

Blickman Inc. offers a wide range of sizes in its case carts from maxi to space-saver options to accommodate routine surgical procedures (labor & delivery) or those requiring larger volume or size of instruments, including five standard sizes. For maximum space, the CCC2E with extension shelves can be utilized as a 72" back table.

Blickman also offers customized carts to a variety of specs, including Automatic Guided System (AGV).

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