1. Introduction Results Method References Using smart phone technology to calculate and monitor gravity infusions Lee, P 1 and Davies M 2. 1 ABM University Health Board, Medical Device Training, Swansea, United Kingdom, 2 University of Nottingham, Computer Science, United Kingdom P.T.Lee: June 2014 Gravity infusion is one of the earliest methods known of delivering Intravenous (IV) therapy and millions of gravity infusions are administered each year in the UK. There are error-prone steps involved in setting up and monitoring these infusions and since there is no technology involved to assist with the procedure, it can be difficult to guarantee the accuracy and consistency of the prescribed fluid delivery. Lack of maths skills and dose calculation error has been identified in the literature and there have been numerous incidents where calculating or entering the wrong dose has led to patient harm or death. We present a new method for accurately setting the fluid delivery, based on a handheld mobile application that includes a novel approach to help estimate flow rates and double-checking the steps involved in setting it up. This new method can reduce errors and slips with gravity drug infusions, as well as making each step simpler and less stressful for nurses to carry out correctly. Background 1.National Patient Safety Agency, Safer Practice Notice 1, Improving Infusion Device Safety. NPSA, London,2004. 2.American Medical News, Revealing their medical errors: Why three doctors went public," August 15 th 2011. www.amednews.com/article/20110815/profession/308159942/4 www.amednews.com/article/20110815/profession/308159942/4 3. How to ensure patient safety in drug dose calculation, Nursing Times, 108(42), 2012. www.nursingtimes.netwww.nursingtimes.net 4. Lee P, Risk-score system for mathematical calculations in intravenous therapy, Nursing Standard, 22(33):35-42, 2008. 5. Thimbleby H & Cairns P, Reducing Number Entry Errors: Solving a Widespread, Serious Problem, Journal Royal Society Interface, 7(51):1429 -1439,2010. 6. Nielsen J (1993) Usability Engineering. Morgan Kaufmann. p. 362. ISBN 978-0-12-518406-9 7. Institute of Safe Medicines Practice: 2013. List of Error-Prone Abbreviations, Symbols, and Dose Designations Discussion and Conclusions Gravity infusion delivers medication to patients without the use of any complex medical device such as an infusion pump or a syringe driver. In the UK National Health Service (the NHS) around 15 million infusions are carried out every year 4. Unfortunately, there are approximately 700 unsafe incidents reported annually, and many more going unreported. 1 The problem of drug dose calculation error has been identified in the literature and there have been numerous incidents where calculating or entering the wrong dose and subsequent administering has led to patient harm or death. 2,3,4 Simple pocket cards, computer software and posters were developed but a portable hand-held calculator was preferred. Errors inputting numbers is known to exist 5 so a dedicated app was developed to reduce these known interface errors. The final version was issued in April 2010, and to date over 20,000 copies have been sold in over 25 different countries. User feedback has been positive, and some areas now use this tool as a training aid in university teaching. Website feedback includes; " Great app! Love the visual aspect, gives you an idea of what the drip rate should look like as no one stands and counts!! Well done!!!“ "Brilliant app for teaching! Simple clean interface and perfect for visual learners. Delighted to find a couple of REAL people behind the app who were accessible, friendly and really helpful. Well done!" Using the following information a basic prescription could be calculated. 1. Total volume of the drug to be infused (in milliliters) 2. Total time of infusion (hours/minutes) 3. The drip factor (number of drops per ml: shown on the giving set packaging) Using the formula below the calculation programme was developed; Drops per minute = Total volume (mL) x Drip Factor Total time (hr/min) 60 Applying ‘user-centered’ design approaches with ‘agile methodologies’ to allow users to feed into the design process helped to develop a system that would suit their needs. We followed the recommendations of ISO Standard 14971, (Application of risk management to medical devices) and ISO Standard 62366 (Application of usability engineering to medical devices) and used Nielsen‘s usability heuristics for user interface design 6. In particular, we adhered to the Institute for Safe Medication Practice’s guidelines for symbols and nomenclature. 7 We developed a mobile solution (Figure 1), which can be used for training purposes and also as a ‘checker’ for nurses when carrying out gravity infusions. The app has features for calculating, setting and checking infusions (Figure 2). A simulated ‘Drip-Chamber’ screen, running at the set drip-rate offers both visual and audible assistance to the user. This is further supported by utilising the built-in vibration device within the iphone handset. Figure 1: Screen for calculating drip rates Figure 2: Screen for checking drip ratesFigure 3: Simulated Drip Chamber screen The IV Drip Rate App © The app was initially developed for ipod/ipad and not for mobile phones as this may go against organisation’s mobile phone policies. However, many patients have downloaded the app themselves to check their own infusions. The software is restricted to IOS(apple) products but 2014 should see the launch of an android version. A plan to achieve CE marking as a medical device is also ongoing. Whilst this device can assist in calculating infusion drip-rates, the need to regularly check patients and their infusions can never be replaced. The use of smart-phone technology in intravenous therapy applications can assist in the difficult process of drip-rate calculation and monitoring. We are now carrying out user studies in hospitals to ascertain the variations in prescriptions versus delivery in the healthcare setting. We are also examining the use of ‘Augmented Reality’ interfaces that would allow the user to capture drip-rates using the phone's camera.