1. Wireless Cardiac Device Monitoring Presented by: Ashley D. Solomon, RN Nursing 457: Nursing Informatics Fall 2009

2. Objectives: Define wireless cardiac device monitoring (WCDM). Describe and evaluate the hardware and software used in WCDM. Describe and evaluate the different types of information systems used with WCDM.

3. Objectives: (Cont.) Depict the function of nursing informatics when working with different WCDM systems in the inpatient and outpatient settings. Discuss the advantages and disadvantages of WCDM from the perspective of a professional nurse.

4. What is Wireless Cardiac Device Monitoring? Implanted Cardiac Devices *Monitor cardiac rate *Monitor cardiac rhythm *Diagnose problems *Change device settings if necessary *Follow up can even be performed from the patients own home!

5. What is Wireless Cardiac Device Monitoring? (cont) Medtronic Boston Scientific

6. What is a Pacemaker? Pacemaker ~ Electrodes placed during surgical procedure Electrodes deliver electrical shock when indicated Regulates beating of the cardiac muscle

7. What is an Implantable Cardioverter-Defibrillator (ICD)? Implantable Cardioverter-Defibrillator ~ Battery-powered electrical impulse generator Device connected to leads inside of the heart or on the surface of the heart Detects ventricular tachycardia or fibrillation and delivers shock

8. Equipment Requirements: Implanted Device Portable Wireless Transmitter Home Computer

9. What Hardware is used? Pacemaker Implantable cardioverter- defibrillator

10. What Hardware is used? (Cont.) Wireless Transmitter Device Wirelessly transmits data from ICD Information sent to healthcare provider via secure server Secure Server Secure internet connection Transfer information to healthcare provider wirelessly Computer Stores, calculates, relays data wirelessly

11. What Hardware is Required? Patient Implanted Cardiac Device (Pacemaker, ICD, etc.) Wireless Transmitter Device Healthcare Provider Computer Secure Server Pager

12. What Software is Required? Application Software Software required to interpret and display cardiac rhythm, rate, and waveform System Software Secure server is required to transmit the patients cardiac information to the physicians office Programming Software Security and anti-virus software is required to maintain patient privacy

13. Usability of the software: Minimal technology is required for the patient. Provides portability for patients and healthcare providers. Real-time monitoring capability during all hours of the day or night. Privacy of the patients own home.

14. WCDM as a Clinical Information System (CIS) Clinical Information System (CIS) Used by physicians, cardiologists, nurses and patients Functionality Diagnosis of arrhythmias Documentation of patients rhythm at any date/time Point of Care Testing, Work Station, Local Area Network

15. Data Standards for WCDM American Society for Testing & Material International Standards Organization International Statistical and Classification of Diseases and Related Health Problems (ICD-9 or ICD-10 used for disease classification.

16. Recommend WCDM systems? The many advantages to WCDM outweigh the disadvantages. Advantages: Minimal Technology is required Provides portability for all users (physicians and patients) Increasing portability for patients causes greater compliance Real-time monitoring capability 24/7 Disadvantages: Cost for technology Possible breach of confidentiality

17. Legal & Ethical Concerns Possibility for breach of confidential information, security, and privacy Patient’s may view this technology as a substitute for regularly scheduled check-up’s with their physician Possibility of equipment error and failure

18. Informatics Competencies Computer Based Learning Modules Yearly competency training and continuous technology upgrade demonstration Up to date nursing license

19. Function of Informatics Nurse Guide the patient in properly plugging into the computer system for interpretation Provide further guidance related to emergency situations (example: Contacting 911) Provide call-backs to the patient on any possible changes needed to be made to the ICD/pacemaker Communicate with the attending physician regarding the patient’s care and current condition Stay up to date on the most current upgrades and trends in WCMD systems Provide patient education

20. Summary Advantages of wireless cardiac monitoring far outweigh the disadvantages New technology that is continuously improving Convenience and safety for the patient and healthcare staff Greater ease of use and portability will increase patient compliance

21. References: Medtronic. Published April 22, 2009. Defibrillators (Implantable). Retrieved September 20, 2009. http://www.medtronic.com/our- therapies/defibrillators/index.html. http://www.medtronic.com/our- therapies/defibrillators/index.html WebMD. “Abnormal Heart Rhythms and Pacemakers”. Retrieved October 11, 2009. http://www.webmd.com/heart-disease/abnormal- rhythyms-pacemaker. http://www.webmd.com/heart-disease/abnormal- rhythyms-pacemaker.

22. References: (Cont.) Cardiac Device Clinic at The Carle Heart Center. February 2009. “Follow up care for patients with pacemakers and ICD’s”. Retrieved October 11, 2009. http://www.carle- clinic.com/Heart/Documents/EHTC1208_CardiacDeviceClini cBro09.pdf.http://www.carle- clinic.com/Heart/Documents/EHTC1208_CardiacDeviceClini cBro09.pdf Boston Scientific. 2009. “ICD Systems and Leads from Boston Scientific CRM”. Retrieved October 11, 2009. http://www.bostonscientific.com/Device.bsci?page=Resourc eDetail&navRelId=1000.1003&method=DevDetailHCP&id=1 0106021&resource_type_category_id=1&resource_type_id=9 1&pageDisclaimer=Disclaimer.ProductPage. http://www.bostonscientific.com/Device.bsci?page=Resourc eDetail&navRelId=1000.1003&method=DevDetailHCP&id=1 0106021&resource_type_category_id=1&resource_type_id=9 1&pageDisclaimer=Disclaimer.ProductPage

23. References: (Cont.) My Life Stages. “Sutter North Launches New Wireless Cardiac Monitoring System.” Published 2008. Retrieved November 21, 2009. https://mylifestages.org/sites/MyLifeStages/featuredar ticle/2009/feb/0209_snmf2_wireless.page. https://mylifestages.org/sites/MyLifeStages/featuredar