Pediatric Informatics: Computer Applications in Child Health (Health ...

28 Medication Administration and Information Technology 361
(including personal health information) can be stored on RFID device (or “tag”)
and accessed by exposure to a specific radio-frequency (RF) at a sufficiently close
range. Its advantage over bar-coding is that it does not require “line of sight” to
operate.
RFID has been used as a clinical inventory tracking tool 15 and was approved by
the US Food and Drug Administration in 2004 for use as an implantable device
for patient identification. Debates on the benefits and risks for patient information
being used for nonmedical issues, as well as provider responsibilities in obtaining
informed consent have arisen. 16,17 RFID is envisioned as a replacement for barcoding
with current barriers being cost and privacy concerns.
In pediatrics, RFID has been used to relax children in radiology suites by giving
them control over the environment (lighting, sound) 18,19 to reduce the need for sedation
and in newborn nurseries (as part of a comprehensive plan 20 that uses the infant
and mother’s wrist bands) to prevent infant abductions and matching infant-mother
pairs (using proximity alerts). 21
28.4.3 “Smart” Infusion Pumps
“Smart” infusion pumps are devices with internal programmable computer control
systems that provide complex and precise control over intravenous infusions,
which presents unique opportunities and challenges with respect to patient safety
and workflow. Smart pumps are now the preferred method for intravenous therapy
administration in the acute care setting, particularly for pediatric and critically ill
patients, and have largely supplanted gravity-fed drip infusions. It is estimated that
as of 2006, 37% of US hospitals used smart infusion pumps. 22
Advantages of smart pumps include: administration of low flow rates that cannot
be achieved with drip infusions, precise timing of intermittent injections and bolus
injections, control over patient administered intravenous medications (such as
patient controlled analgesia, PCA) and management of administration schedules
that use circadian rhythms or other complex protocols. Depending on pump design,
control over continuous infusions results from frequent small “pulsed” (bolus)
deliveries ranging from nanoliters to microliters, while control over intermittent
infusions alternates high and low infusion rates to deliver therapy and to keep the
venous catheter open respectively. For on-demand medications such as patient
(or parent)-controlled analgesia (PCA), smart pump computers manage the basal
rates and dose maximums (lock-outs) to reduce pain while avoiding toxicity.
In the acute care setting, two ranges of pumps are used: large-volume pumps
use peristaltic pumps to control intravenous fluid delivery, while small-volume
pumps use controlled syringes to deliver medications into an intravenous system.
Both ranges use embedded microprocessors to control the fluid delivery rate and
other capabilities of the pump. In home settings, implanted pumps (such as for
insulin therapy) manage bolus and basal doses and provide alarms and integration
to monitors (such as glucometers) and home computers.