One of the very first technical approaches to monitor patient physiology was the strip chart electrocardiogram (ECG) recorder developed by Sir Thomas Lewis in 1912. Interestingly, even some of today’s most innovative monitors still employ elements of Lewis’s original strip chart, with some numerical information added.
Physiologic monitoring displays were introduced into the intensive care unit (ICU) in the 1970s, and they have not changed substantially since then. Patient monitors still employ a conventional format rooted in anesthesiology to present physiologic variables. The design format for these displays is based on a single-sensor-single-indicator (SSSI) approach, which provides a single indicator for each individual sensor connected to the patient. This approach to monitoring is founded in the domain of engineered systems and has been applied to patient monitoring without significant modification.
ICU nurses monitor physiologic patient parameters on a regular basis to ensure the patient’s stability. Among the most common problems they face is detecting changes in one or more physiologic parameters. Timely detection of a change becomes a potential problem. Detection is viewed in the context of comparing the patient’s previous physiologic parameters and medical history with parameters stored in the nurse’s recent memory or the patient’s recent records.
Nurses sometimes have to integrate ten or more rapidly changing physiologic parameters into a clear and qualitative mental representation of a patient’s current state. To make matters worse, in the case of an unexpected and potentially life-threatening event, the cognitive demands increases as the clinicians must interpret new data for problem detection and rapid intervention.
The high cognitive demand for data interpretation reduces available cognitive resources for other important tasks (e.g., taking corrective actions, documentation, communicating with physicians and/or nurses). This can lead to other problems or a cascade of errors, such as interrupted tasks or deviations from the treatment plan or necessary interventions.
Providing nurses with information about the patient’s physiologic status in a manner that is easy and fast to interpret should reduce the time needed to detect and avert potentially dangerous situations. However, currently available monitors are not explicitly designed as cognitive aids for facilitating the rapid detection of changes in patient’s status.
Current ICU monitor displays are also deficient in their ability to facilitate an integrated assessment of the patient’s status that would enable nurses to develop a high level of situation comprehension. Designs that follow the SSSI approach tend to yield data in a sequential, piecemeal form that makes it difficult and time-consuming for nurses to develop a coherent understanding of the relationships and underlying mechanisms of the displayed parameters. However, this situation flies in the face of the fact that a coherent understanding of a system’s function and patients’ physiologic mechanisms is a necessary precondition for optimum performance.
A user-centered approach might help optimize the design of physiologic ICU monitoring equipment. For example, iterative, user-centered design strategies for the development of graphic displays in health care have been suggested.
The aim of this project is to inform the doctor about the ICU patient condition through wireless network; this will remarkably help the medical professionals as it becomes more important to continuously monitor the conditions of a patient. In a large setup like a hospital or clinical center where a single doctor attends many patients, it becomes difficult to keep informed and updated about the critical conditions developed in each of the patients. This project provides a device which will continuously monitor the vital parameters of a patient. If any critical situation arises in a patient, this unit also raises an alarm and also communicates to the concerned doctor by means of a wireless SMS to the doctor or nurse.
FIELD AND SUBJECT OF STUDY
The field of study of this project is electrical/electronic engineering and the subject area of study is controls and communication.
The main object of study is to design a patient monitoring system which targets on the rapid response of the medical professionals to the patient upon receiving a wireless alert from the patient.
To design a monitoring system made of a transmitter unit and a receiver with a display
To design a monitoring system that measures the heart beat rate and the temperature of the patient using sensors integrated to a microcontroller.
To integrate an alarm to the monitoring system which would trigger upon detection of either an abnormal heart beat rate or high/low temperature, automatically.
Programming of the whole system using arduino programming software.
THE RESEARCH PROBLEMS
Difficulty in patient’s data interpretation
Appropriate assessment of a patient’s status requires cognitive integration of physiologic patient parameters, as displayed on monitor screens. One category of issues involves data artifacts (i.e. when measurements of physiological parameters are incorrect, for example, due to sensor-related problems).
Nurses are frequently confronted with these artifacts; correct interpretation of these artifacts requires an assessment of the overall context in which they have occurred. At present, there is no display technology available that would allow nurses to assess a patient’s status in a fast and integrated manner. As a result, nurses are forced to process individual physiologic parameters, both past and present, in a piecemeal fashion and then identify any inconsistencies between the patient’s history and current status.
Novice nurses experience difficulties integrating information from available parameters, consequently, becomes highly prone to costly errors in the patients’ data interpretation. This was improved by introducing data monitor that displays patient health status in a graphic representation; this provided a better solution which would allow an immediate, more holistic and simpler assessment of patients’ status.
Another factor that could influence data interpretation is the long years of experience, which allows nurses/doctors to assess a patient’s status despite problems with monitors (although not necessarily effortlessly).
Lack of data clarity and coherence
The traditional monitoring systems are of excessive small font sizes, which increase the likelihood that numbers would be misread or misunderstood. Abbreviated labels were also likely to be misread; potentially leading to an incorrect assessment of patients’ status and certainly to an increase in the time spent interacting with the monitor.
The prevalent monitoring systems are inconsistent in their use of color coding and the organization of menu structures. In some monitors, menu structure changes based on settings, and color mapping of variables vary with different settings, violating the principle of consistency. This however increases the high cognitive demands in data manipulation
Statistics have proven that most nurses expressed a desire for system flexibility and ease of use, which will allow a direct manipulation of the displayed information, potentially removing or at least reducing, the number of complex menu structures. Hardware modification like the introduction of easy-access buttons would allow them to directly access important information without having to go through menus.
High Energy Consumption.
The currently-in-use monitoring systems are such that are physically bulky, which expends lots of energy because of its high duty demands.
High cost of implementation and maintenance.
The prevalent monitoring systems are such that comprises of lots of sophisticated equipment that are costly to implement and demands a high maintenance culture in making sure they are of high and consistent functionality and performance, this attributes to the system’s complexity.
TERMS OF REFERENCE
Physiology is the study of how living systems function. Physiological parameters are therefore the variables as associated with the functionalities of the internal human system. Physiological parameters includes heart beat rate, temperature, respiratory condition, etc.
Cognitive demands are the mental acts or processes by which knowledge is acquired including perception, intuition and reasoning. In the traditional patients’ monitoring systems, patient’s physiological parameter can be acquired through a high cognitive demand that takes lots of time to figure out exactly what condition the patient is in. this is because of the system’s complexity and rigidity.
Heart beat rate
The heart beat rate is the rate at which the heart beats. It is the speed of the heart measured by the number of poundings of the heart per unit of time. The heart rate can vary according to the body’s physical needs, including the need to absorb oxygen and excrete carbon dioxide.
Nanotechnology is the manipulation of matter on an atomic molecular and supramolecular scale. It’s also the manipulation of matter with at least one dimension sized from 1 to 100 nanometers.
Electrocardiography is the process of recording the electrical activity of the heart over a period of time using electrodes placed on the patient’s body. These electrodes detect the tiny electrical changes on the skin that arise from the heart muscle depolarizing during each heartbeat.
BACKGROUND AND JUSTIFICATION OF STUDY
The genesis of patient care systems started in the mid-1960. One of the first and most successful systems was the Technicon Medical Information System (TMIS), which began in 1965 as a collaborative project between Lockheed and El camino Hospital in Mountain View, California. TMIS was designed to simplify documentation through the use of standard order sets and care pans. Nihon Kohden introduced Japan’s first ICU patient monitoring system. The ICU-80 system monitored patients using a bouncing spot CRT monitor, analog meters, strip-chart recorders and switches for monitoring each patient’s parameters. It was later redesigned for easy waveform and parameter value monitoring with a memory oscilloscope and digital displays. Today’s systems are compact and versatile, requiring little maintenance, they offer advanced capabilities such as inter-bed communication, data trending, arrhythmia interpretation and data storage and recall.
Himmelstein and scheiner reported in a 1952 paper that in January of 1950 they began using an instrument they devised for cardiac accident prevention. They called it the “cardiotachoscope” and found it useful during surgery. It featured the fundamental attributes that most monitoring systems would eventually have. These attributes includes the CRT to view the ECG, a heart rate indicator, alarms for high and low heart rates, and a connection to a conventional electrocardiograph for printouts. This device does not appear to have entered into production and the “cardiotachoscope” term is not used anymore. Within a few years of this original paper, commercial monitors began to appear and eventually they and their manufacturers proliferated by the end of the decade.
Monitors of this era often referred to as electrocardioscopes or cardioscopes. Sometimes they were simply referred to as an oscilloscope. Unlike modern monitors, devices of this era had monochrome displays and the persistence of the wave was generally not sufficient to cover the screen. This meant that the ECG waveform would show only- a second or two of new data.
The use of flammable anesthetics during this period necessitated design considerations to prevent occurrence of a spark. This involved encasing the device in “explosion proof” housing or, later and more commonly, in accordance with the NFPA “Hospital code” of the era, by mounting the monitor of at least five feet above the floor and thereby above the anesthetic gases which tended to settle to the bottom of the operating room.
In early twenty-first century and beyond, the Siemens infinity monitors also offered connectivity to the internet in 2000. This allowed the clinician to use the internet or the hospitals intranet to remotely view a particular bedside and monitors in real-time waveforms, vital signs and trends. Eventually, physiologic monitors as we know them will probably become obsolete and may be replaced by nanotechnology instruments capable of elaborate analysis of the body chemistry and condition. If these devices are cheap and plentiful, it would allow more predictive medical assessments leading to better preventive and personalized care.
However, after an intensive study on the traditional patient monitoring systems, comparing and contrasting their challenges, I have decided to build an intelligent patient monitoring system with the following advantages;
Quick response from the medical professional to the patient through a wireless alert upon pressing a button
Sending a wireless alert to the doctor or nurse on reading an abnormal heart bit rate or high temperature.
Reduction in the cognitive demands in data interpretation.
Reduction in the bulkiness of the traditional monitoring systems.
SCOPE OF STUDY
The scope of this project will cover;
The use of hardware technology to produce a model which represents a real life system
The application of software technology integrated with the hardware to create an intelligent control structure through software programming for the system
Extensive use of a simple system to demonstrate the need for more technology in Africa as it can perform better functions than the traditional systems in control, reliability, durability, flexibility and robustness.
This project is designed with specific and selected hardware components with the objective of improving the effectiveness of patient monitoring.
Elimination of high cognitive tasks to ensure and maintain flexibility.
Reveals the need to develop on existing patient monitoring system with a better quality and efficient output.
The planning, designing, programming, testing, implementation, verification and validation of a working intelligent patient monitoring system with a high performance.
Safety is paramount as far as this project is concern, so adequate measures are put into consideration.
SUMMARY OF RESULT AND POSSIBLE USAGE
The goal of this project is to design a low powered heart bit rate and body temperature monitor that will provide an accurate reading of one’s heart bit rate and temperature. The monitor will be easy to use, portable and affordable. It will measure the heart bit rate from an index finger using an LED and a photo-sensor to detect changes in blood flow in an index finger. The heart bit rate and body temperature will be displayed in a LCD display for easy monitoring. The significance of the monitor is that it provides an inexpensive and accurate means of measuring one’s heart rate at his/her convenience.
The normal core body temperature of a healthy, resting adult being is stated to be at 98.6 degrees Fahrenheit or 37.0 degrees Celsius. Though the body temperature measured on an individual can vary, a healthy human body can maintain a fairly consistent body temperature that is around the mark of 37.0 degrees Celsius.
The normal range of human body temperature varies due to an individual’s metabolism rate, the higher (faster) it is, the higher the normal body temperature or the slower the metabolic rate, the lower the normal body temperature. Other factors that might affect the body temperature of an individual may be the time of day or part of the body in which the temperature is measured at. So as part of its features, the monitor would send a wireless emergency alert to the physician in charge of the patient, immediately when either of the patient’s heart bit rate or body temperature rises above normal, for quick response and intervention so as to avert any pending dangerous situation.
PRESENTATION/LAYOUT OF THESIS
Chapter 1: Consists of an introduction, the research field and subject area of study, study objectives, research problems, methodology, background and justification of the project, layouts of thesis, scope of study and project schedule.
Chapter 2: Consists of detailed literature review/research of different intelligent streetlight system, brief description of its component function and method of control for the purpose of references.
Chapter 3: Consists of the methodology and hardware description, analysis and crystallization of the system.
Chapter 4: Consists of the testing, implementation and system requirement analysis.
Chapter 5: This chapter will briefly highlights summary of research problem and methodology relative to the research results, system design, research findings and results.
Chapter 6: Gives general conclusions arising from the outcome of the research work and recommendations.