Design of Pulse Oximeters - Essay Example

Pulse Oximeter Business Proposal Name Course Instructor’s Name June 29, 2010 Introduction Most of medical devices used for monitoring saturation of oxygen and blood volume changes in patients require blood samples to be taken. With pulse oximeter, these changes can be monitored through production of a photoplethysmograph. The pulse oximeter can be attached to a monitoring device which allows oxygenation to be monitored at all times. The heart rate of the patient can also be displayed by pulse oximeter. Pulse oximeter is a non-invasive device which is used to display the percentage of hemoglobin in the arterial. A pair of diodes which emits light is illuminated through a body part that is translucent such as the finger tip or the earlobe. The diodes produce different lights. One of the diodes produces infrared light while the other produces red light (Bowden & Greenberg, 2007). The diodes are capable of showing the differences in the oxygenation of blood through the ratio of light absorbed by the hemoglobin. The signals usually bounce back in tandem with the heart beat and the oxygen absorption is measured in accordance with the pulse of the patient (Puntonet & Prieto, 2004). Many patients who require emergence attention usually require monitoring of oxygenation (Pinson, 2008). The traditional methods which are invasive cannot allow continuous monitoring of the blood oxygenation. In addition, they cannot be used by paramedics providing medical assistance in pre-hospital environment since they require much time to carry out. With pulse oximeter, the patient’s oxygenation, heart beat and pulse rate can be monitored continuously as the patient is taken to the hospital. We propose the introduction of N595 Pulse oximeter in ambulance services. At a price of $599, this could be able to make early diagnosis and monitor the oxygenation condition of patients especially those with heart conditions (DeThomas & Derammelaere, 2008). This will facilitate the medication of these patients prior to arrival to the hospital. In addition it will facilitate resuscitation of patients with low oxygen concentration (Stutely, 2002). The introduction of oximeters in the ambulances would allow paramedics to evaluate oxygen concentration of patients who are critically ill, patients with inappropriate or unexpected hypoxaemia, patients who experience increasing breathlessness, patients with a risk of hypercapnic respiratory failure, patients at metabolic condition risk such as diabetic ketoacidosis and acutely breathless patients. The oximeter will help the paramedics to monitor the heart beat in addition to pulse rates of such patients. This will enable them to provide necessary management of these patients prior to arrival to the hospital (Bowden & Greenberg, 2007). Justification This proposed project should be undertaken to allow the paramedics to make accurate evaluation of the oxygen concentration, heart beat and pulse rate of patients requiring emergence attention (Webster, 1997). As a result, the knowledge of these measurements will inform the paramedics on the timely and appropriate care to administer to the patient in question and prepare him or her for further treatment on arrival to hospital (Covello & Hazelgren, 2006). The ability of oximeter to obtain these measurement using non-invasive methods is commendable since patients in need of emergence conditions already experience great pain and using invasive methods to obtain concentration of oxygen is like adding insult to injury (Stutely, 2002). In addition, invasive methods are usually slow to obtain the results and therefore oximeter use will reduce the time required to get the measurements. The portability of the oximeter and its easiness to use will save the paramedics the headache of having to wait till they arrive at the hospital to take such measurements which are necessary for administration of emergence care in ambulance prior to reaching the hospital (Bowden & Greenberg, 2007). Project goal The introduction of N595 Pulse oximeter in ambulance services is expected to revolutionize the assessment of the patients with heart and lung conditions in addition to other conditions that need monitoring of heart beat, oxygen concentration and pulse rate prior to arrival to hospital setting. This is expected to in turn improve the service delivery to patients since the paramedics will be able to determine the necessary care required by the patient from the oxygen concentration shown on the oximeter. The monitoring will enable the paramedics to make informed assessment of the patient and make appropriate decision on the care to administer (Ford, Bornstein & Pruitt, 2007). Assumptions and constraints The supply of Nelcor N595 Pulse oximeter in ambulance services is expected to face no constrains since its manufacturer OxiMax Technology has several outlet suppliers in Australia. in addition, bulk ordering may help cut down the cost of the equipment. Any defects in the device could be communicated to these suppliers for necessary replacement to be carried out (Covello & Hazelgren, 2005). We assume that paramedics will be able to use the Nelcor N595 Pulse oximeter accurately to monitor the oxygen concentration, pulse rate and heart beat of the patients to avoid situations where the patient’s status is misconceived resulting in inappropriate care being administered. Incorrect use of the equipment may result in panic of the patient and may worsen his condition. Proper use will ensure that heart and lung related patients receive adequate care prior to arriving to hospital (Abrams & Kleiner, 2003). Several constraints will need to be addressed as the equipment is introduced in provision of ambulance services. These will include: Ensuring that the Nelcor N595 Pulse oximeter’s battery is well charged always to ensure precise and accurate measurement while in the field. The paramedics will need to be educated on proper use of the Nelcor N595 Pulse oximeter since inappropriate use will result in wrong results being obtained and hence poor care administered to the patients. The acquisition of the Nelcor N595 Pulse oximeter is expected to come with additional costs of buying and maintaining it. The oximeter is not able to differentiate when oxygen or carbon monoxide is bound to the hemoglobin hence the Nelcor N595 Pulse oximeter cannot be used in carbon monoxide poisoning cases (Puntonet & Prieto, 2004). The coloration of the nails can affect the accuracy of the instrument and thus paramedics need to be informed to use the earlobe in such cases. The Nelcor N595 Pulse oximeter cannot be used in cases where the patient is suffering from blood flow which is extremely limited such as in cardiac arrest (Parsons & Heffner, 2001) Comparison Table Nelcor N595 Pulse oximeter Arterial gas reading Advantages Portable, non-invasive, measurement can be taken in any posture, easy maintenance If carried out accurately, the oxygen concentration can be obtained accurately It differentiates the oxygen and carbon monoxide attached to hemoglobin Disadvantages Need training for proper use and accuracy, not reliable in conditions like cardiac arrest, color of the nails affect the accuracy and cannot differentiate the oxygen and carbon monoxide attached to hemoglobin Cannot be carried out in pre hospital environment It is invasive hence sterilization of equipments is required and additional pain is experienced by the patient thus it is not patient friendly. Difficult to use in under age patients It is time consuming and the varying concentration of oxygen cannot be monitored. Costs Initial costs are $131,400 but maintenance costs are low. Continuous costs are incurred throughout the year to obtain the disposals. Risks The placement of the equipment wrong may result in inappropriate care given to the patient. The patient is at risk of being infected if the equipment are not sterilized properly. Options Options identified The Nelcor N595 Pulse oximeter Arterial blood gas reading The Nelcor N595 Pulse oximeter Advantages It is portable hence it can be used by paramedics to provide pre hospital monitoring of oxygen, heart beat and pulse rate of the patient. It is non invasive hence does not add pain to the patient and the equipment used do not require thorough sterilization like the invasive ones (Abrams & Kleiner, 2003). The patient is not expected to be in a specific posture for him or her to be measured oxygen concentration. It is rechargeable hence the battery can be used for a long period of time and its maintenance is easy. Disadvantages Needs proper use to obtain accurate measurement It cannot be used in some conditions such as carbon monoxide poisoning and cardiac arrest Dark nails or wounded fingers may result in inaccurate results Costs Initial set up cost is about $600 for buying the Nelcor N595 Pulse oximeter. To buy one Nelcor N595 Pulse oximeter for each of 219 ambulances which are operational in South Australia Ambulance service it will cost: 219 X $600 = $131,400. Therefore, initial cost will amount to about $131,400. Battery charging costs are expected to be low since they can be charged using current generated by the vehicle. Risks Inappropriate placement of the equipment will result in wrong readings which may be detrimental to the patient since he or she may receive inadequate or inappropriate attention from the paramedics. Stakeholders Nelcor N595 Pulse oximeter suppliers Heart and lung related patients and other patients requiring monitoring of oxygen concentration, heart beat and pulse rate. Paramedic staff providing ambulance services Support staff Executive management of the South Australia Ambulance Service The impact of stakeholder Nelcor N595 Pulse oximeter supplier is found in South Australia. The initial set up cost of $131,400 is a very huge expense to be incurred by the ambulance service. The paramedics providing the ambulance services will need to be trained on proper use pof the Nelcor N595 Pulse oximeter in order to obtain accurate measurements. Many patients will enjoy improved care during pre hospital time if the Nelcor N595 Pulse oximeter is used accurately. Heart and lung patients’ blood oxygen concentration is monitored prior to arrival to hospital and necessary care is administered while still in the field. Issues which may arise The coloration of the nails needs to be assessed prior to placement of the diodes on the fingers. Other information that is relevant Maintenance is easy and cheap Can be used in patients of all ages Single equipment is used to obtain oxygen concentration, heart beat and pulse rate Arterial blood gas reading Advantages If carried out accurately, the oxygen concentration can be obtained accurately It differentiates the oxygen and carbon monoxide attached to hemoglobin Disadvantage Cannot be carried out in pre hospital environment It is invasive hence sterilization of equipments is required and additional pain is experienced by the patient thus it is not patient friendly. Difficult to use in under age patients It is time consuming and the varying concentration of oxygen cannot be monitored. Risks The patient is at risk of being infected if the equipment are not sterilized properly. Issues It has many disposables and trhus it is not friendly to the environment Infections need to be controlled Additional information that is relevant The paramedics need to be well trained to obtain accurate readings It is time consuming hence the patient will have for a long time before appropriate medication and care is administered (Pinsky, Brochard & Mancebo, 2009). Recommendation From the above discussion, the introduction of Nelcor N595 Pulse oximeter is recommended. This is expected to alter the provision of care given to patients by the paramedics prior to arrival to the hospital (McKeever, 2008). The patients oxygen concentration is monitored and hence necessary action can be undertaken by the paramedics to ensure that the patient arrives to the hospital alive. In addition, the decision made by the paramedics will be fact based unlike the traditional way where the paramedics depend on charts to provide care without factual data. The fact that the Nelcor N595 Pulse oximeter is non invasive is bound to be received positively by the patients. Furthermore, infections associated with invasive methods are expected to be reduced significantly (Abrams & Kleiner, 2003). The option of using arterial blood gas reading is not patient friendly and its inability to be carried out in pre hospital environment means that patients will not receive improved medical attention prior to arrival to the hospital (Parsons & Heffner, 2001). Moreover, the technique is time consuming and this means that it will take considerable time before the patient receives the appropriate medical attention. Since most of the tools used in this technique are disposable, the technique is both expensive and unfriendly to the environment. Project title The introduction of the Nelcor N595 Pulse oximeter on ambulances Targeted outcomes The equipment is expected to facilitate monitoring of oxygen concentration, heart beat and pulse rate in patients suffering from heart conditions and lung conditions and aid in early pre hospital care. This will change the course of clinical outcomes since the patients will not be expected to arrive to the hospital before the appropriate care and medication is administered. The equipment is also expected to identify the patients whose conditions are deteriorating and give more concentrated attention. Implementation plan and expected outcome Phase 1: July 2010 All stakeholders will be consulted and the advantages of implementing the Nelcor N595 Pulse oximeter in ambulances will be explained to them in detail. If they agree with the proposal and appropriate funding is obtained then the project will be rolled out. Phase 2: August 2010 The project will be implemented and staff will be trained. The project will first be implemented in metropolitan area to assess the benefits for the first three months before being rolled out to other regions. Phase 3: November 2010 The Nelcor N595 Pulse oximeter will be implemented in all ambulances in the state. Phase4: May 2011 A case study will be carried out to review the use of the Nelcor N595 Pulse oximeter and if effective it will continue to be used. Budget The project will require an initial budget of $131,400. Project review and closure The patients who would have benefited from the technology will be followed up with questionnaires to evaluate the reception. The paramedics will also be intervied and given questionnaires to evaluate the benefits of Nelcor N595 Pulse oximeter. The shortcomings will be addressed and the strengths build on. Reference Ford, B, Bornstein, J & Pruitt, P 2007 Ernst and Young business plan guide, 3rd Edition, John Wiley and Sons, New York, pp 89-101. Abrams, R & Kleiner, E 2003 The successful business plan: secrets & strategies, 4th Edition, The Planning Shop, New York, pp. 66-78 Bowden, V & Greenberg, C 2007 Pediatric Nursing Procedures, 2nd Edition, Lippincott Williams & Wilkins, London, pp. 23-29 Covello, J & Hazelgren, B 2005 Your first business plan: a simple question-and-answer format designed to help you write your own plan, 5th Edition, Sourcebooks, Inc, London, pp. 33-36 Covello, J & Hazelgren, B 2006, Complete Book of Business Plans: Simple Steps to Writing Powerful Business Plans, 2nd Edition, Sourcebooks, Inc, London, pp. 11-16 DeThomas, A & Derammelaere, S 2008 Writing a Convincing Business Plan, 3rd Edition, Barron's Educational Series, London, pp. 90-93 McKeever, M 2008 How to write a business plan, 9th Edition, Nolo, London, pp. 78-85 Puntonet, C & Prieto, A 2004 Independent component analysis and blind signal separation: fifth international conference, ICA 2004, Granada, Spain, September 22-24, 2004 : proceedings, Springer Publisher, New York, pp. 102-106. Parsons, P & Heffner, J 2001 Pulmonary/respiratory therapy secrets, 2nd Edition, Elsevier Health Sciences, London, pp. 54-59. Pinson, L. 2008. Anatomy of a business plan: the step-by-step guide to building your business and securing your company's future, 7th Ed. Sydney: AKA Associates. Pinsky, M., Brochard, L. & Mancebo, J. 2009. Applied Physiology in Intensive Care Medicine, 2nd Ed. London: Springer. Stutely, R. 2002. The definitive business plan: the fast-track to intelligent business planning for executives and entrepreneurs, 2nd Ed. New York: FT Press. Webster, J. 1997. Design of pulse oximeters. New York: CRC Press. Read More