How digital monitoring of water treatment gives more time for care
Security and time savings through automation
The everyday life of a dialysis nurse consists of a multitude of tasks and responsibilities. The challenges involved were vividly described by Jennifer Hempel at the 31st Dialysis Conference in Erfurt. She is Head of Nursing at the MVZ Diaverum in Erkelenz and shared the range of her activities with an interested audience in Erfurt.
Ms Hempel described the varied range of tasks in nursing and clearly emphasised one thing: the focus is on the patients, their optimal care and support. In her description of nursing activities, Jennifer Hempel emphasised not only the many patient-related tasks, but also the duties that are no less important for optimal treatment, albeit more technical and therefore remote from the patient (Fig. 1).
This includes monitoring water treatment. The water used for dialysis must therefore fulfil clear quality standards (in accordance with ISO 23500) to ensure patient safety and avoid complications. In addition to regular microbial checks of the water quality, parameters such as water hardness, chlorine content and conductivity of the water must be monitored. Functional values of reverse osmosis, the central "heart" of dialysis water treatment, are also recorded.
The focus is on the patients, their optimal care and support.
Fig. 1 Tasks of the dialysis specialist in everyday working life, including monitoring water treatment in the dialysis unit
Fig. 2 In the SMART DIALYSIS ® system, relevant data is recorded automatically and summarised centrally.
Until a few years ago, dialysis technicians were often responsible for technical monitoring, but it is becoming increasingly apparent that these activities have been transferred to the nursing staff.
So what options are there to support care in such a way that as much of the precious time as possible can actually be used for patient care?
Digitalisation must not be overwhelming, but must be there to support you like a good friend.
One of the answers to this question is digitalisation. It is important that it is a digitalisation that is not overburdening.
Data acquisition with SMART DIALYSIS ®
For this to succeed, the first step is to comprehensively record all relevant data. This should be done in the background without the carer having to intervene.
The SMART DIALYSIS ® system from GreenTec Dialysis GmbH fulfils this requirement. In addition to the reverse osmosis system data, suitable sensors are used to record pretreatment parameters (e.g. water softening and permanent chlorine monitoring) and alarms from optional water detectors and collate them at a central location.
SMART DIALYSIS ® bridges the gap between the technical level and the user level (Fig. 2). Information (e.g. messages and alarms) that is relevant for the proper course of dialysis treatment is forwarded by e-mail to the responsible persons in the dialysis centre. This means that action can be taken quickly.
At the same time, the operating status of the installation is conveniently displayed via a traffic light system: a central alarm light mounted outside the plant room shows at a glance whether everything is in the green zone - or not.
GreenTec Performance System (GPS)
The GreenTec Performance System (GPS) goes hand in hand with SMART DIALYSIS ®. GPS is an online monitoring tool that can be accessed via any browser, smartphone or tablet. It ensures that the amount of data provided by SMART DIALYSIS ® is processed by intelligent analyses into a meaningful data evaluation for the user, in this case the dialysis nurse.
The start page of the GPS (Fig. 3) shows at a glance whether the technology and hygiene of dialysis water treatment are within the strict specifications. The visualised trends also provide a meaningful look into the future and indicate whether preventative measures should be taken. If there is a specific need for action, pending alarms and messages are also displayed here. This is synchronised with the automatically sent e-mails mentioned above and the traffic light outside the technical room. In this way, the people responsible for the technology in the dialysis centre are kept fully informed as to whether a trip to the osmosis room is necessary, e.g. to top up salt for water softening. A tablet set up in the dialysis monitoring centre gives the nursing staff the good feeling of having everything under control and avoids unnecessary visits to the technical room (Fig. 4).
Fig. 3 The GreenTec Performance System dashboard provides an overview of the most important water treatment parameters, but also allows a detailed view of real-time parameters.
Fig. 4 Dashboards of the GreenTec Performance System (GPS) on a tablet
Data recording in the GPS has another advantage: it allows a daily log to be generated at any time for a freely definable period and used for internal documentation (Fig. 5). This type of automation corresponds to the necessary monitoring in accordance with ISO 23500 and helps Mrs Hempel to fulfil the requirements of the quality management system implemented by Diaverum and based on the corresponding standard (ISO 23500). The data recorded in the daily log is subject to an integrated evaluation so that it can be recognised at a glance whether all the specified limit values are being adhered to.
The time previously invested in logging, reading meters or measuring water hardness/chlorine content in the technical room now benefits direct patient care. One aspect that was only mentioned in passing in Erfurt, but which should not be neglected: with the help of the different data visualisation and the possibility of correlating different data sources in GPS, optimisation potential is made visible, which leads directly to savings in important resources such as electricity and water. It is therefore not surprising that GPS is designed in such a way that the Cross-sector Integration data provided by SMART DIALYSIS ® will also be integrated in the future. With SMART DIALYSIS ®, digitalisation goes far beyond water treatment. In addition to medical technology, photovoltaics for green power generation and process heat fed into dialysis operations from renewable sources are also recorded and optimised (see presentation by Christian Rohde, same session).
Digitalisation plays a decisive role in increasing efficiency and improving care in dialysis centres. Mrs Hempel's conclusion was therefore clear:
Every minute gained is one minute more at the patient's bedside.
Fig. 5 Clicking on the "Reports" menu item (top right) lists the centre's daily logs automatically generated by the GreenTec Performance System (GPS). The daily log (see below) displays all data in a tabular overview.