ICU nurses should stay on top of Y2K compliance

Nurses can walk a tightrope on liability

First came the health care industry’s official statement: Don’t worry. Most likely hospitals and health clinics are going to be year 2000 (Y2K) compliant by year’s end. Patient safety will not be compromised.

The message was clearly intended to calm fears and prevent panic.

Then in February came a congressional report. It reversed the health care barometer on Y2K. "The $1.5 trillion U.S. health care industry is one of the least prepared for problems that might arise from the Year 2000 computer glitch," cried an article in The Wall Street Journal.

The news report was about congressional findings. It echoed a Senate report, which stated that the situation in health care "carries a significant potential for harm." The congressional report was based on a nine-month investigation conducted by the Senate Special Committee on the Year 2000 Technology Problem. It evaluated several industries on Y2K readiness, including health care.

The story was carried by major television and radio news organizations, but hardly raised an eyebrow outside the industry. Many inside the medical community were equally unmoved.

Within nursing, apathy about Y2K may be understandable. After all, why should nurses bother about computer glitches? Information officers and computer technicians are paid to worry about such things.

But exactly the reverse is the case, according to Sally Raphel, RN, MS, director of nursing practice for the American Nurses Association in Washington, DC. Nurses have a direct stake in Y2K compliance. And in some respects, critical care nurses face a major Y2K concern.

The more technology dependent a patient-care unit is, the higher the probability that something could go wrong. It’s just common sense, according to a growing consensus of health care organizations, including the American Hospital Association (AHA) in Chicago.

CCUs highly exposed due to high technology

The impact of Y2K problems isn’t going to be limited to tardy paychecks, incorrect dates on automated patient records, insurance claims, or medication orders. Those are bad enough, Raphel claims.

In the worst case, the Y2K problem could trigger a temporary breakdown of vital computer-driven medical equipment such as intubation and incubator monitors that are designed to keep patients alive.

The Joint Commission on Accreditation of Healthcare Organizations in Oak Brook Terrace, IL, which sets hospital operating standards, has stated that "the problem could cause computers and computerized, date-sensitive biomedical equipment to shut down with possible serious impact on patient care."

On the other hand, a doomsday scenario is far from likely across health care locations, says Michael Stewart, who has written extensively about Y2K for American Nurse magazine. Nevertheless, CCU nurses should be aware of certain implications.

For one, the stakes are much higher for them compared with non-urgent care departments due to their critically ill patient load. For another, like all clinicians, ultimately CCU nurses will be held legally and professionally responsible for what happens to their patients, whether or not Y2K factors go from mere concern to serious consequences.

Nurses are being advised to actively participate in Y2K preparations. And in doing so, they should be heedful of liability factors, Raphel advises. Don’t put yourself in the position of being the one held responsible by the hospital, if and when something goes wrong in your department, she adds.

It’s always better to be prepared, even if nothing happens, says Stewart. The following advice may serve to initiate thoughtful preparation regarding Y2K for your department:

  • Equipment checks. Make certain that all biomedical devices and other systems involved in patient care such as heart monitors and infusion pumps are checked. But make certain they are debugged and later tested. The follow-up is vitally important, advises the National Patient Safety Partnership, a Washington, DC-based nonprofit group that tries to prevent health care related adverse events.

    Hospitals are large institutions. In the rush to complete compliance, CCUs may be overlooked or left for last. It isn’t likely, but don’t take the chance.

  • Protect your turf. If you’re a bedside nurse, ask if someone is looking into Y2K compliance for your unit. No one may be thinking about the ICU. Rank and file nurses aren’t expected to participate personally in Y2K compliance planning. And they shouldn’t have to, says Raphel. However, nurses can show support and keep administrators alert by asking questions and staying on top of developments as they trickle down from management.

  • Protect yourself. Make certain a written report is prepared and kept whenever any piece of equipment in the unit is handled by technicians for Y2K modification, says Maureen Mudron, JD, legal counsel for the AHA in Washington, DC.

    The document should identify the specific equipment, what was done to it, by whom, and the time and date of the work should appear on the report. The signature of the unit manager and the technicians who performed the work should appear on the report but are not essential.

    This is important, because if harm should result to a patient due to equipment failure, an attempt will be made to assign responsibility not only to the manufacturer but to the hospital and individual practitioner, Mudron warns.

  • Keep yourself and your staff informed. For example, find out whether inquiries about equipment debugging have been sent to vendors. Part of the industry’s compliance efforts has involved getting biomedical equipment vendors, distributors, and manufacturers to do their part to provide assistance to hospitals in making equipment modifications.

    But the industry is reportedly lagging in doing so. Less than 50% of manufacturers have responded to requests concerning whether their equipment is likely to fail at the onset of Y2K, according to the U.S. Food and Drug Administration (FDA) in Washington, DC. The FDA is requesting information from some 16,000 manufacturers concerning 700,000 known medical devices.

  • Help all staff with new equipment procedures. Request that the administration develop new, specific procedures for using biomedical and non-biomedical equipment during Y2K compliance transition periods if they are needed, Mudron says. Make certain all unit personnel are aware of any new procedures for using the equipment under the Y2K compliance changes.

    Most equipment will not require new operating procedures, but if they do, the staff should be immediately instructed.

  • Develop unit-specific contingency plans. The hospital will likely have contingency plans under development, says Mudron. But make your own. What if certain patient-care monitors or computers stop working at 12:01 a.m. on January 1, 2000? Does the night shift know what to do? Will unit managers on duty know?

    Ask for administration guidance in developing specific options such as having back-up equipment ready that isn’t linked to the hospital’s main computers or scheduling additional nurses and physicians to handle emergencies on the night shift.

    Planning and executing a mock scenario for determining what is needed during an equipment failure also can be on your administration wish list.

    Above all, make certain the hospitalwide Y2K compliance plans are clear and practical for your own unit. Finally, the appropriate role for nurses and unit managers is to remain somewhere "in the middle" regarding their involvement on Y2K, says Raphel. Don’t take the lead, but don’t remain in the shadows either.

    The responsibility for Y2K compliance should not fall on nurses’ shoulders regardless of how involved or concerned one may be, Raphel warns.