Select Committee on Health Written Evidence


Memorandum by Hospedia UK (PS 36)

IMPACT OF MOBILE PHONES ON PATIENT SAFETY

EXECUTIVE SUMMARY

  1.  Hospedia Ltd is a new company that has acquired Patientline UK Ltd, and subject to approval from the Office of Fair Trading (OFT), will acquire Premier Telesolutions Ltd. The group provides bedside entertainment and telephony to over 200 hospitals across the UK—this equates to over 80,000 NHS beds daily across the UK and roughly 10 million patients every year.

  2.  Since the Department of Health published guidelines "Using mobile phones in hospitals" in 2007, Hospedia has found additional evidence to suggest that the use of mobile phones in hospital wards has serious negative impacts on patient safety. This Memorandum outlines both the immediate and potential long-term impact of permitting mobile phone use in hospital wards on patient safety. In the event that mobile phone use is relaxed in hospitals, the bedside services provided by Hospedia, and the improved range of services including those that help improve patient safety that will be made available as a result of the acquisition could become compromised.

  3.  There are case studies outlined in this paper which concern the use of mobile phones in hospital wards. These include:

    —  Inappropriate video content taken with mobile phone cameras by both visitors and nursing staff, with some appearing on the YouTube website threatening patient privacy and dignity;

    —  The health and safety risk of using mobile phones with inappropriate or untested mobile phone chargers;

    —  Patients using their mobile phones to record confidential medical discussions without hospital staff's knowledge;

    —  Scientific journals which show that EMI (Electro-Magnetic Interference) from mobile phones still affect medical equipment to a significant degree;

    —  and the potential for mobile phones to spread infections in hospitals.

  4.  The current risks to patient safety are:

    —  Loss of patient privacy and dignity

    High quality photographs and video could be taken of people in a vulnerable state, and instantly uploaded online or transmitted, threatening the privacy and dignity of patients. This is a particular concern in children's wards and mixed sex wards where inappropriate photos could be taken.

    —  Data protection infringement

    Postings of patients and hospitals have been posted on websites such as YouTube, breaching data protection regulations.

    —  Health and safety risks

    If patients use the hospital mains power supplies, there is a risk that essential medical devices may be inadvertently unplugged. Furthermore, the risk of using unapproved non PAT tested and potentially dangerous mobile phone chargers poses a fire risk to the hospitals

    —  Interference with hospital equipment

    Current advice from the Medicines and Healthcare Products Regulatory Agency (MHRA) continues to advocate that mobile phones should not be used within 2 metres of sensitive equipment and further investigations into this are underway. Equipment that can be affected by mobiles continues to be used in wards, includes defibrillators, ventilators, monitoring devices, infusion pumps and incubators in neonatal units.

    —  Confusion between alarms and mobile phone ringtones

    Whilst the ringtones on bedside systems can be switched off on a ward by ward basis, regulating the ring tones of individual mobile phone use is difficult and time-consuming for hospital staff. Mobile phone ring tones can be confused with medical equipment alarm signals by hospital staff. This also could result in genuine alarm tones being overlooked and have a direct impact on patient safety. Some bedside systems however, give out an alarm tone in the event of a fire and can therefore provide an extra safeguard for patient safety.

    —  Threat of increased spread of infections

    Allowing mobile phones in hospital may also lead to the spread of infections amongst patients. A scientific study published in the influential Anaesthesia journal found that mobile phones used by anaesthetists in the Operating Room demonstrated a high level of pathogen bacteria.

  5.  Mobile phone use in hospital wards also has an adverse impact on Hospedia's industry being able to create new services that encourage patient safety. Should mobile phone use continue unabated or increase over time, there is the further risk that the few remaining companies providing the bedside entertainment and telephony services at no cost to the NHS will not be able to survive, as they rely partly upon the income from telephony to run the service. If this were to happen, provision of alternative services would need to be provided directly by the NHS Trusts at a significant cost. New services, such as bed management systems, cleaning tracker systems to help combat the risk of infections like MRSA, and hospital introduction videos outlining advice or stating their aims at improving the patient experience, would not be available for NHS Trusts.

  6.  In light of these risks to patients, Hospedia recommends the following measures should be taken to ensure patient safety:

    —  Update the Department of Health's May 2007 mobile phone guidelines in light of new evidence outlined in this Memorandum;

    —  Encourage NHS Trusts pro-actively to work towards compliance with the modified guidelines;

    —  Incentivise Trusts through the Patient Environment Action Team (PEAT) assessments to take up the industry's services to reduce costs and increase safety for patients and hospitals

LOSS OF PATIENT DIGNITY

  7.  The continuing development of mobile phones that now typically incorporate camera, video and Email transmission capabilities has caused increasing concern to the health community, as it could lead directly to issues regarding patient privacy and dignity. Given the nature of mobile phones, their ability to take high quality photos without anyone realising is often completely overlooked.

  8.  This is a serious risk especially in mixed-sex wards and children's wards.

  9.  Case Study: Arrowe Park Hospital

  10.  In October 2007 a nurse at Arrowe Park hospital was struck off after getting an assistant to put a brown paper bag over a dementia patient's head and took a photograph of him with her mobile phone. The nurse cut two eye holes and drew a smile on the bag before a colleague put it on the elderly man's head. She then took a picture of the patient on her mobile phone and sent it to her boyfriend. The Nursing and Midwifery Council (NMC) found her guilty of psychological abuse and following the incident, the Trust banned the use of mobile phones throughout the hospital by staff as well as patients.

LOSS OF PATIENT PRIVACY

  11.  There is a legal duty to respect a patient's private life. The Human Rights Act 1998 ("HRA") enshrines the right to respect for private and family life in the European Convention on Human Rights under Article 8. The HRA makes it unlawful for public authorities (which includes health authorities) from acting in such a way that is incompatible with the convention.

  12.  The European Court has recognised that respecting medical confidentiality is a "vital principle" crucial to privacy and confidence in the medical profession. There is also a requirement to take action to protect these rights, which may require health authorities to draft policies to state that cameras and mobile phones are not permitted in hospitals.

  13.  Permitting the use of mobile phones with cameras in hospitals runs the risk of insufficiently respecting medical confidentiality or the patient's right to respect for their private life.

  14.  Case Study: Salisbury District Hospital

  15.  On 25th February 2008, the Salisbury Journal reported that Hospital patients had been using their mobile phones to record confidential medical discussions. Now visitors are being warned that they could be reported to the police and face possible legal action if it happens in future. Staff at Salisbury District Hospital were told that on several occasions over the past six months, inpatients and outpatients had been found to be recording other patients and staff, compromising their confidentiality.

  16.  The article reported that "|one patient used a mobile to make a sound recording of a consultation with a member of staff without their knowledge. Another used a phone to film a clinical setting which could have breached the confidentiality of other patients and staff|"

  17.  A briefing from the hospital authorities says: "While we allow patients and staff to use mobile phones on site, clearly enhanced technology could enable them to record visual and audio material without consent and in inappropriate situations."

  18.  This includes recording consultations without consent; recording encounters between patients and staff; taking photos of staff without permission; photographing children without their parents' consent, and recording images of patients' injuries without consent."

INCREASED RISK TO CHILDREN

  19.  The Children Act 2004 obligates each NHS Trust to safeguard and promote the welfare of children.

  20.  However, the use of mobile camera and video phones in hospitals pose a serious risk to the welfare of children. Fears include that inappropriate photos could be taken either of them or of their confidential information within a hospital.

  21.  Case Study: Bolton Council—Paedophile fear prompts phone ban

  22.  In May 2003, BBC News Online reported that mobile phones have been banned from council sports centres in Greater Manchester to protect children from sex offenders. Officials at Bolton Council feared paedophiles could use the hi-tech picture messaging phones to take pictures of children in changing rooms, and put them on the internet.

  23.  Leisure centres users are banned from using mobile phones in the changing rooms, toilets and showers areas in the town's leisure centres. As the camera phones become more popular, local authorities and some businesses are starting to restrict the places they can be used.

  24.  Bolton Council has implemented a ban on all photography and filming in leisure centres.

  25.  A statement by Bolton Council said: "Mobile phones can be used for taking photos and there is evidence of those photos being downloaded onto worldwide websites.

  26.  "We are being proactive to ensure we are doing whatever we can to protect our leisure centre customers."

DATA PROTECTION INFRINGEMENT

  27.  A number of patients and hospitals have been filmed on mobile phones and posted on YouTube, both threatening data protection and patient privacy:

    As seen on YouTube

    Man filmed in hospital corridor (Swansea)

    Girl filmed in an ambulance following Manchester Met Uni bar crawl

    Man films himself having surgery prep tests (Cardiff)

    Patient and nurse filmed in hospital

    Patient films herself in hospital

    Film of patient with cuts and bruises

    Man filming himself playing with medical equipment

    Film of drunk man in hospital

    Patient being "happy slapped"

    Film of the cleanliness of a hospital

    Happy slapping—comment by Richard Grannon—as featured on Sky News

  28.  NHS Trusts are legally obliged to protect any personal information they hold on patients. As a result, any individual who takes a photograph of another individual using the camera on their mobile will be processing "personal data" (and may be processing "sensitive personal data") and must comply with Data Protection Act 1998 ("DPA") (and there are additional requirements if the data is "sensitive personal data").

  29.  One category of "sensitive personal data" is an individual's racial or ethnic origin, which could be shown by a photograph. Another category is an individual's physical or mental health, which equally could be depicted through photographic means.

  30.  Therefore, under the DPA, consent would be required to take the photograph, which would be difficult to obtain in a hospital environment.

HEALTH & SAFETY RISKS

  31.  Aside from the medical risks posed to patients, there are also serious health and safety risks posed by the use of mobile phones in hospital wards. If patients use the hospital mains power supplies, there is a serious risk that essential medical devices may be inadvertently unplugged. Patients' mobile phone chargers are also not electrically PAT tested, which is likely to contravene hospital policy and also pose a fire risk to the hospital.

  32.  Mobile phone ring tones can also been confused with medical equipment alarm signals by hospital staff. This also could result in genuine alarm tones being overlooked and have a direct impact on patient safety.

  33.  Case Study: Mobile phone causes partial thickness burns

  34.  A study in 2006[186] reported that a female patient aged 16 referred to the Burns Centre in Medical School of Eskis, ehir Osmangazi University in July 2005 suffered second-degree facial and hand burns as a result of a spontaneously exploding mobile phone during a conversation while the phone was still being charged. The study states that people, in general, do not consider a charger to be dangerous, so they often leave the phone switched on while it is being charged.

  35.  Case Study: Swindon Borough Council—Phone charger fire hazard sparks investigation

  36.  In 2007, Swindon Borough Council[187] warned consumers that they should be on their guard when buying unbranded mobile phone chargers after one blew out of an electric socket point in a Swindon Home. The warning came after a series of tests revealed many chargers sold independently of mobiles were not safe. The council said: "We received a complaint from a member of the public who had purchased an unbranded mobile phone charger in a plain white box. After plugging it into a domestic socket, it blew out of the socket causing a near fire hazard.

INTERFERENCE WITH MEDICAL EQUIPMENT

  37.  The reason that mobile phones were prohibited from use on wards was originally based on the interference with medical equipment. Though this is widely and incorrectly reported on in the press, the scientific consensus remains that mobile phones do interfere with certain medical equipment found on wards—infusion pumps, electrocardiograms[188], medical monitors and dialysis machines[189] being key examples.

  38.  An independent scientific study[190] was published on this matter confirming this point, supporting what many Trusts have observed in practice.

  39.  Whilst the Medicines and Healthcare Products Regulatory Agency (MHRA) recommends that there should not be a blanket ban on the use of mobile phones in hospitals, it also recommends that mobile phones should not be used within two metres of sensitive medical equipment. However, this is extremely difficult to regulate for nurses and hospital staff without a ban on mobile phones in wards. The MHRA have also not conducted any studies on the effects of Bluetooth, GPRS, 3G and other devices on medical equipment.

  40.  Case Study: Mobile Phones in the Hospital, Anaesthesia, 2003

  41.  A 2003 article published in Anaesthesia (the official journal of the Association of Anaesthetists of Great Britain and Ireland) found that electromagnetic interference by mobile phones is "real and potentially clinically significant" particularly with pacemakers, ventilators, monitoring devices and infusion pumps.

  42.  The article concluded: "The current body of evidence strongly suggests that mobile phones should not be used in any areas where electronic devices are used in patient care. In addition, they should not be carried in the stand-by or silent mode, and must be switched off to avoid potential EMI. Hospital staff should be educated about the invisible effects of mobile phones and should be encouraged to reinforce phone bans." [191]

  43.   Pacemakers: In a study of four digital phones and one analogue phone tested at the ipsilateral ear and directly over the pacemaker, the incidence of any type of interference was 20%, causing symptoms in 7.2 of cases[192].

  44.   Ventilators: A study[193] which tested four European GSM mobile phones with 22 commonly used ventilators found 95% showed effects. Monitor and alarm system malfunction was seen commonly, including triggering of alarms and parameter display errors. Furthermore, ventilator settings were altered, producing considerable changes in delivered minute volume, inspiratory peak flow, respiratory rate and inspiratory peak pressure. Three ventilators were shut down completely when a phone was used up to 1m away, requiring manual resetting.

  45.   Monitoring: A North American study[194] tested for interference between both digital and analogue phones and ECG monitoring equipment. They found that interference occurred in 41% of the devices tested. The devices included "portable" ECG monitors as well as "bedside" monitors, telemetry packs, an intra-aortic balloon pump and mobile 12-lead ECG recorders.

  46.  Another study[195] tested 366 different types of medical devices by turning a mobile phone on and off at varying distances from the devices. The authors found that interference, eg defibrillator dysfunction, occurred in 66% of the devices.

  47.   Neonatal units and other equipment

  48.  Mobile phone use may cause EMI in neonatal units by resetting incubator heater elements to maximum output[196] and causing apnoea monitors to fail[197],[198]. Furthermore, they interfere with ionizing radiation dose-monitoring equipment, causing over-reading, especially if kept adjacent to the device[199].

  49.  The World Health Organisation (WHO) does not have an official position on the use of mobile phones in hospital. However, it alerts over implications of using any type of wireless communication in healthcare facilities especially in environments with life-support equipment or implantable devices. This topic of Electromagnetic Interference (EMI) and Electro Magnetic Compatibility (EMC) is usually an important aspect addressed at its regular training Advanced Healthcare Technology Management Workshops, particularly in the Region of the Americas.

  50.  A key example of these concerns being realised is in Australia, where there has been one reported death caused by a respirator being switched off by EMI from a mobile phone[200].

THREAT OF INCREASED SPREAD OF INFECTIONS

  51.  Allowing mobile phones in hospital may also lead to the spread of infections amongst patients. A scientific study[201] published in the influential Anaesthesia journal found that mobile phones used by anaesthetists in the operating room (OR) demonstrated a high level of pathogen bacteria. Following hand disinfection, 40 anaesthetists working in the OR were asked to use their personal in-hospital mobile phone for a short phone call.

  52.  In this pilot study, the use of mobile or fixed phones by anaesthetists working in the OR not only demonstrated a high contamination rate with non-human pathogen bacteria but also, more importantly, also caused a 10% rate of contamination with human pathogen bacteria.

  53.  The study concludes that "the potential benefit from using a|mobile phone in particular in the OR or in the ICU must be weighed against the risk of unperceived contamination and infection."

  54.  Independent laboratory testing by MGS Laboratory has shown that significant levels of bacteria are present on mobile phones. To fully identify the risk, further surface testing investigation needs to be undertaken to determine whether these organisms are pathogens. Indications are that significant numbers of organisms will survive up to 24hrs. In light of this, and considering the NPSA recommendation to clean patients' artefacts daily[202], no change should be made to policy until the full extent of the risk is identified.

September 2008








186   Partial thickness burns caused by a spontaneously exploding mobile phone. Burns, Volume 32, Issue 7, Pages 922-924 Y. Karabagli, A. Kðöñse, C. ð&Cced;ñetin Back

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202   NPSA, The national specifications for cleanliness in the NHS: a framework for setting and measuring performance outcomes. April 2007. Back


 
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