Memorandum by Hospedia UK (PS 36)
IMPACT OF MOBILE PHONES ON PATIENT SAFETY
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 UKthis equates to over 80,000
NHS beds daily across the UK and roughly 10 million patients every
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.
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
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
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
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.
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
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."
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 CouncilPaedophile
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."
27. A number of patients and hospitals have
been filmed on mobile phones and posted on YouTube, both threatening
data protection and patient privacy:
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 slappingcomment by Richard Grannonas
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
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
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
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
34. A study in 2006
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 CouncilPhone
charger fire hazard sparks investigation
36. In 2007, Swindon Borough Council
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.
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 wardsinfusion
medical monitors and dialysis machines
being key examples.
38. An independent scientific study
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,
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."
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.
44. Ventilators: A study
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
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
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
and causing apnoea monitors to fail,.
Furthermore, they interfere with ionizing radiation dose-monitoring
equipment, causing over-reading, especially if kept adjacent to
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
51. Allowing mobile phones in hospital may
also lead to the spread of infections amongst patients. A scientific
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
no change should be made to policy until the full extent of the
risk is identified.
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