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The impact of COVID-19 on hospitals and public health institutions

The outbreak of COVID-19 has forced public health institutions to deal with unprecedented conditions, to manage the exposure of healthcare staff, preserve personal protective equipment, manage the scarcity of critical medications, and cope with staff shortages. To address these challenges, hospitals have had to resort to new and unusual measures.

Infusion therapy, the most commonly used technology for drug delivery, is an ever-improving field of healthcare – but infusion pumps and intravenous (IV) drips can still sometimes incur dosing errors simply because of their widespread use in hospitals on a daily basis. While new measures adopted during this pandemic could be essential for preserving the care of COVID-19 patients, there is also the potential for errors associated with the infusion-based delivery of vital medications - that could in fact result in adverse effects for patients in critical conditions.  

EMPIR project ‘Metrology for drug delivery’ (MEDDII, 18HLT08) has played an important role in advancing clinicians’ understanding of how drug delivery devices operate, as well as identifying the issues related to new drug infusion practices that are being implemented at this time.

Using metrology to develop best practices for the response against COVID-19

Members of the EMPIR project ‘MEDDII’ have developed a high-priority case study to outline their specific metrological and clinical physics advice regarding newly adopted COVID-19-related measures. The project consortium has also produced a report and flyer centered around the findings of this case study, to ensure the speedy dissemination of their critical research (see section below: ‘More information’). Elsa Batista, the project coordinator, comments on the importance of this case study - and international collaboration in general - for fighting this public health crisis:

“In the outbreak of the COVID-19 pandemic situation, the project consortium of MeDDII identified several problems related to drug delivery devices use. Therefore, it was decided to develop documents that could help the clinical staff to understand the risk associated with the new implemented procedures. These documents were a product of international cooperation between metrologists and medical personnel, mainly our stakeholders and advisory board.”

Findings of the MEDDII case study

To reduce the exposure of healthcare staff to COVID-19, one option is the use of drug delivery devices outside patients’ rooms. Hospitals around the world are using extension tubing to position infusion pumps outside rooms, but the project-developed case study has identified some risks that are associated with this set up - such as the increase in fluid flow resistance, poor accessibility to corridors that could affect fire regulations, incorrectly attached tubing, and the overall impact on flow accuracy - especially at the low flow rates required for infusion therapies. The project consortium has recommended flow rate and volume testing procedures to minimise errors in drug delivery via extension lines, helping to counteract these issues.

Another key concern at present is the increasing use of lower-accuracy volumetric infusion pumps, that healthcare professionals have had to take up as a result of increasing shortages of syringe pumps. Project researchers have helped to reduce the clinical risks involved with the use of less optimal infusion pumps by outlining metrological rules for their operation – from the recommendation of a suitable flow rate for best conserving accuracy, to the identification of a step-by-step procedure for multiple-pump set ups.  

The case study finally highlights the problems facing some clinicians who are dealing with delays of previously periodic equipment maintenance and calibrations. For hospitals that are experiencing these delays, patient care could be negatively affected by the inadequate performance of infusion pumps, and so project researchers have offered a solution – the ability for internal maintenance officers to perform a much quicker check of these drug delivery devices. This faster alternative for verifying pumps requires the use of just a measuring cylinder and a stopwatch, and can be done in 10 minutes with a 2% uncertainty.

Amongst other metrology research initiatives, the outcomes of this project under EURAMET’s EMPIR programme will be fundamental in helping hospitals to tackle dosing errors and drug delivery issues in these extraordinary times. Project research has played an important role in supporting hospitals to balance the benefits of new practices for staff, against the risks to patient care. Through their focus on metrology for drug delivery, project partners have developed essential best practices and methodologies for infusion therapies used widely in intensive care and acute units – contributing to the global response to COVID-19.

More information

For more information about the case study developed by project partners and the advisory board, please see the flyer and report available on the project webpage >>

This EMPIR project is co-funded by the European Union's Horizon 2020 research and innovation programme and the EMPIR Participating States.

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