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ENable
Improving Enteral Nutrition at Penn Medicine
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Challenge:
The process of administering prescription medications via a feeding tube is so time-intensive and complex that it results in 1 out of every 4 enteral nutrition patients being readmitted to Penn Hospital every single month
Working under the Penn Center for Innovation, we aimed to find a way to transform this highly manual daily chore into a doable, efficient process
EnABLE revolutionizes the way prescription medications are crushed, diluted, and administered to feeding tube patients
Client: Penn Medicine x Penn Center for Innovation x IPD
Tools: Solidworks, Keyshot, Adobe Illustrator, Miro, surveying, user testing, 3D printing, Arduino
Learnings: Early stage user testing with low fidelity prototypes - adapting to changing client requirements - need prioritization
Awards: Winner of the Validation student venture award from the Penn Wharton Innovation Fund
What is a feeding tube?
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Feeding tubes help patients absorb nutrients, fluids, or medications when they are unable to swallow. The need for a tube varies from short-term surgery recovery, to long-term chronic health conditions such as cancer or a stroke
4 Types of Feeding Tubes:
-ND and NG tubes (from nostril to stomach/small intestine) are temporary and can only stay in place for a few weeks before damaging the throat and esophagus
-G and J tubes (directly to stomach/small intestine) are preferable for long-term and even permanent use
The Problem
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23% of all enteral nutrition (EN) patients at Penn's hospital are getting readmitted within 30 days of getting discharged
Feeding tube patients are 1.4x more likely to be readmitted to the hospital vs. none EN patients
Three of the most common issues that cause readmission are GI issues, tube clogging, and sodium imbalances, with tube clogging by far the most prevalent among the three
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Interviews
We conducted 9 interviews with patients, hospital professionals, and caretakers to gauge their various experiences working with feeding tubes
Patients
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Hospital Professionals
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Caretakers
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On-site visit
Hospital of the University of Pennsylvania (HUP)
As a nurse walked us through her daily routine with an EN patient, she took 22 minutes to crush, dilute, and administer all medications into the tube, using 8 different cups and 6 syringes.
"In reality unless we see that a prescription needs to be administered separately we don't have the time to mix each individually"
While in theory each pill must be handled separately due to potential allergy/reaction concerns, she noted:
Just how difficult is the process?
Hoping to ascertain how intuitive the process would be to a first-time caretaker going through the steps at home, we tested out the process of administering food and medication into a feeding tube using only the instructions that outpatients are currently given upon leaving the hospital
Insights & Observations
Preparing and administering medication for EN patients is extremely time consuming and overly-complex
In Hospital
Problem: Time Causes Complexity
Nurses must spend excessive time with each enteral nutrition patient and are forced to rush through the process
Nurses end up spending all their time administering medication, leaving minimal time to address patients' additional needs
At Home
Problem: Complexity Causes Time
Caretakers are overwhelmed by the initial adjustment to using a feeding tube at home. Instructions are difficult to understand, and require physical ability
Caretakers develop shortcuts for handling meds, increasing room for error and causing a large increase in readmission rates
Home Routine
Unlike the typical 30 seconds to swallow a pill, it takes a feeding tube patient an average of 45 minutes to 1 hour to prepare and administer just one round of medication at home
Average morning
Average morning for an EN patient
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In-Hospital Process
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With many patients relying on multiple rounds of medications per day, several hours end up going into manually crushing, diluting, and administering pills into the feeding tube.
Nurses, caretakers, and patients are left feeling overwhelmed with an inefficient system
Patient User Journey
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How might we...
How might we optimize the medication prep + administration process to solve for time and complexity, allowing for more meaningful time spent between nurses, caretakers, and EN patients?
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Ideation
We developed 5 initial iterations of a device to simplify medication crushing, dilution, and administration.
Low-fidelity prototype testing
The idea:
To asses the potential impact that automating the pill crushing diluting process might have on a HUP nurse, our team decided to run an experiment by bringing a rough looks-like prototype to the hospital. I played the part of a fake patient, while my teammates acted as the machine by crushing and diluting the medication before the nurse took over for administration
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Takeaway:
Just automating the crushing and dilution process only solves a part of the problem. To have a real impact we would also need to consider expediting medication administration and incorporating tube flushing/cleaning in between prescriptions
The result:
Taking away the medication preparation process was able to cut down the nurse's time per EN patient by almost half. More importantly, however, was that this extra time could now be spent more directly and meaningfully with the patient
Final concept
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Initial UX design mockup
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Device Walkthrough
Works-Like Prototyping
After pitching our design to the Penn Wharton Innovation Fund, I was able to win the Validation Award grant funding to continue developing the device into a works-like proof of concept
Early stages:
I found it beneficial to break up the device into its 3 components of crushing, diluting, and administerting. I decided to tackle each step separately, and to begin with the pill administering component as I wanted to add some additional safety mechanisms to ensure that each pill was correctly dispensed in the process
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Key call-outs:
-A nested pill dispenser design incorporating a trap door that aligns with each pill in a specific section
-Reflective IR optical sensor to create a checking system, ensuring that no pills got stuck along the path of reaching the blender
-Incorporating a 5V relay to control the blender using a microcontroller
-Controlling 2 peristaltic pumps off of a single microcontroller, using a transistor for current amplification
Material Choices:
For the device's outer enclosure, I would consider injection molding the two halves out of polypropylene. In addition to it being a cost-effective choice for heat resistance and durability, it also provides assurance for added safety during any medical steam sterilization.
Future Design Considerations:
-Light sensitivity of optical sensor: Fine-tuning the optical sensor topick up a larger variety of pill colors and sizes
-Air bubbles in tube: A more robust peristaltic pump system to ensure that there are no air bubbles in the tube when users go through this process
-Controlling the device: In order for patients/nurses/caretakers to be able to interact with the device more seamlessly and customize it to their medication needs, I would like to incorporate an on-board LCD screen interface. This will enable them to input pill type, check for potential medication allergies, and keep track of how much time the process will take
-Sanitization: Moving forward whether for at-home or in-hospital use, additional sanitization elements will have to be incorporated so that there is no leftover medication residue in between different doses. This could include re-evaluating the crushing mechanism itself and exploring different mechanisms such as ultrasonic technology
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