Transmitter Signals a New Approach in Battle Against Incontinence

Wireless technology may ease the suffering of many in nursing homes

Long-term care could be in for a big change, thanks in part to a tiny radio.

Pressed to improve care and reduce costs, long-term care (LTC) facilities are rethinking their methods of handling a variety of problems. One of the biggest of these is managing urinary incontinence. Total costs for dealing with the consequences of incontinence—including urinary tract infections and pressure sore infections caused by prolonged exposure to urine—have been estimated at over $28 billion annually.

In the past, treatment of the 1 million U.S. nursing home residents suffering from incontinence included diapers and periodic visits from nursing home staff to check for voiding episodes. Often, patients would go unattended for hours, which (in addition to personal discomfort) resulted in pressure sores and skin breakdown.

To alleviate the suffering of these people, Health Sense (Santa Margarita, CA) has unveiled a high-tech method of dealing with incontinence. Using wireless technology provided by World Wireless Communications (Salt Lake City), the Health Sense approach aims to reduce and eventually eliminate incontinence episodes.

By some estimates, up to 70% of urinary incontinence is a result of difficulty in self-toileting, rather than bladder-related physical problems. Thus, proper nursing care can dramatically improve recovery rates. Targeted at LTC facilities that provide this care, the Redeem system from Health Sense is designed to help long-term caregivers set up a facility-wide automated incontinence management program.

How It Works

Redeem features a wireless transmitter that clips onto an electrically conductive disposable strip called Sense 'R Strip. When a nursing home resident voids, the strip instantly detects the episode and the radio transmits data on the incident to a central computer at a nursing station. The system promptly notifies caregivers of the episode and stores information about the event in a central database. When caregivers attend to the resident, the system sends the computer a second radio signal to document the time elapsed between the voiding event and the rendering of care.

The Redeem incontinence management system features a wireless transmitter that clips onto an electrically conductive disposable strip called Sense 'R Strip (left). The system also includes a PC and special software.

Over time, data on episodes and caregiving accumulates, creating a visual "fingerprint" of each resident's incontinence patterns. This fingerprint can be viewed on a computer screen or printed out to develop resident-specific care plans, establish bladder and bowel retraining programs, and institute preventive toileting procedures throughout the facility.

The nurse's workstation, a stand-alone PC running special Health Sense software, is the window that allows healthcare personnel to view information about which patient is having an episode, as well as the patient's room and voiding history. Connected to the PC is a receiver, which is linked by coaxial cable to an antenna fixed in position above the monitoring station. A reinforced fiberglass housing was chosen for the antenna because typical PVC material contains enough water to adversely affect the incoming signal.

The antenna receives data sent by the transmitter, which is located near the patient. This transmitter, the 900 Micropulse transceiver from World Wireless, uses a 9-V power source consisting of three stacked-coin cells. Designers chose ABS for the device's exterior because of the plastic's high impact tolerance, UL 94HB fire-retardancy rating, and ability to take on a bright color, which makes the transceiver stand out--and so helps keep it from being accidentally discarded.

Off and On Signal

The 900 Micropulse employs a pulse modulation scheme that turns the signal on and off in pulses. While the transceiver is in operation, the signal is on less than 10% of the time, according to Scott Christensen, an application engineer for World Wireless. Besides reducing power consumption, pulse modulation also extends the transceiver's range. Federal Communications Commission regulations governing unlicensed radio transmissions limit the power of such transmissions, but allow averaging of power output over time. "Since we're only on a tenth of the time, we can increase the power to 10 times the power" of a continuous signal, Christensen explains.

The small size of the 900 Micropulse transceiver makes it easy to wear.

This means the 900 Micropulse can put out a 10-mW, 900-MHz signal, which allows data transmission up to 300 feet. By contrast, other radios that were considered needed the help of antennas stationed every 25 feet to carry the signal the required distance. Earlier versions of the Redeem system, which included less powerful radios, also required multiple antennas, while the new system needs only one, according to Norman Roberts, Health Sense's director of new product development.

At some point, the transceiver may be called on to receive as well as transmit signals, thereby making Redeem a "smart system," Roberts says. Right now, since radio-frequency interference could prevent the nurse's workstation from receiving the transceiver signal, the device can be programmed to send the signal a number of times. But if the computer can send a message back to the transceiver saying that the signal has been received, the transceiver could stop transmitting at that point.

At present, Redeem is installed in just two facilities, where patients are developing fewer bedsores and enjoying a higher quality of life, according to Roberts. He expects the system to be operating in 95 facilities by the end of the year, and Health Sense has ordered 1200 transmitters from World Wireless to meet the anticipated demand.

The performance of wireless technology in the Redeem system may be a debut that leads to more medical roles. "It's a substitute for cables in many applications," Christensen says. "In any application where you're doing remote monitoring, [wireless technology] would be useful."

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