When It Comes to Medical Device Design, Nurses Are Doing It For Themselves (Video)

Anna Young is the CEO of MakerHealth and co-founder of MakerNurse, organizations dedicated to the idea that the most apt tools for treating patients are sometimes developed on the front lines, by those who work directly with patients.

For generations nurses have been raiding hospital supply closets, modifying and repurposing standard equipment to better suit the needs of patients, Young says in a recently released TEDMED presentation. (See above.)

She gives the example of visiting a Nicaraguan neonatal intensive care unit, where the director proudly showed her a brand new ventilator. But what caught her attention was "the nurse working quietly in the background," placing hand-cut cloth glasses on infants under a phototherapy lamp.

"It was amazing to me that this simple, elegant, handmade solution was dramatically improving the quality of care for these tiny babies," Young says.

She believes the health care industry has been “constrained by black box medical device design."

"It’s really not about inventing it at MIT," Young says, "this is about inventing it everywhere."

Below, you can read our original post on how the maker movement has been making inroads into some traditional medical settings.

Original post

Inside sterile hospital environments, medical MacGyvers are designing and building new medical devices with an assortment of raw materials to improve patient care.

Doing the crafting, tinkering and inventing are nurses, doctors, patients and even caregivers.

Nurses have used plastic cups and surgical tape to keep children from picking at their IVs. They've adapted goggles to protect the eyes of neonatal infants. And you've seen tennis balls on walkers, right?

It's called MakerHealth, born out of the maker movement.

Lego Buff Called to Action

Oncology nurse Victor Ty knew the usual protocols wouldn’t cut it when he was assigned a teenager with autism.

Typically, Ty offers a detailed briefing to explain how radiation treatment works at Maimonides Cancer Center in Brooklyn, New York. But his patient was nonverbal and Ty was stumped, until the teen's mother mentioned her son loved Legos.

“I had been a Lego buff my whole life," Ty says, "and a picture speaks a thousand words."

Ty built an elaborate white-and-red Lego model of the large machine to which the patient would roll inside for radiation treatment. The device is called a linear accelerator, which destroys cancer cells with X-rays.

When the patient began playing with the model, Ty used hand gestures to explain the treatment. The experiment was a success; daily radiation was administered for weeks without incident.

Ty has hacked traditional medical equipment, too.

“I think frustrations happen every day in the hospital that require you to innovate or repurpose a device," Ty says. "For example, I might only have a square dressing to lay over a wound in a breast cancer patient. So I’ve starting using nipple pads for nursing if I need a circular gauze dressing.”

Recently Ty designed a Lego MRI machine for a pediatric specialist who hoped the device would inspire kids to skip sedation if they understood the procedure. Over the past year, Ty says, 50 kids who have seen the replica have decided against anesthesia.

Administrators Can Be a Tough Sell

When other hospitals caught wind of Ty’s success with Lego models, they invited him to speak to their staff. But not all institutions are excited about handmade devices. Even Ty’s supervisor was not high on the project.

“I was told the [linear accelerator] Lego model was unprofessional because there was no documentation,” Ty shrugs.

He handed the model off to his wife, who is a pediatric radiation nurse at NYU Langone Medical Center, to help her explain the treatment to young patients.

Long History of Maker Nurses

The founders of the MakerHealth movement recently published an academic article tracing the last 120 years of maker nursing.

In the early part of the 20th century, nurses used common household items for patient care. They paired a rocking chair with roller skates to build a wheelchair, for example, and used hot corncobs as bed warmers.

From 1900-1947, the American Journal of Nursing documented these devices and their blueprints. In 1938, the Red Cross sponsored a training for nurses on how to improvise hospital equipment. There was even a regular series called The Trading Post, which ran in the journal for 15 years after World War II.

But the movement began to lose steam as more rigorous scientific standards in health care took hold. Fewer and fewer DIY solutions were documented in the latter half of the 20th century, and the field of nursing began focusing more on methodology and validation, and less on improvisation.

“They were amazing inventors early on, but eventually nursing administrators, who were likely threatened by anything new, squashed new ideas,” says José Gomez-Marquez, co-founder of MakerHealth. “Hierarchy matters a lot in nursing, and nursing research and evidence became prioritized.”

Marquez wonders whether the movement went dark, or if maker nurses just went underground. Either way, he's trying to reignite health hackers by embedding DIY labs inside hospitals.

A Revolutionary Space

Last fall, MakerHealth opened its first formal laboratory on the fifth floor of John Sealy Hospital, at the University of Texas Medical Branch in Galveston. Just down the hall from patient care, a large room has become a maker-space lab/hospital supply closet mashup.

"The mindset is what we are after," says lab manager Nik Albarran. "It’s OK to tinker. It’s OK to fail. It’s OK to try things out."

A laser cutter, 3-D printer, band saw, belt sander and array of tools are all available to innovators, as are a chemistry lab, sewing machine and fluid management station for IV drips. At any given time, about 25 projects are in the works.

Jason Sheaffer, a nurse manager in the burn unit at UTMB, recently designed a system for irrigating patients with serious burns. Nurses in the unit routinely spend up to 11 hours sluicing water over burn victims, so Sheaffer developed a stand-alone shower system that clamps on to the bathtub inside hospital rooms, allowing patients to irrigate themselves.

The Future of Health Hackers

“Nothing has made it to the market yet,” says Albarran. “Right now, the products are being tested and studied. And then patenting and commercialization could be the next step.”

New maker labs are planned for medical centers in Weymouth, Massachusetts; Richmond, Virginia and Corpus Christi, Texas.

But big institutions can be a tough sell. MakerHealth tried to create labs at UCSF Medical Center and Kaiser in California but ran into bureaucratic hurdles.

“It was difficult to work with large institutions that are accustomed to working with NIH grants and longer-term projects,” says MakerHealth co-founder Anna Young. “They weren’t nimble enough to add something new.”

In systems that depend on billing codes and published research, gaining traction for DIY methods is difficult. But Young is not deterred.

“My hope is that one day, your doctor prescribes not just a pill, but a blueprint for making an easy-to-open pill box," she says. "And you go not just to a pharmacy, but to a craft store with your occupational therapist. And that if you have an idea for improving health care, you go to a medical makerspace and make it!”