Implementation of a Protocol to Improve Monitoring of Neurostimulator Devices: A Patient Safety Initiative

Objective: Provide optimal monitoring of neurostimulator devices and proactively identify devices nearing end of battery life to improve care, prevent complications and minimize cost. Background: Neurostimulators are used to treat many neurological diseases and require regular monitoring to prevent complications. Patients with vagal nerve stimulators (VNS) or deep brain stimulators (DBS) can develop worsening symptoms from the battery reaching end of life or a device malfunction, and this can lead to a medical emergency. We identified two instances over a 3-year span where patients with neurostimulator devices were not optimally followed and had complications. One case led to hospitalization for akinetic crisis and transfer to outside facility as DBS generator replacement could not be emergently coordinated locally. Design/Methods: A database was created to track neurostimulator patients and optimize followup. Barriers to care were identified: Rural location, cost of appointments, prolonged waits for appointments, neurology provider shortage, and lack of patient education on device complications. Review of medical literature and device guidelines were used to create an optimal protocol for monitoring each device. A protocol was developed to allow a clinic nurse (RN) or medical assistant (MA) to perform device check and evaluate battery life for stable patients not needing stimulator adjustment and not needing a neurologist appointment, in order to reduce access barriers and costs. Training was provided by representatives from the device manufacturer. Results: Among 18 patients identified with neurostimulators, there were 10 missed device checks over 37 patient years of follow-up (2017-2019). Following implementation of protocol in February 2020, only one patient did not have appropriate device monitoring;3 other visits were converted to telehealth due to the COVID-19 pandemic. Four device checks were performed by RN/MA. Conclusions: Ancillary staff utilization to perform device checks for stable VNS and DBS patients is feasible, improves access to care, and potentially prevents complications.