Personal Heart Reporting Service MHM 100 Standard Operating Procedure for Pharmacy Version 1.
• • • have any conditions that are risk factors for heart problems, such as diabetes, high blood pressure, smoking, obesity or high cholesterol have already had a heart attack regularly experience symptoms suggestive of poor heart function e.g., dizziness, palpitation, shortness of breath, chest discomfort, weakness or excessive sweating. Please note that anyone experiencing any of these symptoms should first discuss them with their GP.
- Uploading a report Viewing a report Placing an order Viewing the ECG results - On the MHM 100 - On your computer Retrieving the expert report - The expert report - Colour-coded notification - Security and confidentiality Replacing parts How to look after your MHM 100 - Environmental considerations - Cleaning - Faulty equipment - Insurance Troubleshooting Customer support Glossary Product Specification - Electrical - Mechanical - Regulatory standards - Graphical symbols -3-
Introduction to the MHM 100 The MHM 100 is a personal ECG testing device that monitors the heart on a beat by beat basis to detect any irregularities. It does this over a period of up to 8 hours and automatically generates a report of the heart rhythm. The ECG results should always be sent for expert interpretation via the Medick Personal Heart Reporting Service. As part of the agreement you have access to the Corporate Website home page http://club.medick.com/corporate, an area within www.medick.
6. UNDER NO CIRCUMSTANCES should the MHM 100 be used in conjunction with a defibrillator 7. Do not open the MHM 100 or tamper with the connections while the test is running.
Know your MHM 100 Take some time to familiarise yourself with the parts of your MHM 100: Battery cover Serial number inside battery cover Power on/off switch Connector with guide Battery compartment Connector socket and groove Log button Electrode lead Electrodes The ON/OFF switch is located on the top of the MHM 100. The connector socket is used to attach the MHM 100 either to the electrodes or to the computer, depending on which cable is used.
Setting up your MHM 100 Inserting and replacing batteries To insert batteries, firstly ensure the MHM 100 is switched OFF and then press the button at the back of the MHM 100 before sliding off the battery cover. Insert two AAA batteries as indicated by the ⊕ and symbols. Only use high-quality batteries with a capacity of 600mAh or more, such as ‘Varta’, ‘Panasonic’, ‘Duracell’ or ‘Energizer’. 1. New batteries should be inserted for each 8 hour test 2.
Setting the clock Once the batteries have been inserted, switch the MHM 100 on, using the button at the top of the device.
Running the ECG test Attaching the electrode pads 1. Skin preparation There are three areas where the electrodes will be attached Upper left chest just below the collar bone (Yellow) Upper right chest just below the collar bone (Red) On the left hand side, two ribs up from the bottom and approximately 2 inches below the nipple (Green) (women may place it under the breast) A good electrical contact between the skin and the electrodes is needed to get a high quality ECG signal.
Electrode leads should not be used if they appear to be damaged or worn Positioning and attaching the electrode leads The MHM 100 should be switched OFF. The pads should be removed from their backing one at a time and positioned according to the diagram below. Make sure the electrodes are positioned in such a way that the leads won’t get tangled up in clothing - moving the electrodes away from the preferred areas could decrease the accuracy of the test.
Starting the test 1. The connector end of the electrode lead should be pushed firmly into the MHM 100, lining up the guide on the connector with the groove at 12 o’clock on the MHM 100. Do not twist the connector. Ensure that the groove lines up with the top of the device 2. Switch the monitor ON 3. Select Start Test from the Main menu on the MHM 100 screen 4. Once Start Test has been selected, the MHM 100 informs the user that it is checking for a signal; this should take no longer than 3 minutes.
Using the Log Button If any symptoms are experienced while running the test e.g., dizziness, palpitations, excessive sweating, the Log Button at the base of the monitor should be firmly pressed. (Medical advice should be sought if there are any persistent or worsening symptoms.) The Log Button can also be used to check how certain aspects of lifestyle affect the heart, such as smoking or caffeine consumption.
Things to remember • It is important not to switch off the monitor or disconnect the electrode lead while the test is running • The MHM 100 must be kept dry • It is OK to wear the MHM 100 in bed, particularly if the customer has symptoms at night • If the electrode pads cause discomfort or itching, then they should be removed immediately but the test stopped using the Stop button.
The ECG test results are now ready to be saved onto a computer and then sent off for expert interpretation The test results need to be brought back to pharmacy and saved onto a computer within 24 – 36 hours of stopping the test (immediately if the ‘low battery’ warning is shown), otherwise, there may not be enough power in the batteries to allow transferral and the results will be lost.
Connecting to a USB port Plug in the USB-to-serial port adapter into the computer and follow the instructions that come with the cable within the instruction leaflet and installation ‘Wizard’. Once installed, attach the other end to the MHM 100. Follow the instructions in the previous section. Installing the software To install the software, whether it is on a personal computer or one that is part of a network, you will need to log in as an administrator before you can proceed.
Connecting to a serial port Serial ports are the sockets on the back of your computer where devices such as the MHM 100 can be attached. As there may be more than one, your computer must be ‘told’ which one the MHM 100 is plugged into before it will receive information from it. To select the serial port: 1. Plug the MHM 100 into a serial port on the computer using the cable provided ensuring that the guide on the cable aligns with the groove at 12 o’clock on the monitor socket.
Uninstalling Medick Explorer If you wish to remove Medick Explorer from the computer: 1. Go to the Start menu and click Programs 2. Click Medick then Medick Explorer 3. Click Uninstall Medick Explorer 4. Click Yes in response to Are you sure you want to uninstall Medick Explorer and all its components? 5.
Once your ECG test has been successfully transferred, you can switch off the MHM 100 monitor and store the monitor in the Medick storage bag provided. Transferring the ECG results Use the following link to access your page of the Medick Corporate website: http://club.medick.com/corporate 1. Type in your user id and press return 2.
View Report - user email supplied The user will receive an email notification to inform them that their personal report has been produced and is ready to be reviewed. The user will need to take the following actions: 1. Click on the ‘club.medick.com’ link in the email 2. In the ‘Access code’ field they will then need to type the access code on the screen that was printed when you uploaded their report. 3. Click on the ‘View Report’ button.
Test details Provides summary of test duration and signal quality Select [Back] to return to the main menu Heart Rate Summary Gives the mean (average), maximum and minimum heart rate during the test Select [Back] to return to the main menu Tachycardia and Bradycardia Summary Shows how many times the heart was beating faster or slower that usual (see glossary for definitions) Select [Back] to return to the main menu Rhythm Summary Shows how many times wide complex tachycardia, ST segment depression and at
• Heart Rate Trend – shows a graph of the heart rate over the test period - dotted lines indicate a break in the signal.
Heart Rate Trend This page shows a graph of the heart rate over the test duration, including minimum, maximum and mean (average) heart rate Sample Trace The sample trace page shows the signal at 3 minutes from the start of the test - 22 -
Log Buttons There can be a maximum of 10 Log Button pages – one for each of the first nine times it was pressed and the last one. A thick black line appears above the heart rate at the time the button was pressed Retrieving the expert report An email will normally be sent within 24 hours of transferring the ECG results confirming that the expert report can now be viewed via Medick corporate website.
• • blue – the signal quality during the test was too low to be of use. The test may be repeated after referring to the sections on ‘Skin preparation’, ‘Positioning electrodes’ and ‘Things to remember’ to make sure the correct procedures were followed. Users should not be charged for their first blue report pink – A small percentage of people will have a heartbeat that is not suitable for analysis by the MHM 100. This does not mean that they have a heart condition.
Examples of Expert Report Web pages - 25 -
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Should the userer receive either an Amber or Red report, there is the facility to download and print off a letter for them to take with their GP, in order to discuss what treatment or further analysis is required.
Security and confidentiality All personal details provided to Medick Healthcare and the results of the tests are completely confidential and will not be passed on to any third parties. The Corporate section of the Medick website is username and password protected for added security.
Replacing parts The MHM 100 monitor has a number of renewable parts and items that need regular replacement in order to maintain optimum hygiene and efficiency. All parts can be purchased via the Corporate website • Electrode pads – these are for single use only. Additional packs of electrode pads are available for purchase. Abrasive wipes – these are supplied with each order of Electrode pads.
The electrode lead should be kept clean by wiping with lukewarm soapy water, a surgical wipe or a neutral cleaner. Do not immerse it in water. Also, do not use any chemical or solvent cleaning solutions as these may corrode the lead and cause permanent damage. Faulty equipment It is important that you check the condition of the monitor and all its parts as soon as you receive them to check if there has been any damage in transit. If any of the parts are damaged please contact Customer Support – see below.
Troubleshooting The following sections should cover any difficulties you may experience in running your ECG test and receiving your expert report. There is a low battery warning screen; will all the test data be lost? If the MHM 100 has low battery power one of the following two screens will be seen. A B In the case of message A, switch off the MHM 100 and replace the batteries before trying again.
If this happens, make sure the existing report is saved onto a pc before proceeding. The MHM 100 screen is always blank, what happens next? Make sure the batteries are correctly inserted as outlined in the battery compartment. If this does not fix the problem try replacing the batteries, if the problem persists call the Customer Support Team.
If the user thinks there is a malfunction what should I do? For all technical queries, please call our Customer Support Team on 0845 603 7282 (calls charged at local rate). Opening hours are as follows: Monday to Friday Saturday Sunday Bank Holidays 9am to 5pm 10am to 2pm Closed Closed Will high levels of static electricity from modern carpets and fabrics affect the working of the machine? No.
Customer Support Healthantec is very interested in receiving your comments on the performance of the MHM 100, its associated parts and the clarity and accuracy of its user manual and website. If you have any queries or comments (good or bad), problems or suggestions, please contact as shown below. UK Office Healthantec Limited 4th Floor, Exchange House, 494 Midsummer Boulevard, Central Milton Keynes, MK9 2EA Customer Support Team 0845 603 7282 (calls charged at local rate).
Glossary Please note that these terms are provided because they may appear in reports. abnormal morphology Electrical emissions of the heart have been recognised as abnormal and are unsuitable for analysis. This may be due to the position or "tilt" of the heart and can be quite normal in some people. arrest A significant delay (greater than 3 seconds) in between heartbeats. arrhythmia Any variation from the normal rhythm of the heart. artefact Insufficient available ECG data to analyse.
atrial fibrillation (uncontrolled) Atrial fibrillation is uncontrolled when the heart rate response lies outside normal limits (i.e. 50 to 120 beats per minute);. If AF is uncontrolled, cardiac output may be compromised by periods of inappropriate tachycardia and bradycardia. Pauses and arrests may also be evident with an uncontrolled ventricular response. atrial flutter (AF) An abnormally rapid, well organised contraction of the atria at a rate of 250 to 350 per minute.
bundle branch block A form of heart block in which one ventricle contracts later than the other because of a delay in its electrical conduction. couplet Two ectopic beats occurring one after the other. diaphoresis Profuse perspiration. ectopic A heart beat originating from outside the sinoatrial node. Ectopic beats may be either atrial or ventricular in source. electrocardiogram (ECG) A recording, from the external wall of the chest, of electrical activity generated by the heart.
impulse A general term for a heart beat observed on the ECG. intraventricular conduction delay Slower than normal conduction through the ventricles. These beats normally have a widened QRS complex. intraventricular Conduction Delay (ICD) This stands for Intraventricular Conduction Delay and is a generic acronym for wide morphologies. Among other conditions, IVCD include bundle branch blocks and Wolff-Parkinson-White syndrome. A previous heart attack may also show IVCD in the ECG test report.
neural networks A method of computation, simulated on the way that the brain processes information. no ECG The MHM 100 could not detect a heart rhythm which may be due to a technical fault such as a broken lead. normal sinus rhythm A normal heart rhythm. paroxysmal Occurring with a sudden onset. pauses Delays (of up to 3 seconds) between heartbeats presyncope The sensation of lightheadedness and loss of strength that precedes syncope.
RR variability Variation of rhythm, normally due to autonomic tone. salvo A sequence of four to seven ectopic beats one after the other. second degree heart block Some, but not all, heartbeats are conducted from the upper chambers to the lower. This may result in decreasing levels of blood being pumped around the body. second degree heart block (type 1) is where the pauses between each heartbeat become gradually longer until a beat is skipped entirely.
stroke A stroke is a brain attack, as opposed to a heart attack. A stroke is what happens when the blood supply to part of the brain is cut off. Without a blood supply, brain cells can be damaged or destroyed and won’t be able to do their job. Damage to the brain will therefore affect body functions. For example, if a stroke damages the part of the brain that controls how limbs move, limb movement will be affected. ST segment The section of the heart beat which indicates contracted ventricles.
third degree heart block otherwise known as complete heart block. Heartbeats are not conducted from the upper chambers to the lower. Because of this block in conduction, the lower chambers are contracting at a much slower rate than normal transient ischaemic attack Neurological symptoms caused by a temporary reduction in the supply of oxygen to the brain. These include numbness, paralysis, a difficulty in speaking or swallowing, and loss of vision. All of these can be symptoms of stroke, if sustained.
ventricular ectopics (multifocal) Heartbeats originating from more than one location within the ventricles ventricular tachycardia (VT) A fast, abnormal, and life-threatening rhythm, which is more common in people who have had a myocardial infarction wide complex tachycardia (WCT) A sequence of three or more consecutive, ventricular contractions, at a fast rate. In the absence of artefact, this should be considered as ventricular tachycardia.
Product Specification This Appendix contains technical information relating to your MHM 100 device. Electrical Frequency response: Input impedance: Input dynamic range: Intentionally applied current: Channels: Sampling rate: Sampling resolution: Battery: Continuous operation: 0.1 to 23Hz >20Mohm 0 to 5mV -1.3 to +1.3uA 1 bipolar 100Hz 12-bit 2 x AAA min.
Graphical Symbols The following symbols appear on the label on the rear of the MHM 100. This indicates that the MHM 100 is a type B applied part, i.e., the equipment in normal use can be brought into contact with, or touched by the user, and provides protection against electric shock in accordance with EN60601. This indicates that the MHM 100 meets the ISO 60601 Class II requirement, being double insulated and having no earth connection.
