ANovel(Approach(to(Cardiac(AlarmManagement(on ... ·...

Medical Device Alarm Safety in Hospitals Joint Commission Webinar – May 1, 2013

Patricia Covelle, RN, MMHC Director of Critical Care Nursing James Piepenbrink, BS Director, Department of Clinical Engineering Deborah Whalen RNP, MSN, ANP-‐BC, Clinical Service Manager Cardiology Boston Medical Center Boston, MA

A Novel Approach to Cardiac Alarm Management on Telemetry Units

Property of BMC. Not reproducible without permission. May 1, 2013

Overview BMC Quality Improvement Initiative Alarm Management

Focus •  To safely decrease audible cardiac alarms monitor alarms on adult medical-‐surgical

telemetry units while ensuring that all important alarms were captured, displayed and better heard.

Audible Alarms Seen on These Units •  Crisis alarms which require staff to view alarm and either respond to patient for true alarm

or to take some type of action for artifact or clinically insigniSicant alarms •  Warning alarms which alert staff to potential rate /rhythm violation but do not require

staff to view the alarm immediately, could self reset and may be found later in the alarm history.

•  Advisory alarms which signal lower level alarm violations and can also self reset


Our QI Initiative Was Prompted By

•  Review of Alarm Histories that showed signiSicant Warning Alarms were sometimes missed only to be later discovered in alarm history

•  Serial observations of nursing staff interacting with cardiac monitors alarms that found Warning Alarms were often sounding on our Nursing Unit with delayed response from staff who were engaged in other important patient care activities


Pre-‐Pilot Alarm Data


•  Evaluate technology and processes to understand alarm issues •  Assess alarm data to pinpoint contributing factors to alarm fatigue •  Identify strategy to safely effect changes to reduce clinically insigniSicant alarms

System Alarm Defaults


Key Elements

Identify Alarm Default changes

Create grid for changes

Socialize changes

Changes


•  Telemetry Task Force a multidisciplinary group framed Pilot •  Buy in from all stake holders

o  BMC Senior Management o  Patient Safety and Quality Council o  Department of Medicine o  Clinical Engineering o  Division of Nursing o  Most importantly the buy of the care teams on the pilot unit

•  Revision of EMR order sets •  Equipment Default Changes

Designing and Introducing the Pilot

•  Local Champions throughout the roll out

•  Being available 24/7 •  Development of a Sharepoint TM site to journal and chronicle the staff

observations. •  Daily Tips


Key Elements for Supporting Pilot

Tip of the Day Provide infor-‐ mation to users about the use of the system – Improve user experience.


Pre-Pilot Pilot

87,823

9,967

Total Audible Alarms

Aver

age

Ala

rms

per W

eek

Post Pilot Alarm Data


•  Data proved that changes were effective and safe •  Actionable Alarms = Better response •  Better display of events -‐ Many alarms were missed before changes


Pre-‐Pilot Pilot

62,793

3,970

Combined Bradycardia, Tachycardia and HR Limit Alarms

Average Alarms per Week


What staff Nurses are saying: “The monitors were an irritant. Now they no longer seem that way”

“I can spend more time on patient care instead of answering meaningless alarms” “I feel so much less drained going home at the end of my shift”

“This unit is so much quieter than the other units, as a Sloat nurse I want to work here”

“I didn't think I would ever say this, BUT the noise has really gone down, the new telemetry parameters seem to work really well. I didn't think it was possible, with all the cardiac issues and so many patients! GREAT JOB!”


31

51

41

57

42

56

77 79

Nurse Domain Promptness to Respond to Call

Personal Issues Doman Overall Assessment Domaiin

Patient Satisfaction Percentile Ranks for Scores Press Ganey TM

Pre Pilot Pilot

AHA Region 1 Rank

Lessons Learned BMC Quality Improvement Initiative Alarm Management

Crafting Meaningful Quality Alarm Initiative Require •  Both reviewing actual alarm data and closely observing how nursing staff interact with alarms on a day to day basis

Audible Alarms With Self Reset Capability •  Were the basis for the excessive audible alarms and contributed signiSicantly to clinical alarm fatigue at BMC

Improved Management of Self Resetting Audible Alarms •  Improved patient safety and staff satisfaction and may have positively impacted patient satisfaction

LEADERSHIP SUPPORT AND STAFF ENGAGEMENT WERE THE KEY


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