2011 National Clinical Alarms Survey: Perceptions, Issues, Improvements and Priorities

Transcription

1 2011 National Clinical Alarms Survey: Perceptions, Issues, Improvements and Priorities Healthcare Technology Foundation Clinical Alarms Task Force Presented by Tobey Clark President, Healthcare Technology Foundation Affiliation: University of Vermont

2 Healthcare Technology Foundation The mission of HTF is to: ʺImprove healthcare delivery outcomes by promoting the development, application and support of safe and effective healthcare technologies.ʺ The Foundation supports: The promotion of excellence in clinical engineering leadership through research, education and certification Funding of related research and programs, Effective collaborations between medical device producers, regulators, users and clinical engineers, The creation of safety related education material that is useful to members of the public The Healthcare Technology Foundation is a 501 (c)(3) non profit foundation

3 2006 National Survey on Clinical Alarms White Paper 3

4 Literature Review Alarms significant problem area for many years (ECRI Hazard 1974) Humans can t learn more than six alarm sounds and priority difficult to discern False alarms may be the most serious shortcoming May lead to disabling alarm system

5 FDA Maude Reports By Device Types Monitor Ventilator IV Pump Dialysis VAD Defibrillator Oximeter Anesthesia Pacemaker From Kathy Weil, FDA

6 2006 National Clinical Alarms Survey Survey was completed by 1,327 individuals Over half of respondents were Registered Nurses (RN s) Biggest issue: False Alarms and Nuisance Alarms Reduce attention and response Disrupt care and reduce trust in alarms

7 Design Smart alarms Integration/remote Usability/human factors Standards Environmental Better design of facilities Monitoring (rounds) Communication Alarm integration to pager, cell phone, etc. Care management Training Monitoring (rounds) Use best practice guides Institutional standards Clinical engineering Evaluate purchased items for usability Test alarms in their environment Software setup/testing 7

8 2011 National Clinical Alarms Survey Re survey of the field Sponsorship AAMI, ACCE, PHILIPS & HTF : 4278 responders 93% clinical staff Reported on the results at the AAMI Medical Device Alarms Summit

9 Survey Demographics: 4,278 healthcare staff responded to the survey

10 Survey Demographics: 2071 Respiratory Therapist & 1650 Nurses & Managers

11 Nuisance Alarms Biggest Issue Answer Options Strongly agree Agree Neutral Disagree Strongly disagree Percent Count 30.8% % % % % % 28

12 Alarm Management Improvement: Integration and Communications Systems Answer Options Strongly agree Agree Neutral Disagree Strongly disagree Percent Count 17.3% % % % % 97

13 Alarm Management Improvement: Smart Alarms Answer Options Strongly agree Agree Neutral Disagree Strongly disagree Percent Count 22.1% % % % % 13

14 Priorities

15 Demographic Differences Between 2006 and 2011 Surveys Titles the percent response from RNs dropped 51.1% in 2006 and 32.5% in 2011 while Respiratory Therapy increased 14.1% to 50.9%. Clinical engineer and BMET both dropped in percentage response 5.9%/8.6% in 2006 and 2.1%/3% in 2011 respectively. Healthcare experience More experienced staff responded to the 2011 survey with an increase in experience level for 11+ years 65.8% in 2006 and 78.8% in 2011

16 Question Differences Between 2006 and 2011 Surveys Question Nuisance alarms occur frequently: 81% 76% 8. Nuisance alarms disrupt patient care: 77% 71% 11. Properly setting alarm parameters and alerts is overly complex in existing devices: 26. Clinical policies and procedures regarding alarm management are effectively used in my facility: 27. There is a requirement in your institution to document that the alarms are set and are appropriate for each patient: 28% 21% 66% 55% 76% 71%

17 New Question: Adverse Events Answer Options Yes No Not sure Percent Count 17.9% % % 1833

18 New Question: Centrally Located Monitor Watchers Answer Options Yes No Not sure Percent Count 46.8% % % 327

19 New Question: Alarm Improvement Initiatives Answer Options Yes No Not sure Percent Count 21.1% % % 1775

20 Key Results and Recommendations A high priority must be placed on the reduction of nuisance alarms. Manufacturers, clinicians, healthcare leadership, government agencies, and clinical engineering must focus on this area. As has been discussed in numerous professional and lay press articles, nuisance alarms lead to alarm fatigue and adverse events. The very high level agreement with Question 6 Alarm sounds and/or visual displays should be distinct based on the parameter or source. points to consideration by standards organizations to discuss this requirement for future systems.

21 Key Results and Recommendations Smart alarms are viewed as being advantageous in reducing false alarms and improving response to alarms. This area needs novel solutions to develop new methods that leap frog current technology. Central alarm management is viewed as advantageous and many institutions utilize monitor watchers. Hospitals should consider this approach in the developing alarm strategies.

22 Key Results and Recommendations Clinical alarm improvement efforts need to be stepped up in healthcare institutions. The responses show a minority of hospitals addressing this need. Adverse events related to clinical alarm issues were reported by 1 in 5 responders. This causative factor of adverse events may not be fully reported to the FDA.

23 Key Results and Recommendations A large proportion of the responders were unsure if adverse events had occurred in the last 2 years and unsure if there had been new solutions to improve alarm safety at their facility. Improved and open communication is needed in healthcare related to these critical issues. A systems approach is needed to address the complexities of clinical alarm issues in healthcare. The effort needs to involve all stakeholders in developing solutions.