Improving Alarm Management Utilizing Technology NJ/DVHIMSS Annual Fall Event Empowering the New Healthcare Era 1
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How big a deal is this? Up to 350 alarms per day per patient! Ranks #1 on ECRI s 2014 Top 10 Technology Hazards List 2014 Joint Commission National Patient Safety Goal on Alarms The Joint Commission received 98 reports of alarm-related incidents including 80 deaths in the 3½ year period ending in June 2012. * * Too much noise from hospital alarms poses risk for patients, Washington Post, July 7, 2013 3
Alarm Fatigue Underlying Causes Units have high noise level and too many alarms Monitors, infusion pumps, ventilators, call bells, phones, etc. Alarm limits are not tailored for individual patient Poor skin prep and electrode placement Preventative maintenance/troubleshooting not done Lack of trust in the system 4
Reducing the Frequency of Nuisance Alarms Make alarms actionable Analyze unit default settings Tailor alarms per patient Alarm escalation plan Reinforce the high-urgency to address alarms Preventive maintenance Skin prep Proper electrode placement Routine battery replacement Routine electrode changes 5
Utilizing technology to improve alarm management Primary technology solutions to enhance alarm notification: Medical Devices Physiologic Monitoring Systems Telemetry Bed Exit Ventilators 6
Utilizing technology to improve alarm management Secondary technology solutions to enhance alarm notification: Enunciators Pagers Remote displays Phones 7
Utilizing technology to improve alarm management Alarm Integration Systems to enhance alarm notification Middleware is software that allows for communication and data management between different systems. 8
Alarm Integration Middleware As part of the response to The Joint Commission s NPSG on Clinical Alarms, many hospitals are now considering and some have already implemented alarm integration systems. Enhances alarm notification Creates larger care areas Provides for a more quiet environment Very automated! 9
Alarm Integration Middleware System Design Alarm Integration systems are complex Require a multidisciplinary approach Unique to each organization Should fit into the alarm management model of the hospital 10
Alarm Integration Middleware System Design Alarm Integration systems should fit into the care delivery model of the clinical unit Primary Alarm Alarms may come from one or more patients, depending on nurse:patient staff ratios in the clinical unit Primary Alarm Primary Caregiver Primary Caregiver Primary Alarm Decentralized Monitoring Surveillance 11
Alarm Integration Middleware System Design Alarm Integration systems should fit into the care delivery model of the clinical unit Primary Caregiver Primary Alarm Primary Alarm Secondary Notification Primary Alarm Monitor Watcher Decentralized Monitoring Surveillance Utilizing Monitor Watchers 12
Alarm Integration Middleware System Design Alarm Integration systems should fit into the care delivery model of the clinical unit Primary Caregiver Primary Alarm Secondary Notification Secondary Alerting Middleware Nurse:Patient and Nurse:Comm Device Assignments Decentralized Monitoring Surveillance Utilizing Alarm Middleware 13
Alarm Integration Middleware System Design Alarm Integration systems should fit into the care delivery model of the clinical unit Primary Caregiver Nursing Unit 1 Primary Alarm Nursing Unit 1 Monitor Watchers Primary Alarm Nursing Unit 2 Centralized Monitoring Surveillance Primary Caregiver Nursing Unit 2 Primary Caregiver Nursing Unit 2 14
Alarm Integration Middleware System Design Alarm Integration systems should fit into the care delivery model of the clinical unit Primary Caregiver Nursing Unit 1 Primary Alarm Nursing Unit 1 Primary Alarm Nursing Unit 2 Secondary Alerting Middleware Nurse:Pat & Nurse:Comm Device Assignments Primary Caregiver via Communication Device Nursing Unit 1 Primary Caregiver via Communication Device Nursing Unit 2 Primary Caregiver Nursing Unit 2 Monitor Watcher notifies caregivers of other alarms Centralized Monitoring Surveillance with Alarm Middleware 15
Alarm Integration System Design The building blocks End Devices Middleware Alarm Source Communication Engine 16
Alarm Integration System Design Alarm Source Physiologic Monitors Ventilators Nurse Call Infusion Pumps Middleware Systems that collect the alarm information from the primary alarming devices Prioritization of incoming alarms/alerts Customizable by the hospital to fit their needs Reporting abilities Nursing assignments Escalation schemes 17
Design Team Get the right team together A good team will incorporate both internal and external team members Internal - Facilities, Clinical Engineering (CE), Nursing, Clinical staff, IT External Staff from middleware, medical device vendor, communication systems vendor 18
Key Functionality to Focus Prioritization Escalation Reporting Managing Assignments 19
Alarm Escalation Crisis Alarm Escalation Scheme Things to consider Points of delays Acknowledgement of time delays Silencing alarms at primary alarming devices Pulse Oximetry Escalation Scheme can be different if not considered a high-priority alarm Add an initial delay to primary nurse to see if alarm resolves Silencing delays to primary device may be longer 20
Alerting Middleware May Be Part of a Larger Secondary Alerting Application Patient Monitors/ Telemetry Smart Beds Fetal Monitors IV Pumps Others Nurse Call Messaging Middleware PCD Manager Message Org Color Code Early Warning System Lab System Associations: Patient, Nurse, Phone Prioritization Routing Escalation Complex Event Processing Telephone System Call Manager Personal Communication Device (PCD) Environmental Other EMR Interactive Patient Education Staff Assignments Time&Attendance/ Scheduling/Absence Mgmt Public Telephone Network 21
Thinking of Implementing? Issues to Consider Architectural layout Nurse to Patient ratio Technology limitations Testing, testing and testing Possible Suppliers Philips/Emergin Vocera Cerner Extension AMCOM Ascom Globestar Amplion Cardiopulmonary Corp Quickly evolving supplier field! 22
Scenario for what kind of communication is needed Messaging Middleware Options Personal Communication Devices Care Models Functionality Prioritization Routing Escalation Assignments Text Msg. Logging and Reporting Texting Two way or ack Telephony Paging Display Prioritization Device Assignments Logging and Reporting Staff Scheduling and Assignments Nurse Call Monitor Watchers and Voice Communication only Monitor Watchers and Text Communication only Delivery of alerts on nurse phones via voice calls Clinician call back for alert info Manual escalation by monitor watcher Delivery of alerts on nurse phones via text message Clinicians to acknowledge receipt of alert Automated escalation if no acknowledgement Monitor watchers and automated alerts Customizable alert configuration with automated escalation 23
Consider a road map for your implementation Foundation Phase Establish Implementation team and support structures Customize Middleware and business rules Analyze your wireless infrastructure Pilot Establish a test site Maturation Scale the Middleware and introduce multiple units Create specific business rules / unit Continue analysis of wireless infrastructure Establish failsafe methodologies to mitigate large scale failure 24
What s Next? Collect Alarm Load Data Via your middleware Work within the care unit to further encourage frontline staff to tailor alarm limits per the patient s intrinsic value, complying with policies that have been established for that unit. Once policies and protocols are in place, go back after a periodically and recollect data to see the effectiveness of the implemented strategies. Key is to always evaluate and modify strategies to produce effective results 25
For More Alarm Information: Rikin Shah 610 825 6000, ext. 5611 rshah@ecri.org Rob Maliff 610 825 6000, ext. 5130 rmaliff@ecri.org ECRI Institute s Alarm Safety Resource Site https://www.ecri.org/forms/pages/alarm_safety_resource.aspx 26