Ca rdio pulmo na ry Mo nito rs a nd the Mo nito r Ove rsig ht Co mmitte e : L e a rning fro m the Childre n's Na tio na l Me dic a l Ce nte r E xpe rie nc e Je ff Ho o pe r MS, Dire c to r o f Bio me dic a l E ng ine e ring He a the r Wa lsh MSN RN PCNS-BC, Simula tio n Outre a c h Co o rdina to r Pre se nta tio n fo r HT SI April 25, 2013 1
Childre n’ s Na tio na l Me dic a l Ce nte r • 310 Be ds • 6,000 e mplo ye e s • L e ve l 3 NI CU a nd T ra uma Ce nte r • Physic ia ns a re ho spita l e mplo ye e s • E ve ry inpa tie nt b e d ha s a physio lo g ic mo nito r • Sta nda rdize d o n Philips I nte llivue mo nito rs 2
Our Sto ry • Ho w se ve ra l mo nito ring e ve nts le d to the c re a tio n o f a mo nito ring c o mmitte e . Po o rly de sig ne d pro c e sse s o r a c tive e rro rs within a Sig nific a nt we ll-de sig ne d pro c e ss e ve nts o r injurie s Ac tive e rro rs b y individua ls re sult in initia ting a c tio n(s) “Sa fe ty is a Dyna mic No n-E ve nt ” Slide c o nc e pt a da pte d fro m Ja me s Re a so n, Managing the Risks o f Organizatio nal Ac c ide nts , 1997 3
Ba c kg ro und • Mo nito r e ve nt • Adde d Ce ntra l Sta tio ns in a ll Ac ute Ca re units 4
Ba c kg ro und • Mo nito r e ve nt • Adde d pa tie nt c a re te c hnic ia n to wa tc h the mo nito r & “no tify” RNs o f a la rms 5
Ba c kg ro und • Mo nito r e ve nt • Ano the r e ve nt, RN pho ne s with a la rm no tific a tio n • Visua l c ue s (do me lig hts) 6
Ba c kg ro und • Mo nito r F lo w 7
Ba c kg ro und • Ano the r e ve nt- a ssumptio n tha t a ll a la rms se nt no tific a tio n to RN pho ne s; PCT did NOT c a ll & RN una wa re tha t pa tie nt ha d multiple ye llo w a la rms 8
Ba c kg ro und • ** All se rio us mo nito r e ve nts we re pa tie nts with a tra c he o sto my. 9
T he Birth o f the Mo nito r Ove rsig ht Co mmitte e • Ne e d fo r a ssure pre vio us te c hno lo g y so lutio ns we re still via b le • Clinic a l invo lve me nt to c re a te mo nito r sta nda rds a ro und a la rm ma na g e me nt, de fa ult pa ra me te rs, re se a rc h , e duc a tio n, a nd pro c e ss impro ve me nt 10 10
T he Birth o f the Mo nito r Ove rsig ht Co mmitte e De ve lo p a c ha rte r a nd “sho p” to va rio us c o mmitte e s to g a in sta ke ho lde rs. 11 11
T he Birth o f the Mo nito r Ove rsig ht Co mmitte e Me mbe r ship • Bio me dic a l E ng ine e ring • Ca rdio lo g y • Critic a l Ca re Me dic ine • Ho spita list Divisio n • I nfo rma tic s • L e a de rship • Me dic a l Unit Dire c to rs • Nursing Sa fe ty Dire c to r • Nurse s (a c ute & c ritic a l c a re , E D, & PACU) • Pe rfo rma nc e I mpro ve me nt 12 12
T he Birth o f the Mo nito r Ove rsig ht Co mmitte e • Ane c do ta lly, sta ff e xpe rie nc ing mo nito r fa tig ue • Disc o ve re d a wo rka ro und tha t wa s ha ppe ning in re spo nse to mo nito r fa tig ue 13 13
T he Birth o f the Mo nito r Ove rsig ht Co mmitte e • Se ve ra l studie s a b o ut mo nito ring in o ur institutio n • Study re sults no t tra nsla te d into c linic a l pra c tic e 14 14
• Ane c do ta lly, mo nito r te c h ro le no t e ffe c tive • Ac c o unta b ility ide ntifie d a s a c o nc e rn 15 15
T he Birth o f the Mo nito r Ove rsig ht Co mmitte e T he Jo int Co mmissio n a nd the Asso c ia tio n fo r the Adva nc e me nt o f Me dic a l I nstrume nta tio n (AAMI ) F o unda tio n’ s He a lthc a re T e c hno lo g y Sa fe ty I nstitute (HT SI ) a nd the E CRI I nstitute suppo rt the ide a tha t he a lthc a re fa c ility le a de rs e sta b lish a la rm syste m sa fe ty a s a prio rity. 16 16
Go a l o f Co mmitte e T he mo nito ring c o mmitte e ’ s g o a l is to impro ve the sa fe ty a nd e ffe c tive ne ss o f physio lo g ic mo nito ring thro ug ho ut Childre n’ s Na tio na l while pro viding struc ture a nd o ve rsig ht to a ll mo nito ring re la te d issue s. 17 17
Co mmitte e Ob je c tive s • Re vie w a nd re c o mme nd b e st pra c tic e s fo r physio lo g ic mo nito ring • Re c o mme nd a nd imple me nt stra te g ie s to de c re a se (sta ff) mo nito r fa tig ue • Ac hie ve impro ve me nts in mo nito ring thro ug ho ut the o rg a niza tio n 18 18
Ac tivitie s • Cre a te d a mo nito r ma p to hig hlig ht the pro c e ss o f mo nito r o rde ring / initia tio n, ide ntifie d b e st pra c tic e s, a nd c o nc e rns ra ise d b y the pa tie nt c a re te c hnic ia ns. • Cre a te d five ne w pro file s with a g e a ppro pria te de fa ult pa ra me te rs • L o we re d a la rm vo lume s o n b e dside mo nito rs 3 le ve ls • L o we re d a la rm vo lume to the lo we st a udib le a t the c e ntra l sta tio n 19 19
Ac tivitie s • Upda te d mo nito r po lic y to b e spe c ific to a la rm ma na g e me nt, mo nito r te c h dutie s, a nd o ve ra ll ne e d fo r mo nito ring . • Adde d Ala rm F a tig ue tra ining to Ce ntra l Nursing Orie nta tio n • Philips tra ine d e nd use rs o n pro file c ha ng e s in a ll units • Pilo ting “mo nito r disc ussio ns” during ro unds to disc uss pa ra me te rs a nd c o ntinue d use 20 20
Co nduc te d a Surve y • Co nduc te d a surve y o f RN’ s a nd MD’ s to de te rmine the spe c ific issue s ne e ding a tte ntio n. T he surve y re c e ive d re spo nse s fro m 288 c linic ia ns (119 RNs, 116 MDs; o the rs inc lude d NPs, PAs, RT s, & PCT s) with the prima ry issue s ide ntifie d a s: o De fa ult mo nito r a la rm se tting s we re no t a ppro pria te o o muc h no ise o n the unit � a la rm fa tig ue o T o Ne e d fo r ne w pro file s re la te d to pa tie nt’ s a g e o Mo re e duc a tio n a nd a wa re ne ss o f mo nito rs o I na ppro pria te use o f mo nito rs o Sa fe ty c o nc e rns re la te d to e q uipme nt 21 21
Re sults fo r MD vs. RN T o p Sa fe ty Co nc e rns MD T op Safe ty Conc e r ns 45 41 40 35 30 25 21 20 18 20 15 11 10 7 5 5 4 5 2 1 1 0 T o p 3 MD Co nc e rns: Ala rm F a tig ue , L imits, & Misuse 22 22
Re sults fo r MD vs. RN T o p Sa fe ty Co nc e rns R N T op Safe ty Conc e r ns 30 28 24 25 19 20 14 15 10 10 9 9 10 8 5 4 4 5 2 1 0 T o p 3 RN Co nc e rns: Ac c ura c y, L imits, & Ala rm F a tig ue 23 23
Adjuste d Mo nito r Pa ra me te rs T he fo llo wing c ha ng e s we re ma de to impro ve the e ffe c tive ne ss o f the a la rms in 7E , 6E (GI ),5E , 4E , 4M & E R: •Ala rm vo lume s a t the c e ntra l sta tio n we re lo we re d thre e le ve ls •Ala rm vo lume s o f the mo nito rs in the ro o ms we re lo we re d thre e le ve ls •Six pro file s we re c re a te d b a se d o n a g e with ne w he a rt ra te a nd re spira to ry ra ng e s (mPE WS) •De sa t Ala rm wa s re duc e d fro m 90 to 88. No te – the Co mmitte e is a c tive ly mo nito ring CAT s a nd Co de Blue s with ne w mo nito r se tting s to a ssure tha t the ne w re sults ha ve a po sitive impa c t. 24 24
Adjuste d Mo nito r Pa ra me te rs ofile s - for Cur r e nt Pr ofile s NE W Pr MP5 E D & Ac ute Car e , e xc luding HKU 1. Ne o : (up to 1 mo nth) HR 180/ 80 RR 60/ 20 1. Ne wbor n (0-5 mo s.) HR 100/ 180 RR 20/ 70 2. Pe diatr ic : 1 mo nth- 9 ye a rs 2. Infant (6-11 mo s) HR 150/ 60 RR 30/ 20 HR 90/ 180 RR 14/ 50 3. (1-2 yrs.) T oddle r 3. Adult : > 9 ye a rs HR 80/ 170 RR 14/ 40 HR 100/ 50 RR 30/ 12 4. Sc hool age (3-9 yrs.) HR 65/ 135 RR 12/ 40 4. Comfor t : typic a lly use d fo r e nd o f life ; the mo nito r is se e n a t the c e ntra l sta tio n, b ut 5. Adole sc e nt/ Adult (10+) a ppe a rs b la c k in the ro o m HR 50/ 120 RR 12/ 30 6. Comfor t - will re ma in sa me 25 25
E duc a te d Use rs •Philips pro vide d flo o r b y flo o r e duc a tio n fo r 1 we e k to tra in use rs o n ho w to se tup ne w pro file s. •Nursing Orie nta tio n no w inc lude s e duc a tio n o n mo nito r a la rms a nd se tting pro file s. 26 26
Co nso lida te d Da ta Re vie w fro m mo nito rs •Bio me dic a l e ng ine e ring wa s se nding da ta to nursing le a de rship pre vio usly witho ut a na lysis a nd re vie w. •T he c o mmitte e no w re vie ws mo nthly da ta a nd a na lyze s fo r tre nds a nd se nds o ut summa ry a nd a c tio n info rma tio n. 27 27
Pre vio us Style Re po rts– 28 28
Sa mple Re po rt - dra ft– 29 29
Ne w Re po rt – Dra ft – 30 30
Sa mple Re po rt – 31 31
Sa mple Re po rt – 4Main Trend 6000 7 6 5000 5 4000 4 Counts 3000 3 2000 2 1000 1 0 0 2 2 2 2 2 2 3 3 3 2 2 2 3 1 1 1 1 1 1 1 1 1 1 1 1 1 - - - - - - - - - - - - - v y n l g t n r r p c b r u c p a a u o p u e a e e J O A M A M J N A D J F S Monitor Red Alarm CAT Calls CODE Calls 32 32
Sa mple Re po rt – 33 33
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