From the National Coalition for Alarm Management Safety A case - - PowerPoint PPT Presentation
April 17, 2017 12pm to 1pm From the National Coalition for Alarm Management Safety A case study from Rush Medical Center Obtaining Baseline Alarm Data and Reducing Non- Actionable Alarms Stephanie Orr DNP, RN, CCRN Rush University
April 17, 2017 12pm to 1pm
From the National Coalition for Alarm Management Safety A case study from Rush Medical Center Obtaining Baseline Alarm Data and Reducing Non- Actionable Alarms
Stephanie Orr DNP, RN, CCRN Rush University Neuroscience Intensive Care Unit Rush University Medical Center
Vision: To drive the safe adoption and safe use of healthcare technology Complimentary Resources: www.aami.org/thefoundation
Patients on Opioids
Alarm
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Stephanie Orr DNP, RN, CCRN Rush University Neuroscience Intensive Care Unit Rush University Medical Center
ST E PHANI E ORR DNP, RN, CCRN RUSH UNI VE RSI T Y NE UROSCI E NCE I NT E NSI VE CARE UNI T RUSH UNI VE RSI T Y ME DI CAL CE NT E R
Re vie w b e nc hma rks a nd re c o mme nda tio ns
fo r a la rm sa fe ty surve illa nc e pro g ra m
De sc rib e me tho ds o f o b ta ining b a se line
a la rm da ta in a b se nc e o f middle wa re te c hno lo g y
Disc uss e le me nts o f a la rm sa fe ty surve illa nc e De sc rib e Sta ff e duc a tio n: utilizing E
BP to re duc e e xc e ssive a la rms
Disc uss e va lua tio n o f a la rm sa fe ty pro je c t
E
xpo sing c linic ia ns to a n e xc e ssive a la rms de se nsitize s the m to the a la rms a nd c a n c a use the m to miss a la rms. (Se nde lb a c h, 2013)
Curre nt e vide nc e suppo rts spe c ific nursing
pra c tic e s to impro ve a la rm sa fe ty a nd re duc e a la rm b urde n. (AACN, pra c tic e a le rt 2013)
Ala rm sa fe ty e xpe rts re po rt tha t da ily le a d
c ha ng e s re duc e a la rm b urde n in I CUs b y 46%. (Cva c h, 2012)
Ala rm re po rts a nd sta ff e duc a tio n a re
funda me nta l to q ua lity impro ve me nt re la te d to a la rm sa fe ty. (Co spe r, 2017)
Chic a g o , I llino is
Rush Unive rsity Me dic a l Ce nte r Sta ke ho lde rs Pilo t pro je c t a re a Stre ng ths We a kne sse s I
nte rdisc iplina ry c o mmitte e
Co mpe ting pro je c ts
Pa tie nts Nursing le a de rship Clinic ia ns Clinic a l E
I
Risk Ma na g e me nt T
2014 a g g re g a te a la rm da ta wa s c o lle c te d fro m
se rve rs via o ne time middle wa re c o nsult
Ala rm b urde n in the pilo t I
CU wa s 80a la rms/ pa tie nt/ da y
T
he mo st fre q ue nt a la rms we re ar
tifac t a nd leads
De fa ult se tting s fo r a rrhythmia a nd b a sic
pa ra me te rs de te rmine d b y ho spita l le a de rship
Po lic y de fine s te rmino lo g y, re spo nsib ilitie s, a nd
e xpe c ta tio ns fo r a la rm sa fe ty.
Nursing Sta nda rds o f Ca re
20 40 60 80 100 120
Ala rms pe r b e d pe r 24hr
866 351 5995 6977
PVC a pne a le a ds o ff a rtifa c t
500 1000 1500 2000 2500
T
PVC Apne a L e a ds o ff a rtifa c t
T his Jo int Co mmissio n e duc a tio na l po ste r (2013) a sse rts tha t a la rm b urde ns in e xc e ss o f 100 pe r pa tie nt/ da y c o ntrib ute to pa tie nt sa fe ty e ve nts. Ala rms sho uld b e me a ning ful a nd sig na l a n a ppro pria te re spo nse .
Ala rm b urde n: o b ta in #
a la rms/ pa tie nt/ da y
% o f mo nito re d pa tie nts with ide ntifie rs F
re q ue nc y a nd type s o f c usto mize d limits
F
re q ue nc y o f type s o f disa b le d a la rms
% o f a la rm sa fe ty do c ume nta tio n o f
le a ds c ha ng e d q 24hr
% mo nito ring ide ntifie d in E
HR
8 Ra ndo m shifts inc luding nig hts a nd we e ke nds Re vie we d c e ntra l sta tio n mo nito r e ve nt re po rts
a nd E HR do c ume nta tio n fo r e ve ry pa tie nt o n the unit during the da ta c o lle c tio n pe rio d
Da ta po ints fo c use d o n me a suring o rg a niza tio na l
po lic y po ints a nd b a sic a la rm me tric s
Ave ra g e c e nsus 25 Avg time 12 hr pe r 100 c a se s Da ta c o lle c tio n o c c urre d 1x/ we e kly o ve r c o urse 2
mo nths
Ce ntra l sta tio n E
a c h pa tie nt file re vie we d fo r e le me nts o f a la rm sa fe ty pe rta ining to o rg a niza tio na l po lic y a nd pro c e dure
Custo mize d limits a re no te d b y le ve l a nd type Surve illa nc e inc lude d a ny disa b le d a la rms Re vie w numb e r o f a la rms/ pa tie nt/ da y via the
sto re d a la rm e ve nts fo r pre vio us 24 ho urs to de te rmine a la rm b urde n
E MR wa s a udite d fo r do c ume nta tio n o f mo nito ring , a la rms o n, a nd le a d c ha ng e s
I
ntro duc e e vide nc e b a se d pra c tic e
Hig hlig ht o rg a niza tio na l po lic y T
ime a nd c o nte nt fo r sta ff e duc a tio n is ke pt b rie f
Utilize visua l re minde rs o f a la rm sa fe ty
in sta ff a re a s
E
vide nc e o f le a rning is e va lua te d b y q uiz a nd a la rm sa fe ty surve illa nc e da ta
Collec t alar
m data inc luding : a la rm type , fre q ue nc y, a nd
re a so ns why a la rm so unde d
Co nduc t o b se rva tio ns o f ho w a la rms a re ma na g e d o n a
individua l units, identify tr
ends and safety c onc er ns.
I
de ntify the g o a l o r o utc o me me a sure s tha t will g uide q ua lity impro ve me nt.
Implement pr
ategies that inc lude: pr
skin pr ep & lead plac ement, daily lead c hanges, c ustomize limits for individual patient par ameter s as deter mined by patient c ondition and tr eatment goals.
Pro vide o ng o ing sta ff e duc a tio n a nd suppo rt a b o ut a la rm
e na b le d pa tie nt c a re e q uipme nt a nd a la rm sa fe ty.
De ve lo p pa tie nt c a re unit po lic ie s a nd pro to c o ls tha t
a ddre ss a c c e pta b le a la rm sa fe ty stra te g ie s fo r c linic a l mo nito rs.
Metr ic pr e post
Ala rm b urde n 80 59 % pa tie nt ide ntifie rs 94% 92% % c o rre c t se tting 96% 98% % c usto mize d limits 84% 89% % disa b le d a la rms 91% 71% % le a ds c ha ng e d 10% 40%
T
he pilo t pro je c t impro ve d a la rm sa fe ty pra c tic e tre nds.
97% o f c a se s ha d the c o rre c t se tting
84% o f c a se s ha d c usto mize d limits.
20% de c re a se in disa b le d a la rms. 27% de c re a se in a la rm b urde n. 30% inc re a se in do c ume nta tio n fo r c ha ng ing
le a ds
T
he pilo t pro je c t ide ntifie d pra c tic e tre nds tha t inspire d furthe r disc ussio n a nd future q ua lity initia tive s.
I
nc lude a la rm b urde n a nd surve illa nc e o f pra c tic e tre nds a s pa rt o f the
I
nc lude re vie w o f a la rm sa fe ty po lic y a nd pra c tic e e xpe c ta tio ns in a nnua l sta ff tra ining re q uire me nts.
I
nc lude b a sic a la rm sa fe ty me tric s in unit b a se d q ua lity re po rts a s fe e db a c k to sta ff.
Pro mo te a la rm sa fe ty a s pa rt o f the
g e ne ra l c ulture o f sa fe ty a nd re info rc e with visua l re minde rs.
Po lic y & de fa ult pa ra me te rs De fining c usto miza tio n Ana lyzing a la rm flo o ds E
E
No ise le ve ls a nd the e vide nc e fo r
Se nde lb a c h, S. & F unk, M., (2013) Ala rm fa tig ue : A pa tie nt sa fe ty c o nc e rn.
AACN Advanc ed Cr itic al Car e, 12(4), Oc to b e r/ De c e mb e r 2013, p 378-386.
do i: 10.1097/ NCI .0b 13e 3182a 903f9
Cva c h, M., (2012) Mo nito r a la rm fa tig ue : An inte g ra tive re vie w. Biomedic al
Instr umentation & T ec hnology, July/ Aug ust 2012, p.268-277
Gra ha m, K ., Cva c h, M. (2010) Ala rm fa tig ue : Sta nda rdizing use o f physio lo g ic a l mo nito rs a nd de c re a sing nuisa nc e a la rms. Ame r ic an Jour nal
itic al Car e Nur sing, 2010; 19(1) p. 28-34 do i: 10.4037/ a jc c 2010655
Wha le n, D.A, Co ve lle , P.M., Pie pe nb rink, J.C., Villa no va , K .L ., Cune o , C.L ., Awtry, E .H. (2014). A no ve l a ppro a c h to c a rdia c a la rm ma na g e me nt o n te le me try units. Jour nal of Car diovasc ular Nur sing 29(5), pE 13-E 22
T he Jo int Co mmissio n (2013) Ala rm syste m sa fe ty. R3 Re po rt: Re quire me nt, ratio nale , re fe re nc e . I ssue 5. http:/ / www.jo intc o mmissio n.o rg
AACN prac tic e ale rt: NT I Ac tio nPak. Ala rm ma na g e me nt pe rfo rma nc e impro ve me nt pla n: a ste p b y ste p g uide , 2013. Amer
ic an Assoc iation of Cr itic al Car e Nur
/ www.aac n.o rg
Co spe r, P., Ze lling e r, M., E ne b o , A., Ja c q ue s, S., Ra zza no , L ., a nd F la c k, M. (2017). I mpro ving c linic a l a la rm ma na g e me nt: Guida nc e a nd stra te g ie s.
Biomedic al Instr umentation & T ec hnology, Ma rc h/ April 2017, p. 109-115
NACNS Ala rm F a tig ue T
re so urc e s/ to o lkits-a nd-re po rts/ a la rm-fa tig ue -to o lkit/
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