alarm management: understanding and addressing the...

Samantha Jacques, PhD, FACHEDirector, Biomedical EngineeringTexas Children’s Hospital

Alarm Management: Understanding and Addressing the Ecosystem

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Texas Children’s Hospital• Hospital System

• Tertiary Care Hospital• Community Hospital• 4 Health Centers• 5 MFM/OBGyn clinics• 50+ primary care pediatric practices

• 650 Licensed Beds• 173 NICU beds• 118 ICU (including CVICU)• 289 Acute Care/IMU/Rehab• 70 L&D/MBU

• FY 2014 Stats• 117,275 EC Visits• 32,446 Admissions• 189,057 Patient Days• 27,945 Surgeries

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Hurdles in the Long Distance Race

4

Data is not easy to come by

Little Literature or Evidence Based Guidelines on Alarms

One Size Solutions do NOT fit all situations/ units/ institutions

Culture isn’t easy to change

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Multi - Factorate Alarm IssuesAlarm Settings, Limits and Delays

Artifacts

Clinical Population

Staff

Patients

• Prioritize Alarms• Review Settings and Limits• Evaluate Secondary notifications,

delays and escalations

• Review Electrode Choice, Prep, Placement and Replacement Schedule

• Evaluate standard alarms by patient population (Evidence Based)• Set alarms individually by patient

• Educate Staff (Nurses and Physicians)• Enable/Empower to change limits

• Educate Families• Enable/Empower to speak up

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TCH Alarm Management Journey

• High• Medium • Low

Priorities

• Limits by Age and Unit

Thresholds• Delays• Escalations

Secondary Notifications

Reduced Quantity of Alarms by 66%

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Meet Nurse Nancy• Nancy is a Progressive Care (Step down unit) nurse with

15 years experience‐ She is assigned three patients for her 12 hour shift by the unit

charge nurse

• 8yo Cystic Fibrosis patient post lung transplant

• 2 year old on renal patient post pheresis

• 11 month old post heart surgery

‐ Monitors are set with following alarm parameters:

SPO2 HR RR

8 year old 93 – 100% 55 – 85 bpm 12 – 18 brpm

2 year old 93 – 100% 70 – 110 bpm 20 – 30 brpm

11 month old 93 – 100% 80 – 120 bpm 25 – 40 brpm

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• In ONE shift Her patients have a total of 336 alarms –• On average she spends 14% of her shift in ALARM FLOOD – (more than 10 alarms in 10 min)• This day she experienced 7 Floods – 2:25 hours of her shift

• Nancy cannot prioritize how to deliver care during a flood – high risk environment• Secondary notification – Greater than 50% of her messages are “warning” or “crisis”• She only has 70 min of alarm “silence”

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Lessons Learned

•Alarms Happen for unusual reasons – need to understand environmental factors

•Limits set by Age and Unit should be data driven – physiological “normal” based on literature may not be appropriate for the UNIT population – e.g. Respiratory Floor/ Cardiovascular Floor

•Limits by Age and Unit allow better baseline for UNIT, but don’t necessarily match INDIVIDUAL PATIENT NEED

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A New Way

•Real Time Analytics Dashboard Approach‐Unit‐Nurse‐Patient

•Uses‐Historical Information‐Track changes from PDSA cycles‐Nurse Assignments‐Leverage real time data to make clinical decisions on alarm settings on an INDIVUIDUAL PATIENT

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Unit Dashboard

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Unit Dashboard – Deep Dive

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Unit Dashboard – Bed View

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Unit Dashboard - Nurse Assignment

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Patient Specific Dashboard

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Patient Specific Dashboard – Deep Dive

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Patient Specific Dashboard – Deep Dive

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Workflow Nurse Manager uses report to Set Nurse

Assignments

Nurse Manager then highlights patients for

Rounds Review

During Rounds, Clinical team Reviews High Alarming Patients

Clinical Team makes decision

to keep or change alarm limits (orders updated)

At Shift Change: Nurse Manager

Runs Unit Report

Improves Safety –reducing likelihood of alarm floods

Reduces Alarm VolumeImproves Patient Satisfaction

Live Demo

Questions

[email protected]

alarm management: understanding and addressing the...

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