Alarm management in a long-term care environment
Whether it's in a hospital or nursing home, alarm proliferation is a well-documented patient safety threat that also disrupts workflow and quality of patient care. Respiratory therapists and registered nurses are forced to respond to hundreds of daily alarms — the majority of which end up as non-actionable, requiring no intervention. This leads to alarm fatigue and disruption from their primary job: engaging with patients.
This was the challenge we faced at the Hospital for Special Care. As an acute long-term care and rehabilitation facility, many patients at HSC are active, which is typically good for their recovery process. However, the number of non-actionable alarms blaring daily — due to a tightly set alarm parameter or a patient talking/coughing or getting out of bed — was distracting to clinical staff and disruptive to patients.
We were concerned about alarm fatigue because our RTs have a lot of patient care responsibilities in addition to responding to ventilator alarms. To better understand and to begin getting this problem under control, we needed to leverage both technology and the expertise of interdisciplinary leadership. This involved clinical, IT, clinical engineering, and other departments to assess and evaluate which alarms were critical and which were nuisances or non-actionable.
We were able to reduce alarms by an estimated 80% on 100-plus ventilators. We achieved real-time surveillance of patients on ventilation support, and complied with the Joint Commission's National Patient Safety Goal of mandating that hospitals take definitive steps to implement policies and procedures to safely reduce and prioritize clinical alarms. But we wanted to do more.
Our goals included collecting and distributing real-time data from our ventilators, as well as pulse oximeters, for enhanced, continuous patient surveillance, and analyzing objective clinical data after any patient incident to assess response processes and preventative measures.
We also wanted to improve quality and reporting data. Prior to implementing our platform, HSC was dependent on individual recollections from clinical responders after an alarm incident. Today, can use the data provided by its platform to sort out the story behind any incident, increasing accuracy on occurrence reporting and resolution.
In addition, the data collected is used by Respiratory Care Services in reporting to the Performance Management Audit Committee, which monitors ventilator management performance, and also helps identify potential areas of need.
Finally, we wanted to eliminate the manual processes associated with ventilator checks, and automate the capture of all measured parameters (peak airway pressures, volumes, etc.) and settings. In addition to reducing the risk of transcription errors, ventilator check automation means that RTs spend less time completing documentation and more time engaging with patients.
Alarm management is a fundamental part of what we do. It's made a big difference in our staff's efficiency and effectiveness, and reduced stress for our patients and their families. Today, if you go on the unit it's very quiet relative to the number of ventilators in use—something the Joint Commission auditor noted during our last survey.
Achieving measurable progress in clinical alarm management requires a holistic approach. Technology certainly plays a critical role in alarm, but enterprise alarm management is a classic example of interdisciplinary leadership.
Connie Dills, MBA, RRT, RPFT, is Respiratory Practice Manager for the Hospital for Special Care in New Britain and Hartford, CT. Jeanne Venella, DNP, is Chief Nursing Officer for Bernoulli, in Milford, CT.