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
AAMI Foundation Vision: To drive the safe adoption and safe use of healthcare technology Complimentary Resources: www.aami.org/thefoundation • National Coalition for Infusion Therapy Safety • National Coalition to Promote Continuous Monitoring of Patients on Opioids • Compendium: Opioid Safety & Patient Monitoring • National Coalition for Alarm Management Safety • Compendium: AAMI Foundation Management of Clinical Alarm
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Speaker Introduction Stephanie Orr DNP, RN, CCRN Rush University Neuroscience Intensive Care Unit Rush University Medical Center
Obtaining Baseline Alar m Data and R educ ing Non- Ac tionable Alar ms 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
Ob je c tive s 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
L ite ra ture Re vie w 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)
llino is Chic a g o , I
E nviro nme nta l surve y 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
Sta ke ho lde rs in a la rm sa fe ty Pa tie nts Nursing le a de rship Clinic ia ns Clinic a l E ng ine e ring I nfo rma tio n Se rvic e s/ T e c hno lo g y Risk Ma na g e me nt T e c hno lo g y re pre se nta tive s/ E q uipme nt ve ndo rs
Ba se line da ta 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 off 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
Ala rms in the a dult I CUs, 2014 Ala rms pe r b e d pe r 24hr 120 100 80 60 40 20 0
2014 RUMC a la rm da ta 2500 PVC a pne a T o p a la rms pe r unit le a ds o ff a rtifa c t 866 351 2000 1500 1000 6977 500 5995 0 PVC Apne a L e a ds o ff a rtifa c t
Wha t is o ur c urre nt a la rm b urde n? 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 Sa fe ty Surve illa nc e Me tric s 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
Org a niza tio na l po lic y
Da ta c o lle c tio n 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
Me tho d o f o b ta ining a la rm da ta 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
Ala rm sa fe ty surve illa nc e to o l
Ala rm sa fe ty pra c tic e tre nds
Sta ff E duc a tio n: K e y Po ints 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
AACN Alar m Management Guidelines 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 oac tive str ategies that inc lude: pr oper 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.
Ala rm Sa fe ty Sta ff duc a tio n E
E va lua tio n: pilo t pro je c t pra c tic e me tric s 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%
Pilo t pro je c t o utc o me s a nd c o nc lusio ns 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.
Re c o mme nda tio ns 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 o rg a niza tio na l a la rm sa fe ty stra te g y. 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.
I mplic a tio ns fo r a dva nc ing a la rm sa fe ty 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 sta b lishing a n a la rm sa fe ty ro utine fo r QI E nha nc ing c ulture o f sa fe ty: ro unds a nd b e dside re po rt No ise le ve ls a nd the e vide nc e fo r “q uie t time ”
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