The need to improve the safety of clinical alarm systems is a longstanding patient safety consideration. Alarm improvement efforts to date have largely focused on the alarms generated by physiologic monitoring systems – and with good reason: these alarms make up the bulk of the alarm load in many clinical care areas. But alarm management efforts cannot stop there.
Alarm management teams should be using the lessons learned from their existing alarm improvement efforts to address the hazards associated with other alarm-equipped medical devices, such as intensive care ventilators. That’s the recommendation made by ECRI Institute in its recently released Top 10 Health Technology Hazards for 2017. Topic number three on this year’s list highlights the risks associated with ventilator alarms and discusses how organizations can adapt their alarm management programs to address the unique needs of this technology.
Ventilators are critical life-support devices, delivering positive-pressure breaths to patients who require total or partial assistance to breathe. Thus a missed alarm, signaling a problem with either the patient or the machine, could lead to severe patient harm or death.
Causes of missed ventilator alarms or unrecognized alarm conditions include:
Ultimately, efforts to improve the safety of ventilator alarm systems must balance the same two opposing needs as with physiologic monitoring systems:
With ventilators, achieving this balance can be particularly challenging. Factors that complicate the process include the need for the devices to identify subtle changes in a patient’s condition, inconsistent terminology among ventilator manufacturers, exhaustive choices for setting alarms, variability in transmitted data, and the lack of a central location for studying all ventilator data.
ECRI Institute Recommendations
ECRI Institute’s report recommends four steps to help healthcare facilities overcome the challenges associated with ventilator alarm management:
First, initiate a comprehensive, multidisciplinary effort to address the challenges associated with ventilator alarm management.
“This effort should be spearheaded by the existing alarm management committee,” notes Ramya Krishnan, a senior project officer in ECRI Institute’s Health Devices Group, “but additional stakeholders, such as respiratory therapists and other clinicians who routinely address and support ventilator alarms, should also be represented on the committee.”
Second, understand how respiratory monitoring and ventilator alarms are used at your facility, focusing on the alarm load in each care area and the effectiveness of the established notification pathways. A successful alarm management program will require identifying where your vulnerabilities lie and developing appropriate strategies to limit the hazards.
To gain this understanding, observe how the many different alarms are handled in each care area, review your reports of adverse events and near misses, and assess the care area for factors that could be hindering staff recognition of or response to ventilator alarms. Consider collecting and analyzing alarm data to obtain a quantitative measure of the number and types of alarms that activate per device within a care area. This latter step can be accomplished by accessing alarm log data from individual ventilators or by using third-party alarm analytics software.
Third, identify and implement strategies for reducing the alarm load. Using the information that you’ve collected, identify the nonactionable alarms – those that don’t require a clinical response – and work with frontline staff to identify and implement appropriate strategies for reducing the number of these alarms in each care area.
“Adopt tools to facilitate compliance with good practices, including guides for optimal alarm settings for different treatment goals and patient conditions,” advises Jaime Schlorff, a senior project officer in ECRI Institute’s Health Devices Group. “In addition, utilize available ventilator functionality to improve patient-ventilator synchrony. Many ventilators offer advanced capabilities that, when used appropriately, can ventilate the patient in a more effective or comfortable manner.” This could result in fewer alarms or faster weaning, allowing the patient to be removed from the ventilator more quickly.
Fourth, identify and implement strategies to improve staff awareness of ventilator capabilities, effective utilization of device capabilities (e.g. ventilation modes and options for setting parameters), and appropriate responses to ventilator alarms. This might involve investigating whether to adjust staffing levels or staff deployment to improve responsiveness to the needs of ventilator patients. In ECRI Institute’s experience, assigning respiratory therapists to a specific care area, rather than having them float between multiple care areas, leads to the best alarm and patient response.
Additionally, a healthcare facility might want to consider enhancing notification of ventilator alarms with secondary notification pathways, such as interfacing with nurse call or patient monitoring systems or implementing an ancillary alarm notification/alarm integration system. It is important to recognize, however, that the available alternatives have limitations, and facilities must test such notification pathways thoroughly before implementation.
This article supplements ECRI Institute’s Top 10 Health Technology Hazards for 2017. An Executive Brief of the report can be downloaded from ECRI Institute as a free public service. The full report, which includes detailed problem descriptions and recommendations for addressing the hazards, requires membership in certain ECRI Institute programs or separate purchase. For more information, visit www.ecri.org/2017hazards, or contact ECRI Institute by telephone at 610-825-6000, ext. 5891, or by email at firstname.lastname@example.org.
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