The AAMI Foundation has synthesized the knowledge, experience, and advice of leading practitioners into a toolkit designed to help health care organizations meet The Joint Commission’s National Patient Safety Goal on clinical alarms.
As of last month, The Joint Commission now expects hospitals to have established and implemented policies and procedures for managing clinical alarms, as surveyors will be documenting noncompliance to the second phase of the goal.
“Noncompliance will be a direct finding, and the organization will have to submit a plan for corrective actions. Noncompliance also will be posted on Quality Check,” said Ronald Wyatt, M.D., medical director of health care improvement for The Joint Commission. The Quality Check website provides detailed information about an organization’s performance and accreditation.
To assist in developing the necessary policies and procedures, the AAMI Foundation’s complimentary Clinical Alarm Management Compendium provides specific tips and outlines practices already being used by leading institutions. Among them are the following 10 ideas for safe alarm management:
• Issuing a call to action, championed by executive leadership, which recognizes the challenges, risks, and opportunities of alarm management, and committing to solving them.
• Bringing together a multidisciplinary team to spearhead action and build consensus.
• Gathering data and intelligence to identify challenges and opportunities.
• Prioritizing the patient safety vulnerabilities and risks to target with alarm management improvements.
• Setting and sharing goals, objectives, and activities to address these vulnerabilities and risks.
• Developing and piloting potential solutions.
• Evaluating the effectiveness of improvements and making adjustments as needed.
• Developing policies and procedures.
• Educating staff to build and maintain competencies.
• Scaling up and sustaining by creating ownership at the unit level and with continuous improvement.
In addition to outlining ways to implement these ideas, the compendium provides a set of default alarm parameters that could be used to benchmark alarm system settings. These parameters were developed from information reported in a survey conducted by the AAMI Foundation, and they represent responses from 17 of the 25 hospitals and health care system members of the National Coalition for Alarm Management Safety.
“No single institution has the ‘right’ answer that can be turned into an off-the-shelf solution. However, there is a lot we can learn from the practitioners who have been leading the way in meeting the complex challenges of alarm management for years. Their insights and best practices can be used to launch and guide an alarm management initiative, or strengthen one that’s already in progress,” said Marilyn Neder Flack, senior vice president of patient safety initiatives at AAMI and executive director of the AAMI Foundation.
AAMI Board Establishes New Foundation Fund for Research, Initiatives
With an eye on making further inroads toward patient safety, the AAMI Foundation now has a special fund that will support research and initiatives to develop lasting and creative solutions to some of today’s toughest healthcare technology challenges.
At its fall meeting, the AAMI Board of Directors voted to transfer – as a onetime, unrestricted gift in 2016 – $3 million from AAMI’s reserve to a new strategic priorities fund for the Foundation. In addition, the Board of Directors approved the transfer of another $495,000 to the Foundation to support five specific projects.
Marilyn Neder Flack, senior vice president of patient safety initiatives at AAMI and executive director of the AAMI Foundation, expressed her gratitude to the Board, saying the transfer gives new muscle to the work of those looking to make healthcare technology safer.
“The AAMI Foundation has been a leader in bringing together all stakeholders to solve long-standing issues associated with the safe and effective use of healthcare technology,” she said. “Now, in addition to continuing that work, we will be able to lead the national patient safety research effort in healthcare technology. I am extremely grateful to the Board for this visionary, generous, and impactful move.”
The five initiatives in line for the initial financial support of $495,000 are:
• A research project looking at “validated” medical device alarms sounds that will be incorporated into international standards and will have an impact on how all devices with alarm sounds are developed.
• The development of a cloud-based server to hold physiological waveform data and alarm signals. Such a server could revolutionize how alarm algorithms are developed, tested, and validated.
• The development of a toolkit to help hospitals ensure efficient and appropriate labeling of infusion lines with drug names and dates for change-outs.
• A project aimed at evaluating the feasibility of the Foundation launching two new initiatives: one focused on working with hospitals for safe adoption of electronic health records, and one that would involve working with hospitals to improve clinical education about complex technology.
• A project to evaluate the current and future state of infusion therapy in the home setting.
A research review committee will be established this year to assess the merits of proposals received by the Foundation in response to specific requests.
AAMI Board Chair Michael Scholla, global director, regulatory and standards, at DuPont, said his proudest accomplishment for AAMI in 2015 was the establishment of the $3 million strategic priorities fund for the Foundation.
“This is a significant sum – and also shows how far the Foundation has come in the past few years,” he said.
AAMI Kicks Off ‘Reliability-Centered Maintenance’ Project for HTM Field
AAMI has begun exploring whether an approach known as reliability-centered maintenance (RCM) is a feasible strategy that could be adopted on a wide scale throughout the field of healthcare technology management (HTM). After longtime clinical engineer Malcolm Ridgway approached AAMI with the idea, AAMI enlisted the guidance of HTM consultant Ken Maddock to help explore the possibilities.
“In the 1950s, the civil aviation industry pioneered a means of maintaining aircraft based upon analyzing the exact nature of the failures that actually occur, then focusing their maintenance activities on areas where they would be truly beneficial,” Ridgway said. “They called this method reliability-centered maintenance. Other high-reliability industries quickly followed suit, and during the latter part of the last century, military aviation, the entire aerospace industry, the nuclear submarine industry, and the nuclear power industry, among others, all adopted the RCM approach. HTM is the only high-reliability industry that has not yet adopted these very effective and highly efficient practices.”
For this to become a reality in the HTM world, Ridgway said that a scientifically solid, but simple-to-understand and credible, RCM-based method must be developed for determining which specific types of medical devices can truly be made safer through periodic scheduled maintenance. He added that time spent “performing inefficient and ineffective maintenance” should instead be spent on activities that truly improve patient safety.
Maddock stressed that the approach must be “clear, specific, and achievable” and must meet regulatory guidelines. With some exceptions, the Centers for Medicare & Medicaid Services (CMS) allow a hospital to “adjust its maintenance, inspection, and testing frequency and activities for facility and medical equipment from what is recommended by the manufacturer, based on a risk-based assessment by qualified personnel.”
CMS further notes that “hospitals electing to adjust facility or medical equipment maintenance must develop policies and procedures and maintain documentation supporting their alternate equipment management (AEM) program” and that “they must adhere strictly to the AEM activities and/or frequencies they establish.” As a result, a scientifically sound RCM approach could presumably fit within the allowances on equipment maintenance offered by CMS.
Maddock has proposed establishing a task force “to review materials in terms of their practicality and ability to be implemented across different business units.” The task force would also “help the plan to gain momentum and credibility.”
For more information, please visit www.aami.org.
