Q: Looking for some out of the box strategies for tracking and locating our temporary pacemakers. Any best practices or pitfalls you are willing to share would be appreciated.
A: We enlisted the help of the staff and offered a reward of a candy bar or Coke. It worked and most people went for the Coke.
A: When our PM is due for these, I always send out an email to all department managers and directors informing them of the performance check that is due and asking for assistance to locate and have them ready to be picked up. I generally throw a reminder in the email of the risk level that temporary pacemakers are. I generally find all 26 of ours.
A: M&Ms. It is amazing what people will do for M&Ms.
A: Here at UT, we have the RTL tracking system in place. The tracker attached to the unit will tell where the unit is at all times.
A: Tracking equipment is an FDA GMP requirement. Even for hospitals and it’s not limited to where the device is located. Device history and relying on the FDA’s databases helps meet tracking requirements.
Q: I got hit this morning by something that seemed so off-the-wall that I have decided to see if I’m the only one, or if I’ve been asleep. The facility recently had a risk management assessment performed by an outside company. One of that company’s actionable items was that we should be testing alarm audibility via objective measures such as decibels on our clinical equipment that has alarm settings. Testing alarms, verifying that they are audible, and ensuring that any alarm volume controls are working properly is old news, we all do it. What has me stymied is that this company is telling us that we should be quantifying exactly how loud they are. Considering that NIST-certified sound level meters seem to start at $400 and go up from there, it’s kind of irritating that my budget is going to get hit to purchase at least two of these. Am I the only one who hasn’t been doing this?
A: Forget NIST. Use the one that you can get for free with your iPhone.
A: This is not done on clinical alarms at our facility either. The only audible alarms that are quantifiably checked are fire alarm chimes.
A: We are not, but I wanted to also add that one has to be precise in where the sound level meter is physically located in respect to your monitor. Front, back or side … one foot away, two feet, five feet? Sound is like gamma radiation, the further away you are, the less loud it will be, all other things being equal.
A: We have been asked to do this on and off through the years. Most recently as part of the alarm management project. Part of the push has also been a recommendation from World Health Organization (WHO) for decibel levels in patient rooms from 1999 and studies from 2012 about the effects of higher levels on patient healing and recovery. However, their recommendations are lower than the construction guidelines. Through our testing we were able to verify that our baseline levels were within the construction guidelines, but higher than the WHO recommendations and there was nothing we could do to lower the levels without major renovations.
The alarms on our ICU equipment were found to be higher than recommended. The recommendation I found says that low level alarms should be 6-10 db over the baseline and high level alarms 15-16 db over. We were at 15 db over for low level and 30 db over for high level. However, the clinical staff did not want to lower these alarms because during peak times they did not feel they would be able to hear them. Instead of lowering the alarm volume we have been focusing on managing the alarms, which is what The Joint Commission is looking for anyway. We have been able to make a huge difference in the overall noise on the units.
A: I was able to find a sound meter from, I think MCM, for $30 or $40 and that is what I have been using to get baseline measurements in the units.
Follow Up: Based on the feedback received here, I just had a conversation with our risk manager. We are going to use phone apps. Since this is not a Joint Commission or CMS issue, but a recommendation by an outside risk-mitigation company, this should be a viable solution. It definitely will be once we start to build a baseline database for our clinical equipment.
I did already realize that I will have to designate a set “testing distance” that will need to be adhered to, and will also set it that all readings will be facing the front of the device undergoing testing.
I’ve also been told that we will have to do spot testing while the devices are in use. This opened up a heated discussion when I refused for my staff or I to manipulate any piece of equipment while it is connected to a patient simply for a test to mitigate risk! I have now been assured that any spot testing will be performed with my staff or myself being in the room, but nursing will be responsible for any device manipulations to make an alarm.