The Hospital for Special Care in Connecticut, a long-term acute-care facility, had a problem with alarm fatigue, particularly ventilator alarms that were almost constantly going off.
So the hospital purchased alarm management software to get the problem under control and improve patient comfort and safety. The software, from Bernoulli Enterprise, filters alarms and helps providers determine which types of alarms are most important.
There are many ways in which a patient on a ventilator and breathing through a trachea tube can set off an alarm. They many cough, reposition, talk, exhale as the ventilator is delivering a breath, or have secretions that can prevent delivery of a breath.
Every time an alarm sounded, it would also set off an alarm in the hallway, says Connie Dills, respirator practice manager at the Hospital for Special Care. Because there was no way to know if an alarm was indicating a truly a critical situation, nurses spent the day running around checking the patients; most alarms turned out to be non-actionable.
With the new software system, the hospital selected several core alarm metrics as the most important to monitor—low exhale volume, low inspiratory pressure, patient disconnect, no data flowing and loss of connectivity between the ventilator and Bernoulli.
Alerts are displayed at workstations, on laptops and pagers, on an LED board and via an audible overhead speaker. With the new software, the hospital has seen an 80 percent reduction in the number of alarms for which an immediate response is needed, Dills says.
Use of the Bernoulli software also supports new Joint Commission patient safety goals, which require nurses to conduct ventilator checks on each shift. The software generates reports that can show trends of alarms, a log of events and parameters on each ventilator.
Eliminating false alarms has enabled staff to respond quicker to what are perceived to be true emergencies. “Our response time is excellent,” Dills says. When an actionable alarm goes off, the response time is within 10 to 20 seconds.
Dills understands the reluctance of hospitals to pull out some specific alarms and focus on a core set because personnel in her hospital had their own qualms about that. “But if you don’t filter some alarms out, you won’t be better than before,” she advises. And nurses will keep running around checking alarms rather than checking patients. “So, focus on the critical alarms for which you want immediate alerts,” she adds.
As with the introduction of most new information technologies into a hospital environment, the Hospital for Special Care found some resistance to change when the new software went in, Dills says. But respiratory therapists—a very equipment- and tech-oriented bunch—became the clinician champions of the project and camped out in units to talk up the benefits and help connect devices. Hospital departments that should be brought in to this type of program include information technology, clinical engineering, and the safety and risk departments.
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