Category: Professional Posters
Purpose: An excessive number of medical device alarms may result in alarm fatigue and patient risk. Smart infusion pumps are used widely in healthcare and issue alarms with varying levels of urgency. Response to smart pump alarms may be improved by forwarding alarm details directly to the responsible clinician through the electronic health record (EHR) and/or a mobile device, for prompt awareness, assessment, prioritization, and management. This clinical project was undertaken to improve clinician response to alarms and reduce alarm fatigue through implementation of smart pump alarm forwarding technology.
Methods: A hospital design team of nurses and a pharmacist was created to oversee and ensure success of the implementation of alarm-forwarding technology. The team members were experienced with the medical center’s integrated smart pump – EHR infusion system and associated clinical workflows. The alarm forwarding initiative began when the team judged that the hospital’s integrated infusion system technology was ready to expand capability to include smart pump alarm forwarding. In addition to ensuring proper technology readiness, the team was tasked to identify which alarms would be forwarded to the clinicians, which devices would display the alarms, and the associated level of alarm detail and importance. All caregivers utilizing integrated smart infusion pumps are required to utilize alarm forwarding. Quality improvement efforts are led by the team to optimize alarm management and reduce alarm fatigue by ongoing program monitoring and infusion pump alarm data analytics.
Results: Forwarded alarm details include the name of the alarm and the level of importance. The level of importance is color coded as high (red), medium (yellow), and low (blue). Examples of forwarded alarms include: Air-in-Line (high), Depleted Battery (high), Distal Occlusion (high), and Infusion Completed (medium). To facilitate early awareness, alarms are forwarded to the individual patient computer workstation and the unit dashboard. Alarm forwarding to the clinical staff’s hand-held devices is under consideration. Clinicians report that awareness of infusion pump alarms enables task prioritization and reduces interruptions from low priority alarms. It is also reported that knowledge of alarm details enables preparation for efficient alarm management. For example, a forwarded “Infusion Complete” alarm enables the clinician to enter the room with a new container when indicated.
To support the management of forwarded alarms, the team regularly reviews alarm scorecards generated from data held on the hospital’s safety software server. Alarms are analyzed and categorized to highlight opportunities for improvement. Alarm data analysis has provided evidence to drive practice changes such as the selection of intravenous catheter sites to reduce distal occlusion alarms. Statistical analysis of the clinical impacts of alarm forwarding has not yet been undertaken.
Conclusion: This descriptive report demonstrates the method and results of implementing smart pump alarm forwarding technology. The forwarding of smart pump alarms to the EHR may result in earlier awareness of alarms, reduced response times, and improved effectiveness of interventions. Alarm forwarding may serve to reduce alarm fatigue by enabling task prioritization and reduced interruptions in care. Analysis of alarm data provides the hospital with actionable information that may support initiatives to further reduce alarm burden. Additional study is required to confirm and evaluate the implications of these results.