Clinical Alarm Management Project Neonatal Intensive Care Unit (NICU) IWK Health Centre, Halifax, NS

Abstract

Research confirms that more than 70% of clinical alarms are unnecessary. Exposing clinicians to high volume of undesirable alarms may cause alarm fatigue associated with increasing patient risks and deaths. Alarm fatigue is mainly driven by the excess number of non-actionable alarms which are the alarms associated with self-correcting conditions that do not need clinical intervention. Alarm fatigue is considered as a common and significant healthcare problem that needs special attention. The Emergency Care and Research Institute (ECRI) recommends some strategies to eliminate the alarm fatigue and emphasizes on the importance of involving clinical staff, especially nurses, while working on those strategies. The main objective is to eradicate the alarm fatigue to pave the way for a safer and improved healthcare environment. The current open-bay NICU at IWK Health Centre was opened in 1992 and was considered as a state of the art at the time. Concerns with this setting include: lack of privacy and confidentiality, no individual control over the environment in terms of noise, light, temperature, and most unfavorable, a lack of space for families to stay with their vulnerable, critically ill infants. Recently, IWK Health Centre has decided to build a new NICU single-family room unit which is expected to solve all issues of the current open-bay model. Families will have a private room with double sleep sofa, three-piece washroom, and privacy doors which is anticipated to increase their comfort and willingness to stay for prolonged times with their baby. Based on many researches, the new model of care will provide numerous benefits for infants, families and staff. The principle purpose of the internship project was to work with clinical teams and IT teams under the umbrella and guidance of the Biomedical Engineering Department within IWK Health Centre to establish an effective clinical alarm management strategy for NICU and reduce their alarm fatigue. Then, to propose a workflow best practice for assigning care teams to the patient monitors and End User Devices (EUDs) for effective utilization in the new NICU single-family room care setting. The scope of work has been defined to the primary alarm signals produced by patient monitors (Philips) with its various locations inside NICU (please view figure 3), in addition to the primary alarm signals produced by two types of ventilators (Servo-I and VN-500). Patient monitors were desired to be fully integrated with the middleware (Connexall) to produce and escalate secondary alarm signals to the care team EUDs (iPhones). A clinical alarm steering committee was created to provide strategic directions and secure the necessary approvals. Similarly, a NICU task force was created to accomplish major tasks in a timely manner aiming at meeting the project deadline through working in a team collaborative environment. The internship road map and milestones were discussed and agreed with all key stakeholders early in the project. The internship project ended up by proposing a reasonable new clinical alarm strategy for physiological monitoring and ventilators which represent the majority and most crucial monitoring inside the NICU. The project final deliverables (please view appendix B through H) were submitted to both IT teams and Biomedical Engineering Department at the end of the project for their future work. Based on alarm data for three-real NICU case studies that have been collected during the course of the internship, non-actionable alarms represent an average of more than 60% of the total daily alarms inside NICU. Considerable delta gains of -15%, -30% and -46% are anticipated to be achieved if the non-actionable alarms inside NICU are reduced by 25%, 50% or 75% respectively for the same or similar cases. The internship project was a great learning experience and was a remarkable tool to implement what have been learnt as a clinician and as a prospective health informatician in a real-life experience. It was a concrete opportunity to implement health informatics concepts in a high-quality project that included a complicated and significant healthcare problem like alarm fatigue. Also, it was a wonderful opportunity to practice working collaboratively with other healthcare professionals in a patient centric approach to accomplish project deliverables with a challenging due time. As planned, the internship project has been completed in sixteen weeks under the supervision and mentorship of Manager, Biomedical Engineering at IWK Health Centre. The internship project was full of challenges but at the same time was interesting, meaningful, worthy and rewarding.