UCSF’s experiences with sending alarms to phones in the...
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December 15, 2017 12pm to 1pm From the AAMI Foundation’s National Coalition for Alarm Management Safety UCSF Alarms Kevin Spolini MSN RN Manager of Clinical Informatics UCSF Benioff Children’s Hospital
Transcript of UCSF’s experiences with sending alarms to phones in the...
December 15, 201712pm to 1pm
From the AAMI Foundation’s National Coalition for Alarm Management Safety
UCSF AlarmsKevin Spolini MSN RNManager of Clinical InformaticsUCSF Benioff Children’s Hospital
A Special Thanks
Thank You to Our Industry Partners!DIAMOND
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Speaker Introduction
Kevin Spolini MSN RNManager of Clinical
InformaticsUCSF Benioff
Children’s Hospital
UCSF Alarms
12/15/2017
Kevin Spolini MSN RNManager of Clinical InformaticsUCSF Benioff Children’s Hospital
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UCSF Medical Center at Mission Bay• State-of-the-art, sustainable, six-story,
289-bed children’s, women’s specialty and cancer hospital complex
• $1.5 billion project
• 878,000 gross square feet, 2 blocks long
• San Francisco’s first new hospitals in 30 years
• Opened February 1, 2015
Medical BuildingHelipad
Energy Center (central plant)
Parking
UCSF Benioff Children’s Hospital
183 BedsPediatric Care
Urgent/Emergency CareSpecialty Outpatient
Care
Cancer Hospital70 beds
First step to full cancer services at Mission
BaySelect adult cancer outpatient services
Women’s Specialty Hospital
36 bed birthing centerSelect women’s
ambulatory servicesSpecialty Surgery
Creating the Patient Experience UCSF Medical Center at Mission Bay
Mission Bay Guiding Principles
Design operations and workflows that support patient- and family-centered care models.
Remember that patient safety is at the center of everything we do.
Create an outstanding environment and culture that fosters ownership, accountability, and open communication for all
who work here.
Streamline operations, make full use of technology, and eliminate non-value tasks to ensure that resulting processes
enable staff to perform as efficiently as possible and also allow flexibility as situations warrant.
Pilot new processes and technology at the Parnassus and Mt. Zion campuses to the extent possible, and evaluate
outcomes prior to Mission Bay campus deployment
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Voalte Smartphones
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Unified voice solution
Secure texting
Alarms and alerts
• Rauland Responder 5 nurse call
• Physiological alarms (GE, Vent)
• Epic EHR bed alerts (transport, bed turnover, bed assignments)
• TUG robots
• RoomReady
Moved from ICUs with small floor plans and high staff visibility to large floor plans and private rooms
Provided security that something critical would not be missed
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Value of Alerts
Alerts to smartphones are always the secondary alarm source.
Connexall Install
VoalteVoalte
R5 – Nurse Call• Seizure Response• Code Blue
GE Monitor Alerts Bedmaster
Ready ListTugsAwarepoint
Connexall
Timed Reminders
EPIC• ADT• Pediatric Early
Warning Score
Massimo Spo2
Intensive Care Nursery
Alarm overload at go live
Staff were leaving their phones at the desk, or off, because of the number of alarms
Alarm/Alert Management Program
Strategies to do this include:
Turning to informational or off alarms that are non-actionable
Ensure default parameter alarms are appropriate
• Ensure nurses are selecting the correct profiles and customizing settings per patient as appropriate (in pediatrics profiles are age based)
Ensure monitor system settings are optimized for the patient population and patient
Work with manufacturer to optimize technology
Our goal is to reduce the alarms that come from our devices and, as applicable, those are sent to end user devices to ones that are meaningful and actionable.
12/15/2017Presentation Title and/or Sub Brand Name Here16
Routing Alarms and Alerts
A portion of GE alarms pass through alarm router to BedMasterEx (the light level audible alarm at the time). Vitals are then attached from the HSDI and passed to Connexall.
Receive: • Voice calls• Text messages• Alerts
• GE• R5• Epic EHR• TUG robots
Alarms initiated:• Parameter violation• Arrhythmia algorithm• Technical violationAlarm levels:• High• Medium• Low• Informational
Middleware determines:• If an alarm is sent• Delay before sent• Who to send to• When to escalate• Who to escalate to• When to stop
Working with manufacturers to optimize alarm middleware and mobile communication.
Text SentText ReceivedCall PlacedNurse Call AlertsGE AlarmsSMTP Messages
April May June July AugustGE Alerts to Phones per nursing shift 29.43 32.59 27.04 23.61 23.86
29.43
32.59
27.04
23.61 23.86
10.00
15.00
20.00
25.00
30.00
35.00
40.00
April May June July August
GE Alerts to Phones per nursing shi April 2015 - November 2015
Pre Interven on
Initial Settings• High Level Alarms‒ Delay before send = 0‒ Time to accept = 15‒ Delay after accept = 20
Asystole
Vfib/Vtach
• Med Level Alarms– Delay before send = See below– Time to accept = 20– Delay after accept = 20
• SpO2 Low– Delay before send = 15
• Tachy– Delay before send = 0
• Brady– Delay before send = 0
• Leads Fail– Delay before send = 20
• No SpO2 Probe– Delay before send = 20
ICN Alarm Task Force Management
Staff Nurses
Clinical Informatics
Clinical Systems
Signoff by Medical and Nursing Leadership• Process‒ Was this alert appropriate to send to a smartphone for the population (would it make you
return to the bedside)?‒ If yes, was the timing appropriate?
Changes• Eliminate Asystole, Vfib/Vtach, Tachy, Leads Fail, SpO2 Probe Off, No SpO2 Probe, Vbrady
alerts to Voalté phone
• Timing changes to Brady and SPO2 low alerts‒ Brady
Keep no delay before sending
Time to accept to 30 seconds
Delay after accept to 60 seconds‒ SPO2 Low
Increase delay before sent to 25 seconds
Time to accept to 30 seconds
Delay after accept to 60 seconds
April May June July August Sept Oct NovGE Alerts to Phones per nursing shift 29.43 32.59 27.04 23.61 23.86 15.15 16.97 16.45
29.43
32.59
27.04
23.61 23.86
15.15
16.97 16.45
10.00
15.00
20.00
25.00
30.00
35.00
40.00
April May June July August Sept Oct Nov
GE Alerts to Phones per nursing shiftApril 2015 - November 2015
Pre Intervention
Post Intervention
Intervention
A strong relationship between IT and Clinical Staff is a must
• Ideally a clinical champions who understands IT takes the lead
Consider data analysis and the creation of reports up front
Know their will be changes to be made
Make departments responsible for their handsets from day 1
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Lessons Learned
Where to go from here?
QlikView
Voalte
Nurse Call
Nurse Call
Staff/Shift
ADT
Connexall GE Monitor
Future/Ongoing Initiatives27
January 12, 2018 12 noon to 1 pm EST
Using Continuous Monitoring for Early Recognition of Patient Deterioration in the Post-
Op Population...It Just Makes Sense
Jessica Gabriele, BS, MSN, RN-BC, CNL, South 6 Nurse, Lynn Jansky, MSN, RN-BC, Professional Development SpecialistMiddlesex Hospital, Middletown, CT
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January 15, 2018 12:00 PM to 1 PM EST
“Clinical Alarm Management Strategies – Meaningful Alerts; Reducing Non-actionable Alarms”
Please join us to learn the technique of creating alarm default settings specific to certain patient profiles to
reduce alarm fatigue!
Presenter: Sharon H. Allan, DNP, RN, ACNS-BCCentral Nursing - Clinical Standards
The Johns Hopkins Hospital
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Thank You to Our Industry Partners!DIAMOND
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