I am a pragmatist. If you are not honest about obstacles – how can you change them?
Six reasons AM programs have not made a huge difference:
- Because alarm management is complex
- Getting your baseline alarm count is not easy
- Just simply knowing your numbers has never changed outcomes
- Just sending alarms to phones – will drive all clinicians mad
- The programs need to be directed across teams – not just a nursing issue
- There is no silver bullet- it takes time
- Must be C suite Champions- behavior change is complicated
Technology (physiological monitoring) was well intended over 60 years ago but has unintended consequences. Today where the entire hospital’s level of acuity is higher- more patients are monitored outside of the ICU. We tend to use monitors as an insurance policy. 40% of them according to the literature are not needed.
Questions you need to ask- so we can make a difference:
- Who do we monitor and for how long?
- Once a patient who does need monitoring is on the floor – how do we work in responding to alarms?
- What does your team do in response to alarms?
- Are we pro-active? Do we wait until something rings?
- Do we use the data? How is it used?
- Do we communicate the information across teams?
- Do we use monitoring data to manage patients, risk and staffing?
- Are we pro-active with skin hygiene, lead and battery change?
- How do we handle off-monitor for any reason - across teams, transfers, procedures, bath?
- Do you even have an alarm management committee - a multi-disciplinary serious committee?
A clue…. the reality does not look like your stated policy or even evidence-based practice. That is why we include current state workflow as an integral part of alarm management - you must be pragmatic.
- We know so much today about evidence-based practice
- We can pull alarm counts across the system
- We know defaults by disease, unit and some basic principles to follow across personalization of default settings.
- We know that skin hygiene and proactive lead changes make a difference. i.e. changing tele batteries before they die.
- We know that current state (the reality) is discoverable.
- We know we can plan for future state
- We know that this is a problem across multi-disciplinary teams
- We know we must move from reacting to being predictive
- We need C suite involvement
We have a knowledge base for alarm management that is based on 2015 and forward evidence-based data. Send me an email. Mary.email@example.com and we can talk.