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Alarms Externalisation

Alarms Externalisation . Dr Signouret Thomas. Intensive care unit. Patients Vital prognosis committed Multiorgan failure Cares : Invasives, painfull , 24 h/24 Life support equipment : ventilator , dyalisis , infusion pumps Monitoring : 24 h/24 Caregivers

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Alarms Externalisation

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  1. Alarms Externalisation Dr Signouret Thomas

  2. Intensive care unit • Patients • Vital prognosiscommitted • Multiorganfailure • Cares : • Invasives, painfull, 24 h/24 • Life support equipment: ventilator, dyalisis, infusion pumps • Monitoring: 24 h/24 • Caregivers • Monitoring device

  3. Noise: World Health Organisation guidelines: 35→40 dB • Currentlyaverage noise: 60 → 70 dB • Alarms: 70 → 80 dB !!! • Staff conversations: 59 → 90 dB Bush-VishniacJ acoust soc Am 2005 • 10 à 25 % of alarms do induce a therapeutic modification Lawless ST Crit Care Med 1994 • Patients: • Disturbance • Tachycardia, hypertension • Pituitaryand adrenal gland stimulation XieCrit care 2009 • Nurses: Concentration, stress, Phenomen of alarm fatigue Morrison Crit Care Med 2003 Chambrin MC crit care 2001

  4. Link between noise and sleepdisturbance ? • Sleepdisturbance: • Slowerhealing • Cognitive function • Décreaseimmune response • ICU delirium : 20 →80 %  ↗lenght of stay ↗morbi-mortality Ely EW JAMA 2004 • Noise is one of manyfactors of sleepdisturbance: • 17→ 56 % XieCrit care 2009

  5. Historic Remove the cardiacs monitor alarmsfrom the room to the centrale station Close the patient door’s room Pb: What about the othersdevicesAlarm’s ? Need a translation of all the alarm in the samelanguage (HL7): Capsultech® Need to bring and allocate the alarm to the caregiver: Connexall®

  6. Aims of the Externalisation alarms • Decrease the noise due to the alarms in the patient room. • Allow the doorclosing: • Decrease the noise from the nursing station - 4 dB: Lawson Am J Crit Care 2010 • Overpressurelevelrespected in the unit • Aspergillose prevention R113: Référentiel structVdef2011 • Alarmssend to caregivers • Tracability

  7. Définition of gravitylevel • Cardiacarrest(vital priority): Vital emmergencywhoneed an immediatrespons of all the caregivers( nurses and doctor) of intensive care unit • Critical(highpriority ) : Urgent situation whorequire an immediatresponse of caregivers • Grave(medium priority) :Imminent riskwhorequires a rapidresponse of caregivers • Message(lowpriority) : Attention of medical staff isrequire Europeanstandard medicaldevices.EN 475:1995

  8. Mappingalarms

  9. Workflow

  10. The Daily Job of the Nurse

  11. Hardware connectivity

  12. Check devices connexion • Specificconnection by DIM Capsultech® on device RS232 outlet • Connection IT wires on DATACAPTOR®module for sending the information on the network

  13. Sélect and Assign the patients 303 304 305 301 302 R2.2 R2.1 • Connexall central station: • Assignement of each patient on an iPoDwhichisdedicated to a nurse

  14. Assignment

  15. Connexall Central stationMain Screen

  16. Alarms on mobile Device Arrêt cardiaque box 1 Acknowledgment

  17. Currently • Golive on a five beds unit after a training of all nurses of the unit • Connection of all devices • Good expression of the sonorAlarmswith right tonality, gravity and workflow • Visual alarms: Good rendering • Doorsclosedrecently • Weleft the sound in the box due to an IT server issue

  18. Alarm Externalisation Risk • Log out the devicesfrom the datacaptor • 4 or 5 network • Drager • Capsultech • Connexall • Hopital européen Marseille • Apple RegulatedMedicalDevices Class II FDA

  19. Whatweexpected ? Sécurity • A visual indicator of log out on connexall central station • An automatic detection of IT server issue by heart bit then an alarm message with a workflow to: • Drager IT engineer • Biomed • Doctor • Chief nurse • A new device who avoid apple network • Evaluation the quality of caregivers réaction

  20. And Also…: Dévellopment • Transitory (2min) Inhibition of the transmission of all alarm on the Connexall system when the Nurse active “a nursing function” • Showing the waves in live in case of alarm: Link patient watch • Sending vocal message with: • 1st : the sound characteristic of level of gravity • 2nd : the number of room • 3rd : the message of alarm

  21. Link on patient watch

  22. Evaluation Safety Efficacy Perception

  23. Safety • Description of differentsalarm : • Number of alarm / hour and /12 h • Number by device • Number by nurse • Number by gravity • Delay betweenalarm and acknowledgment • Delay betweenalarm and resolution

  24. Efficacy • Averageintensity noise duringday and night : • In the room • In the nurse station • Number of Peaklevel> 80 dB/ h duringday and night : • In the room • In the nurse station

  25. Perception • Patient questionnaire : • Sleepquality : Richards Campbell Sleep Questionnaire • Noise discomfort • Care giversquetionnaire : • Noise discomfort • Satisfaction

  26. A prospective open interventionnel studyévaluatea reducingstratégy of noise by an alarm notification system Primarypurpose: réduction of10 dB by currentlyaverage noise level 60 +/- 10 dB Weneed16 patients in eachstategies Power: 80 % alpha risk : 5 %

  27. Middle and Long terms Plan • Extended the externalisation of the alarm to other medical Device • ECMO, Bed, Labs, etc… • Extended the externalisation of the alarm to other medical specialties • Anesthesia : An anesthesiologist works on several OR • Cardiology • Special device to show the alarm: Samsung gear, Google Glasses

  28. Thankyou for you attention

  29. Functionnal Basics of Third-Party Alarm Notification Systems B MoormanBiomed Instrumentation and Technology 2011

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