In 2008, Boston Medical Center (BMC) was in the process of growing its telemetry capacity. At that time, the facility created a tele-task force comprising nurse managers, nurse educators, residents, attending physicians, IT staff, and biomedical engineers. James Piepenbrink, director of the department of clinical engineering and of clinical asset management at BMC, explains that the group began by evaluating crisis alarms, and over the next couple of years made incremental changes based on the collected data.
In 2010, a negative news report regarding alarm issues at a local hospital prompted BMC to shift into high gear and look at its internal process. “We focused on medical surgical telemetry, an area that is not as technologically intensive as the ICU, where we use technology all the time,” Piepenbrink says.
BMC held a summit and identified which clinical alarms were insignificant and what to do about them. Pulling together the data and observing staff in their work environments reaffirmed findings. “Until you look at the data, you can’t quantify what is good and what’s not,” Piepenbrink notes. Once the group determined which alarms to downgrade, eliminate, or change settings on, BMC conducted a 2-week pilot. “We educated staff on the alarms, what we were doing, and why and how we would measure.” More important, senior management fully supported the plan.
The BMC system went live in August 2012 without any snags. Two important components of the process included education and giving staff autonomy to make individual alarm changes. “Nurses now own the process. They are the only ones who can make changes,” Piepenbrink says. “We decided we’re not adding new technology or making other investments. Some places use middleware. If the process is broken, adding middleware doesn’t add anything.”
BMC received an internal quality grant of $25,000, which it used to hire dedicated educators to support the rollout. The task force did not rely on vendors. “We have to work under our ownership and management. We felt this was the best use of our staff and expertise,” Piepenbrink says.
Since rolling out this project, BMC has conducted a pilot for tachycardia alarms and is planning a second one for pulse oximeter alarms. Piepenbrink emphasizes that customization is an important part of the process. “It’s important to identify that it’s not a one-size-fits-all approach,” he says. BMC’s success in implementing a viable alarm management program drew attention from The Joint Commission, which asked it to conduct a webinar on its project in May 2013. “They recognized the value of the type of work we did. It was great validation,” Piepenbrink notes.
Phyllis Hanlon is a contributing writer for 24×7. For more information, contact editorial director John Bethune at [email protected].