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The BMC Brief

October 12, 2012 Volume 1, Issue 32

All Quiet on the 7North Front; Alarm Pilot Team is One of Seven Patient Safety Grant Winners

7North Nursing leaders
7North nursing leaders stand before the alarm monitor system

Imagine working on a floor where the sounds of alarms are constant day and night. On 7North in the Newton Pavilion, this was reality. Until recently.

The unit cares for cardiac patients, using telemetry equipment to monitor heart rates, blood pressure, oxygen levels and more. Warning alarms often went off for non-serious changes in heart rate, for example, and competed with alarms for life-threatening conditions like critical heart rhythms and alarms that told staff patients were off their monitors. With a multitude of alarms being used to monitor up to 28 patients at a time, more than 21,000 alarms went off per day, for a total of more than 151,000 a week. Many of those alarms indicated clinically insignificant events that required no action by staff, but the noise was deafening.

“The warning alarms for clinically insignificant events were constantly going off and creating unnecessary background noise, causing us to struggle with alarm fatigue,” says Deborah Whalen, NP, Clinical Service Manager, Cardiology. “Nurses often could not hear the call bells that patients rang when they needed assistance. We knew something had to change so that all alarms became meaningful and actionable by our nurses.”

Nationally, hospitals around the country grapple with the issue of alarm fatigue. With alarms constantly blaring, the concern is that they can contribute to the desensitization of nurses and risk patient safety.

A multidisciplinary team that included physicians and nurses and was led by Patricia Covelle, RN, Director, Critical Care Nursing, came together with the goal of increasing patient safety by reducing the number of clinically insignificant cardiac monitor alarms. The group also thought that by decreasing the number of unnecessary alarms, patient satisfaction scores would increase given the quieter care environment.

7North staff
Members of the 7North team

The team worked with Clinical Engineering to review the alarm data and develop a list of safe changes that would decrease the number of total alarms, while still ensuring that alarms continued for all events that required immediate attention. Those changes included moving some warning alarms from an audible tone to message status and elevating other alarms to crisis level. All audible alarms became actionable, with a nurse responding to each one. Immediately “our patients became safer,” notes Whalen. The group also surveyed patients and staff to gauge noise and satisfaction levels prior to the start of the pilot project. All unit staff then were educated on the new processes before the go-live date, which occurred in August.

The project was an overnight success, with changes being noticed immediately.

“The day we went live, it was so quiet on the floor that night shift staff thought the telemetry system was down,” says Karen Villanova, Nurse Manager, 7N. “They kept going into patients’ rooms to check on them.”

“Prior to the pilot, at times it could be almost impossible to think clearly with the noise,” says Eric Awtry, MD, Inpatient Medical Director, Cardiology. “The difference now is incredible.”

During the six-week pilot, the number of alarms dropped from 94,500 to 11,800 per week; a stunning decrease of more than 80,000 audible alarms. Staff satisfaction increased, too, with many nurses remarking on the quietness of the unit and noting in a post-pilot survey that they could spend more time caring for patients than answering clinically insignificant alarms. Physicians noted that patient alarm histories now were more meaningful. The unit was in agreement: care was safer and better.

While patient satisfaction data has yet to be received, the team anticipates positive results. Plans are in the works to expand the pilot to other medical and surgical units.

“This project was a phenomenal undertaking where all staff took a tremendous amount of ownership,” remarks Jim Piepenbrink, Manager, Clinical Engineering. “We didn’t fix this problem by throwing technology at it; instead we addressed it by process. We looked at ways to make changes meaningful and easy for staff and to do it in a fiscally wise manner."

Piepenbrink notes that BMC is the first hospital in the nation to successfully tackle telemetry alarm fatigue and noise levels.

For their hard work, the 7North Alarm Pilot team won a $25,000 Patient Safety Grant from BMC and BMC’s Insurance Program. The team is one of seven that received a grant for interdisciplinary projects designed to improve patient safety and simultaneously reduce the hospital’s liability exposure. This year 31 teams submitted applications, up from 18 in 2011, and the program distributed more than $188,000 in grant awards.

“This project is a fantastic example of what a dedicated team of frontline caregivers can do to improve patient care and patient and staff satisfaction,” says Stanley Hochberg, MD, SVP, Quality, Safety and Technology. “We were pleased to award the team a patient safety grant to allow this important work to be extended to other units.”

“This team took on a clinical concern, studying it and working toward novel solutions,” says Lisa O’Connor, RN, BSN, MS, NEAA-BC, SVP, Clinical Operations/Chief Nursing Officer. “I am incredibly proud of their hard work and congratulate them on this outstanding achievement.”

The other grant award recipients include:

  • Initiative for Excellence in Physician-Patient Communication
    Manas Kaushik, MD, MS, ScD
    Julie Crosson, MD, Medicine
    James Moses, MD, MPH, Pediatrics
    Sheryl Katzanek, Patient Advocacy

  • Comprehensive Emergency Airway Response Team (EART) Training and Education: Impact on Team Effectiveness, Personnel Knowledge and Technical Proficienc,y and Patient Safety and Outcomes
    Greg Grillone, MD, Otolaryngology
    Mauricio Gonzalez, MD, Anesthesiology
    Janet Crimlisk, RN, Nursing
    Julie Silva, RRT, Respiratory Care

  • Reduction of Central Line Associated Bloodstream Infections on Non-ICU Wards
    Nahid Bhadelia, MD, Infectious Disease

  • Retrieval of IVC Filters to Decrease Associated Complications
    Jeffrey Kalish, MD, Vascular Surgery

  • Point-of-Care Coagulation Monitoring to Improve Care of Stroke Patients and Safety of Administration of Thrombolytics and Parenteral Anticoagulants
    Anna Cervantes-Arslanian, Neurology
    Carlos Kase, Neurology
    Viken Babikian, Neurology
    Thanh Nguyen, Neurology
    J. Rafael Romero, Neurology
    Aleksandra Pikula, Neurology
    Helena Lau, Neurology
    Judy Clark, Neurology
    Deborah Green, Neurology
    Joseph Burns, Neurology
    Christina DeFusco, Neurology
    Lauren Nentwich, Emergency Medicine
    James Holsapple, MD, Neurosurgery
    Janet Means, Pathology and Laboratory Medicine
    Daoreuang Pongvongkeo, Laborabory Medicine
    John Cho Lee, Pathology and Laboratory Medicine

  • Improving Clinical Care and the Patient Experience at Boston Medical Center: Promoting Effective Communication in the Interdisciplinary Family Meeting for Critically Ill Patients
    Matthew Russell, MD, MSc

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    Recent Enhancements to the BMC Patient Experience

    In an ongoing effort to enhance the patient experience at BMC, the hospital has rolled out several new initiatives.

    The introduction of new programs and facility enhancements has grown out of the work of four groups dedicated to improving the patient experience at BMC. The changes are part of BMC’s strategy to fulfill its QUEST patient satisfaction goal of increasing the number of patients who rate the hospital a 9 or 10.

    Night OWLS

    The Night OWLS program began earlier this month to create a quieter, more restful environment for patients. At 9 p.m. every night, an overhead message announces the start of quiet hours in the Menino and Newton Pavilions. At that time, the Night OWLS program goes into effect. The acronym “OWLS” stands for the actions that all staff should take:

    Overhead page and intercom use stops
    Whispered voices only
    Lights dimmed
    Sleep promotion

    “The OWLS acronym is an easy-to-remember way for staff to be mindful of the noise level in patient-care areas,” says Jane Jansen, RN, Director, Nursing, who worked on the program. “Our goal is to make it as easy and comfortable for patients to sleep as possible. Sleep promotion can mean something as simple as shutting the door to a patient’s room if the care allows for it or offering earphones to drown out noise.”

    BMC has also added a new channel to the inpatient TV lineup. The Care Channel, which can be found on channel 3, plays 60 hours of non-repetitive nature photos and music. The channel is in use in many hospitals around the country and is known to have a calming effect on patients.

    “For patients who don’t have many visitors or who are anxious, the soothing music and peaceful scenes can be very calming and relaxing,” says Sister Maryanne Ruzzo, Pastoral Care. “It also can be helpful with patients’ pain management.”

    Work also continues on BMC’s Room-a-Day program, which takes two inpatient rooms out of commission each day of the week to "refresh" them by painting walls, waxing floors and maintenance work on heating and cooling systems.

    The program has refreshed 155 rooms, as well as updated Menino 7East, 6East, 6West, 5West, the NICU and Newton 8West and 7East. Pediatrics is currently undergoing renovations.

    “We have received positive feedback from both patients and staff,” says Dave Maffeo, Senior Director, Support Services. “The work is ongoing and our goal is to reach every unit until all rooms have been refreshed.”

    “Each of these new programs has been developed with input from staff and we believe that each initiative will help improve the quality of patients’ experiences,” says Rebecca Blair, Executive Director, Patient Experience. “Patients and families constantly provide us with feedback that we continue to use as a guide for our improvement efforts.”

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    Department of Medicine Celebrates Centennial

    The Department of Medicine celebrated its centennial with a two-day symposium Oct. 5-6 highlighting 100 years of healing, discovery and education.

    Woven throughout the various activities that brought current and former faculty together along with residents, fellows and medical students were anecdotes shared about the department’s vast contributions to the field of medicine, including the identification of the first confirmed human cases of equine encephalomyelitis in 1938 and the establishment of the specialty of gastroenterology in 1942; to the first use of chlorothiazide to treat hypertension in 1958.

    Department of Medicine Centennial 

    The symposium also included sessions on “Training Clinicians in an Urban Healthcare Environment” and “Creating a Sustainable Healthcare System” before culminating in a gala dinner that recognized past chairs of the department.

    How it began …
    The modern history of the Department of Medicine arguably began on July 4, 1909. While preparing for the arrival of US President William Howard Taft, wealthy industrialist Robert Dawson Evans was riding a horse on his Beverly, Mass., estate when the horse stumbled, throwing him to the ground.

    Evans’ family transported him to the Massachusetts Homeopathic Hospital in Boston’s South End, where surgeons operating on him discovered that his small and large intestines were distended and full of fluid. They inserted a metallic tube into the small intestine to allow gas to escape and closed the abdominal wound with catgut. For two days, Evans received oxygen, small amounts of food, brandy, and even champagne. Despite efforts to save him, Evans died July 6, 1909, at the age of 65.

    To commemorate her husband’s life, Maria Antoinette Evans made two major charitable gifts: one to the Museum of Fine Arts to build the Evans Wing for Paintings, which fronts the Fenway; the other gift established the Robert Dawson Evans Memorial Department for Clinical Research & Preventive medicine, one of the first centers in the country to combine clinical care and research.

    The cornerstone for the Evans Memorial’s first building, now known as the A Building on the BU Medical Campus, was laid in February 1911. The four-story brick structure, which cost $500,000 to construct, on East Concord Street was designed to include wards for patients participating in research programs, laboratories, offices and a rooftop sun parlor.

    Mrs. Evans attended the building’s formal opening in 1912. Five years later, when she died, she left an additional donation and established the goals of the department as clinical research, training and public education. Although technically a separate research institute, the Evans Memorial Department always has operated in close connection with Boston University’s School of Medicine and the Massachusetts Homeopathic Hospitals and its successor hospitals University Hospital and Boston City Hospital, which are now known as Boston Medical Center.*

    Today, the department boasts a faculty of 434, approximately $120 million in research funding, 210 residents and fellows, 71 graduate students, 270,000 outpatient visits and 13,000 inpatient discharges on its medical service.

    “The Department of Medicine is steadfastly committed to the excellence exemplified by our predecessors in research, education and patient care,” said David Coleman, MD, Wade Professor and Chairman, Department of Medicine. “We are fortunate to work with an extraordinarily diverse patient population that encompasses a range of socioeconomic and cultural backgrounds. It also is very exciting to train the next generation of physicians and scientists who will provide exceptional and high-value clinical care and discover innovative strategies to prevent, diagnose and treat disease into the next century.”

    Learn more about the Department of Medicine.

    *Reprinted from the spring 2012 issue of BUSM’s Campus and Alumni News magazine.

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    What Do You Do, Tom Loring?

    Name: Tom Loring
    Title: General Service Associate
    Department: Environmental Services
    Years at BMC: 23

    Tom Loring
    Tom Loring

    What brought you to BMC?
    Before coming to BMC I was an industrial engraver for a small family-owned business called TJ Edwards. I mostly engraved for the shoe industry, but also hand-cut dyes that burn impressions for logos, like Jack Daniels. As it became more common to create logos digitally, the company folded and I was out of work. I had put in for a city job and was notified about an opening in the Environmental Services Department at the former Boston City Hospital. I was hired and I’ve been here ever since.

    What do you do here?
    My job consists of cleaning buildings, delivering cleaning supplies, re-hanging curtains in patient rooms and setting up and breaking down conference rooms before and after meetings. I tend to cleaning needs all over campus, so my job varies from day to day and I’m constantly moving.

    How does your job contribute to the patient experience?
    No one wants to be a patient in the hospital, so as an employee, you want to make the experience as positive as you can, and that includes a clean and pleasant atmosphere. If your bed is made and your room is in order you feel like you are well taken care of. Since I’m working independently most of the day, I enjoy the chance to interact with patients and help them in any way I can.

    We hear you recently quit smoking. Congratulations! What made you decide to quit?
    After 32 years of smoking two packs a day, it was time to take my future health into consideration. Susan DeCristofaro, RN, OCN, helps BMC staff and patients quit, and knowing I was a smoker, she asked me to join the smoking cessation program. I had tried the patch a few years ago, which was unsuccessful, so I decided to give the program a chance. I used the cut-down method and was down to about 10 cigarettes a day. My official quit date was Dec. 17, 2012, and I even wrote a letter to my cigarettes, terminating their services.

    How has your life changed since you quit?
    I used to get shortness of breath when I was smoking and that has stopped since I quit. My lifestyle hasn’t changed much; I’ve always been an active person who likes to get up and out of the house and I’m still like that. I do miss the routine of driving to New Hampshire to buy my cigarettes while listening to the Beatles every Sunday morning and the social aspect of going outside to talk to people and smoke, but my health is more important.

    What advice do you have for others who are trying to quit?
    When times get hard, a cigarette is not going to help. One of the hardest parts about quitting for me was the boredom. Smoking can be a social activity, a time to bond over a cigarette or a time in your day in which you go outside to clear your head, but it’s better to just find a different activity.

    Do you know a staff member who should be profiled? Send your suggestions to communications@bmc.org.

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    News of Note

    Jasraj Dhanoya
    Jasraj Dhanoya, age 9

    Pediatric bWell Center holds drawing contest
    The bWell Center, a program that aims to provide an innovative approach to educating and supporting BMC’s pediatric families, recently celebrated its first drawing contest. Of the 160 pediatric patients who entered drawings, seven lucky winners were chosen to have their art framed and displayed in the department. Special musical guest Sol Y Canto played original Puerto Rican music while contestants created more art and enjoyed snacks.

    “The drawing contest exemplifies the bWell Center’s unique programming, which creates a dynamic and educational experience for pediatric patients and allows patients to showcase their creativity while developing fine motor skills,” says Meg Wood, MPH, MSW, Project Manager, Pediatrics.

    Sumit Sehgal named Director of Information Security
    Sumit Sehgal joins BMC as Director of Information Security on Oct. 15. Sumit previously served as director of Information Security at George Washington University Hospital and manager of Information Security at Riverside HealthCare.

    Williams named Medical Director of Boston HealthNet
    Charles Williams, MD, Family Medicine, has been named Medical Director of Boston HealthNet (BHN). Williams will lead Boston HealthNet’s clinical programs and bring together leaders from across BMC and its network of 15 community health centers to build systems and relationships that will further coordinate, integrate and improve quality care across the continuum. He will also provide leadership on the establishment of patient centered medical homes and a clinical system redesign necessary to respond to changes in payment methodologies.

    Adams named Community Health Informatics Director at Boston HealthNet
    William Adams, MD, Pediatrics, has been named Community Health Informatics Director at BHN. Adams’ extensive experience in clinical care, medical informatics, and quality measurement and improvement will guide and support work to expand the capacity of all BHN partners to improve the quality of care they deliver by improving existing health information systems; expanding the use of shared data for quality measurement and improvement; and identifying innovative HIT solutions to better support the clinical activities within BHN.

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    Contact Office of Communications

    Communications Staff
    Media information after hours: 617.638.8405

    Boston Medical Center
    Office of Communications
    85 E. Newton Street
    4th Floor
    Boston, MA 02118

    Fax: 617.638.8044

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