October 12, 2012 Volume 1, Issue 32
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.
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:
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.
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:
“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.”
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.
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 …
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.”
*Reprinted from the spring 2012 issue of BUSM’s Campus and Alumni News magazine.
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