Calm the Alarm – A Path Forward for Safe Alarm Management to Save the Patient Lives
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Abstract:
ICU noise is a common problem that affects patient well-being and staff productivity. The Apollo Hospitals in Kakinada have initiated a project to address the issue of excessive noise in the ICU. The project team comprises nursing staff, a biomedical engineer, and a quality in-charge. The goal is to optimize the intensity and number of alarms in the ICU to ensure that actionable alarms are not compromised. The project aims to improve patient compliance, staff welfare, and well-being.
Organization Profile
The Apollo Hospitals in Kakinada, which is a multi-specialty hospital with 100 beds, is accredited by NABH and introduces a novel healthcare concept to the Godavari Districts in Andhra Pradesh. It is located in the heart of Kakinada, making it easily accessible from the railway and bus stations. This facility is equipped with advanced technology to provide top-notch medical care to the community. It is the first corporate multi-specialty tertiary care hospital in the East and West Godavari districts within a radius of 100 km, and it performed the first CABG in the district. Moreover, it carried out the first neuronal navigation procedures and RSOV in the region in July 2019. The hospital also completed the highest number of Peripheral-Carotid-Renal angioplasties for the first time in this area. Additionally, the facility holds ISO Certifications 9001–2015, ISO 10002:2018, and ISO 27001:2013.
Introduction:
Noisy ICUs are a common problem in clinical settings and often result in patient irritation, sleeplessness, and requests to be moved out of the ICU. Elderly patients are especially prone to developing psychosis after prolonged stays in the ICU.
Feedback from patients and attendants has indicated that alarm sounds are a significant contributor to this issue. Nursing staff also suffer from anxiety and sleeplessness due to excessive alarm sounds.
To address these concerns, the upper management has initiated a project to improve the well-being of ICU patients and staff. The project team comprises the nursing team, including the unit head nursing and selected ICU nurses; a biomedical engineer for continuous input on equipment; and a quality in-charge to study the entire process, analyze results, and formulate an action plan. Moreover, ICU patients and their relatives provided feedback indicating irritability, a desire to move out of the ICU, sleeplessness, and, in severe cases, anxiety bordering on psychotic symptoms, particularly among elderly patients. Hospital staff also reported experiencing anxiety, insomnia, tinnitus, and hallucinations. The problem is clearly defined and observable. Thus, based on the problem description, it was easy to determine that noise in the ICU was the primary causal factor. The only exception was with elderly patients, who displayed more symptoms of anxiety and confusion, which led us to consider alternative causes. To achieve the solution, we need to optimize the intensity and number of alarms in the ICU to ensure that actionable alarms are not compromised. And perform a trial to reduce the number of non-actionable notices while consulting with biomedical engineers and ICU doctors.
Outcomes:
After implementing the improvement measures, significant progress has been made in enhancing the efficiency and quality of the defined process. A total of 10 monitoring indicators have been established to track and evaluate the process on a regular basis. These indicators are designed to collect and analyze data both weekly and monthly, providing valuable insights into the performance and effectiveness of the process.
Regular audits are conducted to ensure the collected data’s accuracy and reliability. These audits serve the purpose of validating the data, identifying any discrepancies or errors, and promoting staff awareness regarding the importance of maintaining data integrity. These audits promptly address any issues or areas requiring further improvement, and corrective actions are implemented.
In order to focus on the improvement of the overall quality of care, the study initially concentrated on the cardiac ICU as a pilot project. The ICU block was selected as the primary area of focus due to its critical nature and potential for significant impact on patient outcomes.
Following the successful implementation of the improvement strategies in the cardiac ICU, the study expanded its scope to include other ICUs within the healthcare facility. By cloning the improvement measures, the benefits and positive outcomes observed in the cardiac ICU were replicated across the different ICUs, enhancing care delivery and patient outcomes throughout the facility.
This approach of cloning the improvement measures from one unit to another not only ensures consistency in quality improvement efforts but also maximizes the effectiveness of the interventions. By leveraging the lessons learned and best practices from the initial pilot project, the subsequent implementation in other ICUs is streamlined, accelerating the overall improvement process and fostering a culture of continuous quality enhancement throughout the organization.
Conclusion:
The “Calm the Alarm” project implemented by the Apollo Hospitals in Kakinada has successfully reduced the number of non-actionable alarms in the ICU while ensuring that actionable alarms are not compromised. This has resulted in improved patient compliance and staff welfare. The project has been monitored using ten monitoring indicators, and regular audits have been conducted to validate the data and increase staff awareness. The project was initially completed in the cardiac ICU as a pilot project before being expanded to other ICUs. The hospital’s commitment to improving patient care and staff welfare is evident in this initiative, a path forward for safe alarm management to save patient lives.
