Alarms Externalisation Dr Signouret Thomas Intensive care unit

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 § Monitoring device

Noise: World Health Organisation guidelines: 35→ 40 d. B § Currently average noise: 60 → 70 d. B § Alarms : 70 → 80 d. B !!! § Staff conversations: 59 → 90 d. B Bush-Vishniac J acoust soc Am 2005 § 10 à 25 % of alarms do induce a therapeutic modification Lawless ST Crit Care Med 1994 Patients: Disturbance Tachycardia, hypertension Pituitary and adrenal gland stimulation Xie Crit care 2009 § Nurses: Concentration, stress, Phenomen of alarm fatigue Morrison Crit Care Med 2003 Chambrin MC crit care 2001

Link between noise and sleep disturbance ? § Sleep disturbance: § Slower healing § Cognitive function § Décrease immune response § ICU delirium : 20 → 80 % ↗ lenght of stay ↗ morbi-mortality Ely EW JAMA 2004 § Noise is one of many factors of sleep disturbance: § 17→ 56 % Xie Crit care 2009

Historic 1. Remove the cardiacs monitor alarms from the room to the centrale station 2. Close the patient door’s room 3. Pb: What about the others devices Alarm’s ? 4. Need a translation of all the alarm in the same language (HL 7): Capsultech® 5. Need to bring and allocate the alarm to the caregiver: Connexall®

Aims of the Externalisation alarms § Decrease the noise due to the alarms in the patient room. § Allow the door closing: § Decrease the noise from the nursing station - 4 d. B: Lawson Am J Crit Care 2010 § Overpressure level respected in the unit § Aspergillose prevention R 113: Référentiel struct Vdef 2011 § Alarms send to caregivers § Tracability

Définition of gravity level § Cardiac arrest(vital priority) : Vital emmergency who need an immediat respons of all the caregivers( nurses and doctor) of intensive care unit § Critical (high priority ) : Urgent situation who require an immediat response of caregivers § Grave (medium priority) : Imminent risk who requires a rapid response of caregivers § Message (low priority) : Attention of medical staff is require European standard medical devices. EN 475: 1995

Mapping alarms

Workflow

The Daily Job of the Nurse

Hardware connectivity

Check devices connexion § Specific connection by DIM Capsultech® on device RS 232 outlet § Connection IT wires on DATACAPTOR®module for sending the information on the network

Sélect and Assign the patients § Connexall central station: § Assignement of each patient on an i. Po. D which is dedicated to a nurse 303 304 305 R 2. 2 301 302 R 2. 1

Assignment

Connexall Central station Main Screen

Alarms on mobile Device Arrêt cardiaque box 1 Acknowledgment

Currently § Golive on a five beds unit after a training of all nurses of the unit § Connection of all devices § Good expression of the sonor Alarms with right tonality, gravity and workflow § Visual alarms: Good rendering § Doors closed recently § We left the sound in the box due to an IT server issue

Alarm Externalisation Risk § Log out the devices from the datacaptor § 4 or 5 network § § § Drager Capsultech Connexall Hopital européen Marseille Apple Regulated Medical Devices Class II FDA

What we expected ? 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

And Also…: Dévellopment § Transitory (2 min) 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: § 1 st : the sound characteristic of level of gravity § 2 nd : the number of room § 3 rd : the message of alarm

Link on patient watch

Evaluation 1. Safety 2. Efficacy 3. Perception

Safety § Description of differents alarm : § Number of alarm / hour and /12 h § Number by device § Number by nurse § Number by gravity § Delay between alarm and acknowledgment § Delay between alarm and resolution

Efficacy § Average intensity noise during day and night : § In the room § In the nurse station § Number of Peak level > 80 d. B/ h during day and night : § In the room § In the nurse station

Perception § Patient questionnaire : § Sleep quality : Richards Campbell Sleep Questionnaire § Noise discomfort § Care givers quetionnaire : § Noise discomfort § Satisfaction

A prospective open interventionnel study évaluate a reducing stratégy of noise by an alarm notification system Primary purpose: réduction of 10 d. B by currently average noise level 60 +/- 10 d. B We need 16 patients in each stategies Power: 80 % alpha risk : 5 %

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

Thank you for you attention

Functionnal Basics of Third-Party Alarm Notification Systems B Moorman Biomed Instrumentation and Technology 2011