Data-Driven Implementation of Alarm Reduction Interventions in a Cardiovascular Surgical ICU.

BACKGROUND: Alarm fatigue in the ICU setting has been well documented in the literature. The ICU's high-intensity environment requires staff's vigilant attention, and distraction from false and non-actionable alarms pulls staff away from important tasks, creates dissatisfaction, and is a potential patient safety risk if alarms are missed or ignored. This project was intended to improve patient safety by optimizing alarm systems in a cardiovascular surgical intensive care unit (CVSICU). Specific aims were to examine nurses' attitudes toward clinical alarm signals, assess nurses' ability to discriminate audible alarm signals, and implement a bundled set of best practices for monitor alarm reduction without undermining patient safety. METHODS: CVSICU nurses completed an alarm perception survey and participated in alarm discriminability testing. Nurse survey data and baseline monitor alarm data were used to select targeted alarm reduction interventions, which were progressively phased in. Monitor alarm data and cardiorespiratory event data were trended over one year. RESULTS: Five of the most frequent CVSICU monitor alarm types-pulse oximetry, heart rate, systolic and diastolic blood pressure, pulse oximetry sensor, and ventricular tachycardia > 2-were targeted. After implementation, there was a 61% reduction in average alarms per monitored bed and a downward trend in cardiorespiratory events. CONCLUSION: To reduce alarm fatigue it is important to decrease alarm burden through targeted interventions. Methods to reduce non-actionable alarms include adding short delays to allow alarm self-correction, adjusting default alarm threshold limits, providing alarm notification through a secondary device, and teaching staff to optimize alarm settings for individual patients.

Impact of donor lung organisms on post-lung transplant pneumonia.

BACKGROUND: Fear of transmission of donor organisms that may result in recipient pneumonia has a negative impact on donor lung utilization. We reviewed our experience with routine donor bronchial aspiration and culture at the time of transplantation to study the impact of donor bronchial organisms on the development of recipient post-lung transplant pneumonia (PTP) and other outcomes. METHODS: We reviewed 80 consecutive single and bilateral lung transplants (SLTs and BLTs) from August 1998 to August 2001. Pediatric recipients and those not surviving >3 days were excluded. All donors met standard criteria for donor acceptance. All recipients received broad-spectrum antibiotics pending the results of final operating room cultures. PTP required clinical evidence (fever, leukocytosis and hypoxia), radiologic evidence (infiltrate), and culture confirmation during initial hospitalization or within 30 days. RESULTS: Sixty-four donors for 71 recipients (39 SLTs, 32 BLTs) comprised the study population. Organisms were grown from 57 (89%) donors and 46 were polymicrobial. A total of 149 organisms were cultured consisting of 21 different species, with Staphylococcus (n = 35) and Streptococcus (n = 33) being the most common. PTP was seen in 31 (41%) recipients, with Pseudomonas species (n = 13) the most prevalent. Of the 71 donor-recipient pairs, 2 had both donor and recipient with no growth and PTP. The donor organisms had a sensitivity of 0.75 with a low specificity of 0.04 and were negatively correlated with development of PTP. PTP was an independent predictor of overall mortality. CONCLUSIONS: The presence of donor organisms does not predict PTP. Therefore, donor acceptance criteria need to be re-examined.