Continuous Patient Monitoring Addresses Common Clinical Concerns

Robert Bell

Manage Alarm Fatigue with Vital Sync

Continuous patient monitoring systems let you see what’s happening at a patient’s bedside without having to be in the room. These systems ― such as the Vital Sync^TM monitoring and clinical decision support solution ― help you address pressing healthcare challenges such as:

Managing alarms
Using multiple bedside parameters to detect problems sooner
Sharing data across various platforms and devices

In this blog post, we’ll address these issues and highlight how our Vital Sync^TM system can help you go beyond the basics of continuous patient monitoring.

Alarm Fatigue: A Patient Safety Concern

Patient monitors extend your reach so you can observe changes to key physiologic parameters. Monitor alarms alert you to changes in a patient’s condition that may indicate the need for intervention. These alarms are essential to patient safety across the healthcare continuum — and in many cases are lifesaving.

Today’s market offers several monitors to give you more information and improve patient safety. But the increase in information has led to a proportional rise in the number of alarms you encounter. In fact, 85 to 90 percent of alarms don’t require clinical intervention.¹

Overwhelmed by the sheer multitude of beeps, it can become easy — even the norm — to ignore alarms, and that can decrease patient safety.

Nuisance alarms can contribute to:

Clinician stress and workload^2,3
Alarm fatigue⁴
Missed events leading to catastrophic consequences⁵

With data-driven alarm management strategies, you can reduce alarm burden without losing sensitivity to clinically relevant events.⁶

Our Vital Sync™ remote monitoring and alarm management system collects and analyzes EtCO2 and SpO2 data to help you centrally monitor and alert clinicians of a possible sentinel event. It also allows you to fine-tune specific alarms to meet your clinical needs. For example, you can set alert delays or disable alerts you don’t want. You can also set different protocols and thresholds for bedside devices than for central and/or remote monitoring and paging/annunciation. In short, you can design a system that works for you, instead of you working for the system.

The Vital Sync™ system also has several alarm reports preconfigured. These reports help clinicians understand the prevalence of device alarms so you can better manage the threshold settings on the device. By analyzing the historical alarm data, for example, you’ll see if it makes sense to change the settings on your pulse oximeter. And by using your historical data, you can confidently predict the outcomes of these changes.

Related: We can help you reduce nuisance alarms, so you can focus on caring for your patients. Learn more about our alarm analysis program.

It’s Hard to Catch Patient Deterioration Early with a Single Vital Sign

If you’re only monitoring one parameter of your patient’s condition, you may not notice any deterioration right away. But early warning scores (EWS) can tell you when the first signs of deterioration appear — so you can intervene faster. These derived parameter scores are based on data from physiologic readings (systolic blood pressure, heart rate, respiratory rate, body temperature) and observations (level of consciousness).

To determine the EWS, a number between 0 and 3 is assigned to each of the vital signs and observations, based on how far the parameter value (or observation) is from normal ranges. The sum of the scores of the different parameters yields the patient’s total EWS. The higher the EWS, the more serious the patient’s condition.

Early warning scores have been shown to reasonably predict the occurrence of cardiac arrest and death within 48 hours of measurement.⁷ Evidence also suggests they may predict risk of ICU admission, length of hospital stay, and death.^8,9

With the Vital Sync™ EWS app, you can continuously and automatically access accurate parameter measurements on your web-enabled devices. Our app pulls information directly from the patient’s bedside monitoring devices rather than relying on the electronic medical record as the sole data source. Because of this direct-from-the-device capability, the app provides an “earlier” EWS than many other systems.

You get critical information quickly, so you can respond to signs of clinical distress faster.

Related: Learn more about remote patient monitoring and its role in critical care units. Read the blog post.

We Need to Share Patient Data Across Platforms and Devices

As a clinician, you need access to the right information at the right time to provide the right care for your patients. Remote monitoring software such as the Vital Sync^TM system lets you share data across platforms and devices — so you can use that information to help your patients.

The features of the Vital Sync^TM system give you more control over the data you collect and help simplify information sharing:

HL7 interfaces ― Export directly to electronic medical records, import registration and demographic data, and export alerts to phones and pagers.

Expanded device portfolio ― Connect with the Vital Sync™ system to non-Medtronic devices (such as Phillips V60 Bipap or Draeger ventilators) using middleware so the Vital Sync™ system can report on all your data.

Clinical applications ― Assimilate data from different devices and look at algorithms to make more informed clinical decisions. For example, it can be challenging to know precisely when to start ventilation weaning and when to extubate your patients. Protocolized weaning can help you identify patients who are ready for weaning more quickly and manage the weaning process.

Evidence has shown that clinical applications such as clinical decision support (CDS) technology may help with implementing and adhering to protocol-driven management of your ventilated patients,^10,11, which has been shown to reduce weaning duration, time spent on a ventilator and ICU length of stay.¹²

Learn how to simplify protocol-driven weaning. Download the brochure.

References:
1. The Joint Commission. Medical device alarm safety in hospitals. Sentinel Event Alert. April 8, 2013; issue 50.
2. Gorges M, Markewitz BA, Westenskow DR. Improving alarm performance in the medical intensive care unit using delays and clinical context. Anesth Analg. 2009;108(5):1546–1552.
3. Darbyshire JL. Excessive noise in intensive care units. BMJ (Clinical research ed). 2016;353:i1956.
4. Cvach M. Monitor alarm fatigue: an integrative review. Biomed Instrum Technol. 2012;46(4):268–277.
5. Medical device alarm safety in hospitals. Sentinel Event Alert. 2013(50):1–3.
6. Graham KC, Cvach M. Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms. Am J Crit Care. 2010;19(1):28–34; quiz 35.
7. Smith ME, Chiovaro JC, O’Neil M, et al. Early warning system scores for clinical deterioration in hospitalized patients: a systematic review. Ann Am Thorac Soc. 2014;11(9):1454–1465.
8. Groarke JD, Gallagher J, Stack J, et al. Use of an admission early warning score to predict patient morbidity and mortality and treatment success. Emerg Med J. 2008;25(12):803–806.
9. Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM. 2001;94(10):521–526.
10. Piquilloud L, Jolliet P, Revelly JP. Automated detection of patient-ventilator asynchrony: new tool or new toy? Crit Care. 2013;17(6):1015.
11. Sinderby C, Liu S, Colombo D, et al. An automated and standardized neural index to quantify patient-ventilator interaction. Crit Care. 2013;17(5):R239.
12. Blackwood B, Burns KE, Cardwell CR, O’Halloran P. Protocolized versus non-protocolized weaning for reducing the duration of mechanical ventilation in critically ill adult patients. The Cochrane database of systematic reviews. 2014(11):CD006904.

TOPIC: Vital Sync™, Medical-Surgical