Continuous Remote Patient Monitoring & Alarm Management: Your Role in Successful Patient Outcomes

Mary Reagan-Zingler

In this blog post, we detail how continuous remote patient monitoring equipment, combined with nursing expertise, helps enhance patient outcomes on the medical-surgical floor. Our goal is to provide nurses with the tools to help you better assess patient status using near real-time clinical data and trends to enhance clinical decision making.

Traditional vital sign monitoring alone vs. real-time continuous remote patient monitoring

Early in my career — almost 25 years ago — I worked as a nurse on the medical-surgical floor. At that time, one of the devices we relied on was a pulse oximeter to assess patients’ respiratory status prior to surgery.

The pulse oximeter would often trigger alarms all night long, and patient assessment rarely told us the cause. We would respond to the dipping oxygenation values and alarms by applying or increasing oxygen delivery. The values would look better for a while, only to begin alarming again.

It was common practice in those days as well as now to give patients several medications simultaneously. However, we now know that this can increase the effects of other medications and the risk for respiratory depression.¹

Checking vital signs alone is an incomplete way to prevent respiratory depression.¹ That’s why clinicians are turning to continuous remote patient monitoring to analyze clinical data trends to help detect changes in patient status earlier.²

Integrated patient monitoring solutions offer reliable patient assessments

With remote continuous patient monitoring tools, nurses now have access to reliable, real-time data that may help them make evidence-based clinical decisions.

Capnography devices continuously monitor the patient’s physiological data by capturing values in pulse oximetry, oxygenation, pulse rate, respiratory rate, and ventilation. The waveform provides clinical data on the quality of the patient’s ventilation.^1,2 Integrated pulmonary index (IPI) adds an additional piece of data in the form of a single digit, depicting real-time changes in clinical status. Looking at data in this format can help nurses assess trends in the patient’s respiratory status — especially if opioids were given.

Because capnography equipment measures real-time breath-to-breath ventilation — not just oxygenation — it helps provide reliable information during clinical patient assessments. Research suggests that using real-time information can help determine whether early intervention is necessary⁵ — especially when nurses suspect an adverse respiratory event with their patient.³

Continuous remote patient monitoring systems let you see what’s happening at a patient’s bedside without having to be in the room. This type of continuous remote patient monitoring offers trends in respiratory parameters not captured by spot check monitoring. It could help improve patient safety because it can help you detect changes in patient physiology, which can allow for more timely clinical decisions and possible early interventions.⁶

Alarm management — how to establish alarm criteria and safety protocols

Continuous remote patient monitoring equipment requires knowledge of alarm protocol thresholds and best practices. Nurses hear around 1,000 alarms in a typical shift.⁷

As a result, alarm fatigue is a patient safety matter that contributes to alarm-related deaths.⁶ Education and training can help combat this and foster an environment for safe alarm management. It can help you better understand:

Device functionality
Alarm settings and configurations
How staff operates devices
Patient condition

So how can you tell the difference between alarms? As nurses, we need to begin to recognize the difference between a frequently occurring alarm and a true nuisance alarm.

Our goal is to help you identify and prioritize frequently occurring alarms designed to prompt a clinical assessment or intervention.

Filtering and prioritizing important alarms can help you recognize when alarms correlate with potential life-threatening or fatal consequences. More and more nursing teams are establishing criteria to identify and prioritize alarms.⁶This can greatly enhance clinician response to alarms and reduce events from escalating.

In a Johns Hopkins pilot study, hospital staff reduced alarm fatigue by 43 percent. The staff customized alarms based on patient need — changing default monitor parameters and empowering nurses to customize alarms within specified parameters.⁶

We hope that these clinical insights and practice tips assist you in helping to keep your patients safe and reduce the volume of nuisance alarms.

Related: If you want to know more, we offer educational opportunities on creating custom alerts for mobile devices that send high-priority alarm messages. Contact your Medtronic representative to learn more.

References
1. Wong M. Detection of opioid-induced respiratory depression through continuous electronic monitoring. Physician-Patient Alliance for Health & Safety website. http://www.ppahs.org/2018/08/detection-of-opioid-induced-respiratory-depression-through-continuous-electronic-monitoring/. Published Aug. 23, 2018. Accessed Feb. 14, 2020.
2. Jungquist CR, Smith K, Nicely KL, Polomano RC. Monitoring hospitalized adult patients for opioid-induced sedation and respiratory depression. Am J Nurs. 2017;117(3 Suppl 1):S27–S35.
3. Rajnish GK, Edwards DA. Monitoring for opioid-induced respiratory depression. APSF Newsletter. 2018;32(3).
4. Richardson M, Moulton K, Rabb D, et al. Capnography for Monitoring End-Tidal CO₂ in Hospital and Pre-hospital Settings: A Health Technology Assessment [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016.
5. Ronen M, Weissbrod R, Overdyk FJ, Ajizian S. Smart respiratory monitoring: clinical development and validation of the IPITM (Integrated Pulmonary Index) algorithm. J Clin Monit Comput. 31:435–442. 2016.
6. Cvach MM, Currie A, Sapirstein A, Doyle PA, Pronovost P. Managing clinical alarms: using data to drive change. Nurs Manage. 2013;44(11 Safety Solutions):8–12.
7. Ruskin KJ, Hueske-Kraus D. Alarm fatigue: impacts on patient safety. Curr Opin Anaesthesiol. 2015;28(6):685-690.