Proactive Problem Solving Across the Care Continuum

Greg Spratt

The ECRI Institute creates an annual list —Top 10 Patient Safety Concerns — that supports health organizations striving to be proactive problem solvers for patient safety.^1,2

The 2019 report highlighted concerns from across the continuum of care. Strategies are increasingly focused on collaboration between provider organizations, community agencies, patients, and family members. It also identified challenges that might be high priorities, like new risks, existing concerns that evolve because of new technology, or care delivery models. Persistent issues that require more attention or create new opportunities for intervention were also covered. In this blog, we’re focused on three concerns from the list:¹

Clinician burnout
Early identification of changes to patient condition
Early recognition of sepsis

The 2020 report noted clinician burnout, as it relates to alarm management, as number six on the top ten.²

Burnout and its impact on patient safety

Burnout is indiscriminate. It can affect physicians, trainees, nurses, allied healthcare providers, and organizational leaders alike. Nurses burn out at a rate of 49 percent for those under 30 years old, and 40 percent for those over 30.³

Frequent false alarms can contribute to clinician fatigue and stress. In a single shift, clinicians may hear up to 1,000 alarms.⁴ But many of those may be false positives or considered clinically insignificant. One report by The Joint Commission (TJC) estimated that 85 to 99 percent of alarms didn’t require an intervention.⁵

As part of the National Patient Safety Goal 06.01.0, TJC recommends that hospitals should know its current monitoring and alarms situation. They should also develop an alarm management program to help address this important patient safety issue.⁶

To help get you started addressing clinician burnout and its impact on patient safety, check out the Medtronic alarm analysis program. The program is intended to highlight areas of opportunity that optimize alarm parameters and help reduce nuisance alarms — without sacrificing alarms that indicate significant patient events.

Related: Watch this video and hear from clinicians at Barton Health about their experience establishing an alarm management program.

Early recognition of sepsis

Early recognition of sepsis is critical to initiate timely interventions that can significantly reduce patient morbidity and mortality. Risk for death increases an additional 4 percent for every hour that treatment is delayed.⁷

A challenge clinicians may face is recognizing the signs and responding to them during the onset of sepsis. One of the strongest predictors of mortality from sepsis is abnormal etCO₂ levels. Also, a significant inverse relationship exists between etCO₂ and lactate in all categories of sepsis.⁸ Within moments of application, capnography devices are designed to display etCO₂levels, offering an early alert to abnormal ventilation as a sign of sepsis.

Detecting changes in patient condition

Failure to detect changes in a patient’s condition efficiently and effectively is an ongoing safety concern across the continuum of care. From a patient under procedural sedation, to postanesthesia care monitoring and during transitions of care within the hospital, deterioration can arise quickly.

When monitoring a patient’s respiratory status, continuous monitoring across the continuum of care versus spot-check monitoring can make a difference. The standard monitoring practice on the medical-surgical floor is spot checking every 4–6 hours⁹, and spot-checking may be inaccurate.¹⁰ As an example, in one study, intermittent pulse oximetry spot-checks missed 90 percent of hypoxemic episodes.⁹

Continuous oxygenation and ventilation monitoring with Microstream™ capnography and Nellcor™ pulse oximetry may help you improve patient safety. Together, the technologies allow you to detect a patient’s deteriorating condition earlier offering trend patterns for you to analyze over time. Observation of hospitalized patients with continuous monitoring technology can help facilitate efficient interventions and provide another layer of care by offering alerts to patients showing signs of deterioration.¹¹

References
1. ECRI Institute. 2019 Top 10 Patient Safety Concerns Executive Brief. ECRI Institute. 2019.
2. ECRI Institute. 2020 Top 10 Patient Safety Concerns Executive Brief. ECRI Institute. 2020.
3. Holdren P, Paul DP, Coustasse, A. Burnout syndrome in hospital nurses. Paper presented at: BHAA International 2015 in Chicago, IL. March 2015.
4. Ruskin KJ, Hueske-Kraus D. Alarm fatigue: impacts on patient safety. Curr Opin Anaesthesiol. 2015;28(6):685–690.

5. Patient Safety Advisory Group. Medical device alarm safety in hospitals. The Joint Commission Sentinel Event Alert. http://www.jointcommission.org/assets/1/18/SEA_50_alarms_4_5_13_FINAL1.PDF. Published Apr. 8, 2013. Accessed May 1, 2019.

6. The Joint Commission. National Patient Safety Goal NPSG.06.01.01. Joint Commission Perspectives. 2013;33 (7).
7. Raja AS. Reviewing Seymour CW et al. N Engl J Med 376; June 8, 2017. Sepsis mortality increases with delays in treatment. N Engl J Med. May 21, 2017.
8. Hunter CL, Silvestri S, Dean M, Falk JL, Papa L. End-tidal carbon dioxide is associated with mortality and lactate in patients with suspected sepsis. Am J Emerg Med. 2013;31(1):64–71.
9. Sun Z, Sessler DI, Dalton JE, et al. Postoperative hypoxemia is common and persistent: a prospective blinded observational study. Anesth Analg. 2015;121(3):709–715.
10. Williams, Jill S. Opioid Safety & Patient Monitoring Conference Compendium. The National Coalition to Promote Continuous Monitoring of Patients on Opioids. JSW Communications. Nov. 14, 2014.
11. Bates DW, Zimlichman E. Finding patients before they crash: the new major opportunity to improve patient safety. BMJ Qual Saf. 2015;24(1):1–3. doi:10.1136/bmjqs-2014-003499.

TOPICS: Microstream™ Capnography Monitoring, Vital Sync™ Monitoring and Clinical Decision Support