2004 OPEN FORUM Abstracts
POINT-OF-CARE REMINDERS IN RESPIRATORY CARE: EXPERIENCE WITH OPTIMIZING VENTILATOR ALARM SETTINGS.
Lucy
Kester, RRT, MBA, FAARC, James K Stoller, M.D, M.S, FAARC, The
Cleveland Clinic Foundation, Cleveland, Ohio.
Background:
Assuring compliance with best practices in respiratory care is an
ongoing challenge for all departments. Recent experience with a
strategy to optimize therapists’ setting ventilator alarms by
placing reminders on the ventilators suggested that putting notices
where the service is delivered, an approach that might be called
“point-of-care reminders,” can be effective.
Methods:
Audits on the rate with which ventilator alarms were set for low
pressure, high pressure, and low minute ventilation have been
conducted as routine practice in the Section of Respiratory Therapy
at the Cleveland Clinic Foundation. A policy to audit
compliance with written procedures for setting ventilator pressure
alarms (low pressure 10 – 15 cm H2O < ventilating
pressure, high pressure 10 – 15 cm H2O >
ventilating pressure, and low minute volume 20 % < set minute
volume) on a monthly basis was implemented in January, 2004. Because
audits for January, February, and March 2004, showed rates below
threshold (Figure 1), a “point-of-care reminder” strategy
was implemented beginning in April, 2004. This strategy called for
placing printed reminders summarizing the ventilator alarm setting
criteria on the ventilators with the intent of improving
compliance with the written procedure. Rates of compliance
with the written procedure were assessed both before implementing the
point-of-care reminder strategy, and for 3 months thereafter.
Results:
Figure 1 presents the rate with which alarms were set in
compliance with the policy over time, stratified by alarm type (low
pressure, high pressure, and low minute
volume).
Alarm
Type
Figure 1
Ventilator Alarm Compliance
Not
surprisingly, the rate at
which alarms were set in accordance with the written procedure before
the point-of-care reminder strategy was introduced was low, e.g.,
with rates as low as 57% for the high pressure alarm in January 2004.
In contrast, the rates with which alarm settings complied increased
strikingly after initiation of the point-of-care reminders. For
example, 3 months after introducing the policy, the rates of
compliance were 98%, 98%, and 89%, respectively for low pressure,
high pressure, and low minute volume alarms.
Conclusions:
Our experience shows that high rates of compliance with a new
policy can be achieved by placing printed reminders about the policy
on the equipment to which the policy applies. In the context that
having a large number of departmental policies poses a challenge to
therapists’ remembering and implementing them, this experience
with “point-of-care reminders” indicates it is an
effective strategy that is applicable to other equipment-directed
policies.