The Science Journal of the American Association for Respiratory Care

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.

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