Safety analysis of proposed data-driven physiologic alarm parameters for hospitalized children

Safety Analysis To assess the safety of the newly created 5th and 95th percentile heart rate and respiratory rate parameters prior to clinical adoption, we retrospectively reviewed data associated with all rapid response team and cardiorespiratory arrest events on the hospital’s medical/surgical units from March 4, 2013 until March 3, 2014

Veena V. Goel; Sarah F. Poole; Christopher A. Longhurst; Terry S. Platchek; Natalie M. Pageler; Paul J. Sharek; Jonathan P. Palma

2016

Scholarcy highlights

  • Modification of alarm limits is one approach to mitigating alarm fatigue
  • Chart review of rapid response team and cardiorespiratory arrest patients with abnormal heart rate and respiratory rate per current limits considered normal by data-driven limits revealed that clinical status change was identified by other vital sign abnormalities or clinical context
  • In anticipation of local implementation of these data-driven vital sign ranges as physiologic monitor parameters, we performed a retrospective safety analysis by evaluating the effect of data-driven alarm limit modification on identification of cardiorespiratory arrests and rapid response team activations
  • Safety Analysis To assess the safety of the newly created 5th and 95th percentile HR and RR parameters prior to clinical adoption, we retrospectively reviewed data associated with all RRT and CRA events on the hospital’s medical/surgical units from March 4, 2013 until March 3, 2014
  • The greatest difference between our study and the 2013 study was across data-driven 95th percentile RR parameters, which were an average of 4.8 points lower in our study
  • We estimated 55.6% fewer out-ofrange HR and RR measurements with our data-driven parameters
  • Our results suggest that modifying HR and RR alarm parameters using data-driven 5th and 95th percentile limits to decrease alarm frequency does not pose additional safety risk related to identification of RRT and CRA events
  • We believe it is crucial to perform a safety analysis prior to implementation due to the role vital signs play in clinical assessment and detection of patient deterioration. Though a few studies have shown that modification of alarm parameters decreases alarm frequency, to our knowledge no formal safety evaluations have ever been published

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