This report consists of two separate studies on the use of continuous capnography monitoring conducted in an effort to improve patient safety at Virtua Health System. The desire for improved patient safety is motivating continuous monitoring and improved surveillance in clinical areas not traditionally equipped for such monitoring. We explored the use of remote monitoring of capnography, using enterprise middleware, in patients recovering from surgery in a medical-surgical unit. Continuous monitoring traditionally has been used in higher-acuity settings, such as intensive care units. Patients diagnosed or suspected to have obstructive or central sleep apnea may benefit from the increased surveillance afforded by continuous monitoring. Pain management in this cohort of patients, recovering from bariatric, joint replacement, or other major surgery, often involves administration of opioids (e.g., hydromorphone, morphine sulfate), which are known to increase risk of respiratory depression. Continuous monitoring of these patients increases the likelihood of detecting adverse clinical events. Our goal was to implement continuous monitoring in order to identify alarm conditions caused by adverse clinical events requiring intervention (e.g., opioid-induced respiratory depression) and artifacts related to patient movement, suspect measurements, or other medical device–generated alarm signals.
John Zaleski, PhD, CAP, CPHIMS, Chief Analytics Officer of Bernoulli, the real-time leader in patient safety, is featured in the May/June cover story of RT Magazine, “Patient Monitoring and Alarm Fatigue.”
The article notes that alarm fatigue continues to remain a significant patient safety threat and details how clinicians can mitigate this problem.
Zaleski says that hospitals and health systems need better understanding of their current state environment, including clinical workflows, patient cohorts, and assessments in order to develop comprehensive guidelines and protocols for clinical alarm management.
As for solutions, Zaleski recommends one with integration capabilities. “Combinatorial alarms take multiple sources of information and bring it together to corroborate events. This is not simply limited to data extracted in real time from patient care devices at the point of care, but also can be drawn from ancillary sources.”