Exploring the Limit Locator Tool April 2017 Jennifer Hill, Data Analyst Regenstrief Center for Healthcare Engineering

Purpose New REMEDI tool aimed at reducing infusion pump alerts Current practice focuses on drugs that alert the most frequently The Limit Locator focuses on potential reduction in alarms, not just alert counts - The purpose: to reduce alerts - Current practice looks at top 10 or so drugs by alert count - The difficulty with this method is eventually the potential for meaningful changes drops - Drugs with fewer alerts may still be able to reduce 3, 6, or more alerts each, and what if there are 200 like that? - Limit Locator provides a method to review limits that focuses on performance rather than number of alerts

Method Algorithm developed by Dr. Steven Landry Performance-based using count of false alarms and missed detections Shows potential reduction in false alarms for any proposed limit Pre-calculates maximum possible reductions for all drug/field limit/etc. combinations - Assumptions: override = false alarm b/c no change; moving the limit and omitting a false alarm reprogram = missed detection b/c change; moving the limit and omitting a ‘true’ alarm - LL gives changing counts as you adjust the limit - Disclaimer: this is not a clinical recommendation! We don’t know if it makes sense, can only say “this change has these potential results” - Lastly, can pre-calculate maximum possibly reduction in false alarms which gives the user an easy way to view which drugs have the highest potential for reducing alarms  

Demo catalyzecare.org/labs/run/limitlocator

Future Work Remove duplicate alerts from the analysis. For example, if a nurse receives an alert, cancels and reprograms twice, then overrides Add option to display limits used by other hospitals in the graph. (Before implementing need a way to find equivalent drug/profile/etc. at other hospitals) Add option to only view alerts from a selected time frame or data set On the “Auto” tab, allow the user to indicate if a combination has already been evaluated