1. The “WHY” Behind Infusion Pump Alarms
Rob Regedanz Product / Market Manager Alaris Medley Platform Medication Management Solutions (MMS) Tim Vanderveen, PharmD, MS Med Safe Practices LLC San Diego, CA April, 2017

2. Pump Alarm and Alert Definitions
For this presentation:
A pump “alarm” is defined as an unanticipated event
Occlusion
Air in line
Free Flow condition
Pump “alert” is an anticipated notification
Infusion completed
Reminder to visit patient
Secondary to primary transition
Bolus to continuous transition
Walk-away alert – programming not completed
Alarms and Alerts further differentiated
Require bedside visit or
Occur when caregiver at the pump
Retrospective Data – Not real time distribution

3. Alarms and Alert Data for the Alaris® System (does not include Et/CO2 and Pulse Oximetry modules)

4. Issues with Infusion Pump Alarms and Alerts
Alarm and alert “fatigue” poster child
Pumps rarely have “false” alarms
Pumps are not associated with the patient
Audible alarms and alerts typically sound the same
Unlike monitors, alarms cannot be configured “off”
Where are they coming from and why?
Current system of bedside (only) infusion alarms and alerts require multiple visits to the bedside
Pump alarms are actionable ( vs monitors)

5. Issues with Infusion Pump Alarms and Alerts
Multiple configurable pump settings impact frequency of alarms
Pressure settings
Air bubble size
Near end of infusion
Significant source of patient and family dissatisfaction – theirs and other patients
Historically there has been no data on true frequency of pump alarms and alerts and limited focus on alarms reduction
Wireless connectivity and all infusion data transfer now provide a window to infusion pump alarms and alerts

6. One patient’s “epiphany” with device alarms and alerts
Recounted by a Senior Monitoring Device Engineer Hospitalized for 10 overnight treatments Included an infusion pump and a multi-parameter monitor Monitor was a personal request – not typically indicated for this type of treatment. 10 pump alerts for infusion completed 1 air alarm, 3 consecutive patient side occlusion alarms (catheter was occluded) 1 alert that prevented a concentration programming error/potential adverse event Frequent monitoring alarms interfered with sleeping

7. Alarms During One Patient’s Admission
Estimated greater than 50 IV pump alarms and alerts daily
emergent antecubital IV insertion site in the ED
IV placement not changed to a more appropriate site on patient care unit
no arm board provided
personally reset occlusion alarms
triple antibiotics IV timing = 9 infusion completion alarms
Did not use the secondary piggyback function
completion of the antibiotic fluid triggered an alarm
I turned off the alarm and used the call bell when no response in 5 minutes
Alarms during transport went unanswered
low battery alarms
had BR privileges, however unable to bend over to plug in the IV pump

8. Enhanced Retrospective Data Alarms Management
Alarm data
By type
By drug/fluid
Care Area
Time
Risk mitigation
Contributors to the noise
Workflow changes
Dataset configuration
TJC Compliance

9. © 2017 BD Corporation or one of its subsidiaries. All rights reserved.
Analysis Overview
An analysis of alarms and alerts received during the drug or fluid infusion was completed
130 hospitals’ data with 8,089,207 Infusions from 12/15/2016 to 03/15/2017 were analyzed.
An Infusion consists of a start and end of an administered dose of a specific drug/fluid (could be 30 minute or 30 hour infusion)
95,376 Total Infusion Systems (PCU and 1-4 pumps)
61,070 pump modules were used (LVP, Syringe, and PCA)
6,741,005 Alarms recorded
1,026,164 Alerts recorded
Bullet points are gray instead of orange.
co_Hospitals: 130 = Total number of hospitals captured (Time Period: 12/15/2016 to 03/15/2017)
co_Infusions: = Total Infusion
co_System: = Total Infusion Systems
co_Module : = pump modules
co_Alarms : = Total Alarms
co_Alerts : = Total Alerts
© 2017 BD Corporation or one of its subsidiaries. All rights reserved.

10. Percentage of Infusions with Alarms
© 2017 BD Corporation or one of its subsidiaries. All rights reserved.

11. Number of Alarms Received During Infusions
Key observations:
81% of infusions had no alarms
6% had one alarm
13% had from 2 to 50 alarms
I need to get the query to run so I can populate this slide with the correct data.
© 2017 BD Corporation or one of its subsidiaries. All rights reserved.

12. All Alarms Received During Infusions Includes LVP, Syringe and PCA Pumps
Key observations:
43% were below the pump occlusions
50% of all alarms were occlusions
30% of alarms occurred with caregiver at bedside

13. Patient Side Occlusion Alarms by Care Area Profiles
Alarms before the first secondary infusion.
Other than possible set mis-loading at initial start, this seems to show air alarms can occur about any time
Answer: It may be worthy to note that alarms tend to go up right after infusion start and then at 30 minutes interval.
© 2017 BD Corporation or one of its subsidiaries. All rights reserved.

14. Hospital 1-Top 25 Drugs With Alarms

15. IDN 1 Adult Critical Care Top 10 Drugs/Fluids with AIR alarms
Key Observations:
Amiodarone had 28% of all AIR alarms
4 drugs contributed 63% of AIR alarms

16. IDN 2 Adult Critical Care
Top 10 Drugs/Fluids with AIR alarms
Key Observations:
Amiodarone was 6th in frequency
IDN 1 – Outsourced drug, long shelf life
IDN 2 – Drug prepared when ordered

17. Palomar Health Public health care district in North San Diego County
3 acute care facilities and 1 skilled nursing facility
Palomar Medical Center, Pomerado Hospital, Palomar Health Downtown Campus and Villa Pomerado

18. Project Purpose: Reduction of infusion pump alarms
SEA #50 & Joint Commission National Patient Safety Goal on Alarms Management Clinical Excellence Grant CareFusion® Foundation

19. Which Medications Cause Alarms?

20. Survey estimate of average number of pump alarms per shift
% of respondents
Number of alarms per shift

21. Likelihood of Causing Alarms
Least Likely Most Likely

22. Number of AIL Alarms and Infusions 75mcL AIL Dataset

23. Improve Implementation of Anti-Siphon Valve Amiodarone Albumin TPN
Lipids
Etoposide
Crofab
IVIG
Implementation of Anti-Siphon Valve

24. Desired improvements for clinical alarms
Respondents were asked to comment on desired improvements that would increase alarm recognition and response (free text format)

25. Thank You