Improving the Rate of Home Ventilator Alarm Use in a Pediatric Pulmonary Medicine Clinic

Abstract

Background: Children requiring chronic mechanical ventilation in the home setting are at extremely high risk of morbidity and mortality. Internal ventilator alarms are one mechanism to improve safety for these patients but there are no guidelines or standard practice for how to use these alarms. Objective: The aim of this quality improvement project was to increase the mean rate of critical ventilator alarms set in our home ventilator population when seen in clinic from 63% to >90%. Methods: Using the Model for Improvement we developed, tested and implemented a series of interventions using Plan-Do-Study-Act cycles. Our measure was tracked using statistical process control methods. Our primary interventions were: (1) standardization of the clinic workflow, (2) development of an algorithm for ventilator alarms, (3) updating that algorithm based on tracking of recurrent failures and inpatient testing, (4) engagement of staff to change the culture surrounding ventilator alarms. Results: Baseline data was collected from May 1 – July 13, 2017 on 130 consecutive patients and showed a baseline of 63% of critical alarms set in patient seen in clinic. Observation of the process, standardization of workflow and adaptation of an alarm algorithm led to an increased to 85.7%. Revision of our algorithm to include an apnea alarm in conjunction to increased provider engagement led to rate of 95.1%, exceeding or goal. Continued improvement to a rate of 98.6% was seen and sustained as a result of culture change related to ventilator alarms. Conclusions: This stepwise approach to ventilator alarms led to a sustained improvement in the rate of critical ventilator alarms used in our chronic ventilator patients. Many of our interventions could be generalizable to other pediatric institutions. current ventilator alarms utilized in inpatient and outpatient settings and the process for collecting and evaluating information in the pulmonary clinic setting. Gaps in knowledge and process were identified. Using the Model for Improvement, global and SMART (Specific, Measurable, Actionable, Relevant, Time-Bound) Aims were defined and a key driver diagram was developed describing the team’s theory for improvement. We tested our hypothesized strategies for improvement using Plan-Do-Study-Act (PDSA) cycles to allow for further testing and refinement.