An Early Look at Infusion Pump Alarms and Alerts

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An Early Look at Infusion Pump Alarms and Alerts

Tim Vanderveen< PharmD, MSVice PresidentCenter for Safety and Clinical ExcellenceCareFusionSan Diego, CA


Issues with Infusion Pump Alarms and Alerts – The Current State• 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

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Issues with Infusion Pump Alarms and Alerts – The Current State• 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 no focus on alarms reduction

• Wireless connectivity and all infusion data transfer now provide a window to infusion pump alarms and alerts

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Alarms During One Patient’s Admission

• Estimate 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• nurses connected antibiotic above the pump chamber, changed

the IV pump setting, and lowered the primary IV• completion of the antibiotic fluid triggered an alarm

– I turned off the alarm and used the call bell when no response in 5 minutes

– low battery alarms• had BR privileges, however unable to bend over to plug in the

IV pump 4


Knowledge Portal for Infusion Technologies

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Percentage of Infusions with Alarms

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All Alarms Received During InfusionsIncludes LVP, Syringe and PCA Pumps

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Key observations:• 43% were below the pump occlusions • 50% of all alarms were occlusions• 30% of alarms occurred with caregiver at bedside

Patient Side Occlusion Alarms by Care Area Profiles

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Hospital 1-Top 25 Drugs With Alarms

16%26%

35%43%

49% 54% 59% 63% 66% 70% 73% 76% 79% 82% 84% 87% 88% 90% 92% 93% 94% 96% 97% 99% 100%

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0100020003000400050006000700080009000

AlarmCount Cummulative Frequency

Hospital 2 -Top Drugs With Alarms

25%33%

40%46% 52% 57% 61% 66% 69% 73% 76% 79% 81% 83% 86% 88% 89% 91% 93% 94% 96% 97% 98% 99% 100%

0%

20%

40%

60%

80%

100%

120%

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1000

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6000 AlarmCount CumulativeCount

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

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Likelihood of Causing Alarms

Pump Failure

Stat ‐Lock Use

Secondary line

Priming The Line

Medications

Sensitivity of the Infusion Pump

IV Tubing (e.g. kinked tubing)

IV Site Placement

Least Likely Most Likely 11

Which Medications Cause Air Alarms?

Amiodorone39%

Albumin19%

TPN/Lipids9%

Blood Products3%

ABX8%

Other 22%

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Summary• Based on nursing perception, the most frequent cause

of alarm is patient-side occlusions• Based on the results, educational opportunities for

nursing staff include:– Volume adjustment– AC adapter adjustment – Attention to all pump alarms regardless of assignment

• Based on nursing perception, the most frequent medication-related alarms were due to – Amiodarone – Albumin– TPN – Blood products


Short Term Strategies

• With high percentage of air alarms right after infusion start, reinforce slow priming of IV tubing.

• Closing roller clamp before priming and filling drip chamber 2/3rd full improves priming and does not waste fluid.

• Do not “Burp” the air from IV bags. This can lead to significant air in the tubing that comes from the air in the drip chamber.

• Always Pause an infusion before changing an IV container. Turning the IV spike upside down allows air to enter the set.

• Refrigerated infusions warm up and outgas: consider preparation and storage practices and warm fluids to room temperature where possible.

• Certain drugs and fluids tend to have multiple air alarms; consider adding anti-siphon valve for drugs such as etoposide, albumin, IVIG.

• Volumes to be infused are frequently used as reminders to visit the patient; 2 and 4 hour VTBI limits.

• Battery alarms are frequent – check to see if transport attendants, physical therapists, are assisting by plugging in pumps upon patient return

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Short Term Strategies

• Frequent occlusions can be due to catheter placement. Consider arm boards or limited motion dressings to reduce catheter kinking, catheter location.

• Certain fluids and drugs in bottles (proteins, lipids, high surfactant content) can wet IV spike filter and cause fluid side occlusions alarms.

• Bottles must be vented. More frequent IV set changes may be required if the infusions are stopped for extended periods or multiple bottles are administered with same set

• With high percentage of pump alarms occurring while caregivers are at the pump, consider distribution of tips to reduce these alarms (example: manually close flo-stop clamp before installing the set).

• Consider reducing alarm loudness during night shift. • Review practices that lead to alarms; example is infusing antibiotics

as primaries rather than secondary infusions.• Evaluate the need for certain alerts, such as near end of infusion

(NEOI), secondary to primary 6 beeps at transition

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Documents

An Early Look at Infusion Pump Alarms and Alerts