Arkansas
Children’s
Hospital
A few fun facts about ACH
• ACH celebrated 100 years of service to families of Arkansas in
2012
• ACH has 370 beds, most of which are in private patient rooms
and the campus spans 29 city blocks
• On average, around 250 children spend the night in our care
every evening.
• ACH is one of the state’s largest employers with about 4,000
team members, including the physicians
• Kids at ACH needed 265,000 Band-Aids last year
• We have 19 pets that are certified as part of our Therapeutic
Animal Intervention Lifts Spirits (or TAILS) program. They visit
patients in clinics, play areas and at besides.
Integration of Patient Alarms and
Nurse Call to Vocera Badges
Lessons Learned
Who is part of the Implementation
Team
•
•
•
•
•
•
•
•
•
IT-Telecom
Clinical Informatics
Unit Nurse Manager
Clinical Engineering
Physical Facilities
Vendor- Team
Nurse Call (Hill-Rom)
Clinical Monitor (GE)
Mobile Voice (Vocera)
Headaches Along the Way
Clinical monitor’s (GE) required their gateway in place
to send clinical data to Connexall. Per GE this is an
FDA requirement.
Hill-Rom required a telephony gateway. Arkansas
Children’s Hospital required SIP vs. PRI into the Avaya
Telephone System.
There is truth in the saying less is better
•
•
•
•
The areas of deployment were CVICU and NICU
In 90 percent of these rooms the Nurse to Patient ratio is 1 to
1 with the exception of the step down unit in NICU.
The tendency is for the Unit staff to request more Alarms
than need to be sent to the badge which has the potential to
create alarm fatigue.
Determine if the Alarm will be silenced at the bedside faster
preventing it from being sent to the badge.
Staff Assignments
•
•
•
•
•
Choose which system handles Staff Assignments and
Escalation of Alarms
Nurse Call
Vocera
Connexall
At Arkansas Children’s Hospital we use Vocera it is easy to use
and a perfect match defining Buddy Nurse and Shift
Coordinator for escalation of Alarms.
Nurse Call Alarms and Clinical Alarms by
Staff Assignment per Unit
What happens when you have visibility into the Nurse Call and
Clinical Monitoring System
•
•
•
•
What was a closed database system is now a open database.
How the unit and patient rooms are identified in nurse call is
now part of how that room communicates alarms and nurse
call to the Vocera badge.
The Clinical Monitor Name is now part of the room and how
alarms communicate with badge.
IT-Change Management is now a requirement of Nurse Call
and the Clinical Monitoring System.
GO LIVE
• Be Flexible
• On the CVICU unit Low Sat was removed, there
were too many triggers for this Alarm which
was silenced at the bedside. These alarms went
to Nurse, Nurse Buddy then to Team Leader
• It is a big adjustment for nursing and quite
stressful for the week of go live.
New Connexall Project for Arkansas Children’s
Hospital
• Integration of Vent Alarms for Private Rooms in
the NICU.
• Arkansas Children’s Hospital is using Excel
Medical’s BedComm product with a Perle Hub
to collect alarm data from the serial port to the
Vocera Badge and to the EMR.
• Go Live Date Set for April 1 2014
Vent Alarms –Sample of Alarms
ONLY NICU Nurse Alarms
ONLY Respiratory Dept Alarms
NICU Nurse AND Respiratory
Dept Alarms
Device
EME Name (OBX-3-2)
SERVO-i
O2_HI
SERVO-i
O2_LOW
SERVO-i
ETCO2_HI
SERVO-i
ETCO2_LOW
SERVO-i
BREATHING_MODULE
SERVO-i
INSPIRATORY_MODULE
SERVO-i
PANEL_MODULE
SERVO-i
LINEARIZATION_MODULE
SERVO-i
SYSTEM_MODULE
Possible Values (OBX-5)
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Manufacturer Description
02 conc. too high - alarm
02 conc. too low - alarm
EtCO2 conc. too high - alarm
EtCO2 conc. too low - alarm
Breathing system uP Module error - alarm (emulated = 0)
Inspiratory control uP Module error - alarm (emulated = 0)
Panel Interface uP Module error - alarm (emulated = 0)
Exp. flow & CO2 linearization uP Module error - alarm (emulated = 0)
Monitoring System uP Module error - alarm (emulated = 0)
SERVO-i
INTERFACE_MODULE
SERVO-i
AIRWAY_HI
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
SERVO-i
EXPIRATION_VOLUME
Alarm Active
Alarm Active, but Silenced
SERVO-i
APNEA
Alarm Active
Alarm Active, but Silenced
SERVO-i
GAS_SUPPLY
Alarm Active
Alarm Active, but Silenced
Computer Interface Emulator technical error - alarm (emulated = 0)
Airway pressure alarm Upper pressure limit exceeded - alarm
Exp. minute volume - alarm
One or more of following alarms:
Exp. minute volume too high
Exp. minute volume too high
Exp. minute volume too low
Apnea alarm/Backup ventilation
One or more of following alarms:
Apnea
No Patient Effort
(Ben) I think we could not include this alarm. This is the less critical alarm in terms of
patient effort. The ventilator will provide this alarm when backup ventilation kicks in.
The patient can trigger the ventilator out of backup breathing 2 more times before an
intervention is required.
No Consistent Patient Effort
- (Ben) this is the most critical alarm in terms of patient effort. At this point, the
ventilator will be set to stay in backup breathing, and will require an intervention to
resume the spontaneous component.
Check Catheter position - RR and HR coupling
(NAVA)
Check Catheter position - Edi Invalid (NAVA)
Gas supply alarm
Battery alarm
SERVO-i
BATTERY
Alarm Active
Alarm Active, but Silenced
One or more of following alarms:
Limited battery capacity
No battery capacity
Power Failure - alarm
One or more of following alarms:
SERVO-i
POWER_FAILURE
Alarm Active
Alarm Active, but Silenced
-12V too low/high
12V too low/high
24V too low/high
SERVO-i
MAINS_FAILURE
SERVO-i
O2_POTENTIOMETER
SERVO-i
CMV_POTENTIOMETER
SERVO-i
RANGE_SWITCH
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Mains Failure - alarm
02 potentiometer error - alarm (emulated = 0)
CMV potentiometer error - alarm (emulated =0)
Range Switch error - alarm (emulated = 0)
SERVO-i
MODE_SWITCH
Alarm Active
Alarm Active, but Silenced
Mode Switch error - alarm (emulated = 0)
Barometer error - alarm
SERVO-i
BAROMETER
Alarm Active
Alarm Active, but Silenced
One or more of following alarms:
Baro. Press. too high
Baro. Press, too low
SERVO-i
HI_CONTINUOUS_PRESSURE
Alarm Active
Alarm Active, but Silenced
High continuous pressure - alarm
Overrange - alarm
SERVO-i
OVERRANGE
Alarm Active
Alarm Active, but Silenced
One or more of following alarms:
Insp. Tidal volume overrange
Insp. Flow overrange
SERVO-i
O2_CELL
Alarm Active
Alarm Active, but Silenced
02 cell disconnect - alarm
Computer Interface Emulator Internal communication failure - alarm
SERVO-i
COMMUNICATION
Alarm Active
Alarm Active, but Silenced
One or more of following alarms:
Panel/Breathing/ExpFlowMtr disconnect
Panel/Breathing/ExpFlowMtr connect timeout
SERVO-i
HARDWARE
SERVO-i
ALARM_BUFFER
SERVO-i
CI_BATTERY_VOLT
SERVO-i
TIME
SERVO-i
NO_PATIENT_EFFORT
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Computer Interface Emulator hardware error - alarm (emulated = 0)
Alarm buff (emulated = 0)
CI Battery Voltage - alarm (emulated = 0)
Time in waiting position exceeds 2 min
No Patient Effort
SERVO-i
LEAKAGE
SERVO-i
TUBING
SERVO-i
REGULATION
SERVO-i
BREATH_FREQ_HI
SERVO-i
BREATH_FREQ_LO
SERVO-i
PEEP_LO
SERVO-i
MODE_SWITCH
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Leakage out of range
Check tubing
Regulation pressure limited
Breath frequency High
Breath frequency Low
PEEP Low
Mode Switch error - alarm (emulated = 0)
Barometer error - alarm
SERVO-i
BAROMETER
Alarm Active
Alarm Active, but Silenced
One or more of following alarms:
Baro. Press. too high
Baro. Press, too low
SERVO-i
HI_CONTINUOUS_PRESSURE
Alarm Active
Alarm Active, but Silenced
High continuous pressure - alarm
Overrange - alarm
SERVO-i
OVERRANGE
Alarm Active
Alarm Active, but Silenced
One or more of following alarms:
Insp. Tidal volume overrange
Insp. Flow overrange
SERVO-i
O2_CELL
Alarm Active
Alarm Active, but Silenced
3 cell disconnect - alarm
Computer Interface Emulator Internal communication failure - alarm
SERVO-i
COMMUNICATION
Alarm Active
Alarm Active, but Silenced
One or more of following alarms:
Panel/Breathing/ExpFlowMtr disconnect
Panel/Breathing/ExpFlowMtr connect timeout
SERVO-i
HARDWARE
SERVO-i
ALARM_BUFFER
Alarm Active
Alarm Active, but Silenced
Alarm Active
Alarm Active, but Silenced
Computer Interface Emulator hardware error - alarm (emulated = 0)
Alarm buff (emulated = 0)
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
Alarm Active
Alarm Active, but Silenced
Alarm Active
HELIOX_ADAPTER
Alarm Active, but Silenced
Alarm Active
EDI_SIGNAL
Alarm Active, but Silenced
Alarm Active
EDI_INVALID
Alarm Active, but Silenced
Alarm Active
RR_AND_HR_COUPLING
Alarm Active, but Silenced
Alarm Active
INCONSISTENT_PATIENT_EFFORT
Alarm Active, but Silenced
Alarm Active
LEAKAGE_FRACTION_HI
Alarm Active, but Silenced
Alarm Active
HIGH_PRIORITY
Alarm Active, but Silenced
EXPIRTION_VOLUME_LO
Exp. Minute volume too low - alarm
Check Heliox adapter
Unreliable Edi signal
Check Catheter position - Edi Invalid
Check Catheter position - RR and HR coupling
No Consistent Patient Effort
Leakage fraction too high
High Priority Alarm
• The Servo-1 has 52 Alarms which can be sent the Vocera Badge the
other models VNS 500 73 Alarms and LTV 27 Alarms.
Alarm Active
Exp. Minute volume too low - alarm
Alarm Active, but Silenced
Alarm Active
SERVO-i
HELIOX_ADAPTER
Check Heliox adapter
Alarm Active, but Silenced
Alarm Active
SERVO-i
EDI_SIGNAL
Unreliable Edi signal
Alarm Active, but Silenced
Alarm Active
SERVO-i
EDI_INVALID
Check Catheter position - Edi Invalid
Alarm Active, but Silenced
Alarm Active
SERVO-i
RR_AND_HR_COUPLING
Check Catheter position - RR and HR coupling
Alarm Active, but Silenced
Alarm Active
SERVO-i
INCONSISTENT_PATIENT_EFFORT
No Consistent Patient Effort
Alarm Active, but Silenced
Notification: Primary, Secondary (RT vs. RN)
Alarm Active
SERVO-i
LEAKAGE_FRACTION_HI
Leakage fraction too high
Alarm Active, but Silenced
Alarm
Alarm Active
SERVO-i
HIGH_PRIORITY
High Priority Alarm
Alarm Active, but Silenced
SERVO-i
EXPIRTION_VOLUME_LO
Vent Alarms for Go Live
Sevo-1
Apnea (will include Apnea, ‘No Patient Effort’ or ‘No
Consistent Patient Effort’)
Primary : RN
Secondary: RT
Tertiary : Team Leader
Expiratory Minute Volume – Too High or Low’
Primary : RN&RT Secondary: Buddy Nurse Tertiary : T L
Mains Failure
Primary : RT
• The
Servo-1 has 52 Alarms which can
be sent Secondary:
the Vocera
Gas Supply
Primary : RT
RN Tertiary : Team Leader
Badge
Alarms
LTV 27
Battery the other models VNS 500 73
Primary
: RT and
Secondary:
RN Tertiary : Team Leader
Alarms.
Power Failure
Primary : RT
Secondary: RN Tertiary : Team Leader
Secondary: RN
Tertiary : Team Leader
Alarm Active
Exp. Minute volume too low - alarm
Alarm Active, but Silenced
Alarm Active
SERVO-i
HELIOX_ADAPTER
Check Heliox adapter
Alarm Active, but Silenced
Alarm Active
SERVO-i
EDI_SIGNAL
Unreliable Edi signal
Alarm Active, but Silenced
Alarm Active
SERVO-i
EDI_INVALID
Check Catheter position - Edi Invalid
Alarm Active, but Silenced
Alarm Active
SERVO-i
RR_AND_HR_COUPLING
Check Catheter position - RR and HR coupling
Alarm Active, but Silenced
Alarm Active
SERVO-i
INCONSISTENT_PATIENT_EFFORT
No Consistent Patient Effort
Alarm Active, but Silenced
Alarm
Notification: Primary, Secondary or Both
Alarm Active
SERVO-i
LEAKAGE_FRACTION_HI
Leakage
fraction tooRT
high Tertiary : Team Leader
Airway Obstructed
Primary : RN
Secondary:
Alarm Active, but Silenced
Apnea
Primary : RN
Secondary: RT Tertiary : Team Leader
Alarm Active
SERVO-i
HIGH_PRIORITY
High Priority Alarm
Alarm Active, but Silenced
Airway Pressure Low/ Disconnection
Primary : RN&RT Secondary: Buddy Nurse Tertiary : T L
SERVO-i
EXPIRTION_VOLUME_LO
VN500
Neo Flow Sensor Failure
Primary : RT
Secondary: RN
Tertiary : Team Leader
Power Failure
Primary : RT
Secondary: RN
Tertiary : Team Leader
Mains Failure
Primary : RT
Secondary: RN
Tertiary : Team Leader
Supply
Primary : RT
• Air
The
Servo-1 has 52 Alarms which can be
sent theSecondary:
VoceraRN
No Oxygen Supply
Primary : RT
Secondary: RN
Badge
the
other
models
VNS
500
73
Alarms
and
LTV 27
Ventilation Unit Restarted/Vent Failure
Primary : RT
Secondary: RN
Alarms.Valve Malfunction
Expiratory
Primary : RT
Secondary: RN
Tertiary : Team Leader
Tertiary : Team Leader
Tertiary : Team Leader
Tertiary : Team Leader
System Fault (Button stuck;Rotary stuck)
Primary : RT
Secondary: RN
Tertiary : Team Leader
Internal Power Supply Failure
Primary : RT
Secondary: RN
Tertiary : Team Leader
Internal Battery Discharged/Failure
Primary : RT
Secondary: RN
Tertiary : Team Leader
Alarm System Malfunction
Primary : RT
Secondary: RN
Tertiary : Team Leader
Alarm Active
Exp. Minute volume too low - alarm
Alarm Active, but Silenced
Alarm Active
SERVO-i
HELIOX_ADAPTER
Check Heliox adapter
Alarm Active, but Silenced
Alarm Active
SERVO-i
EDI_SIGNAL
Unreliable Edi signal
Alarm Active, but Silenced
Alarm Active
SERVO-i
EDI_INVALID Alarm
Check Catheter position - Edi Invalid
Alarm Active, but SilencedNotification: Primary, Secondary or Both
Apnea
Secondary: RT Tertiary : Team Leader
Alarm Active Primary : RN
SERVO-i
RR_AND_HR_COUPLING
Check Catheter position - RR and HR coupling
Alarm Active, but Silenced
Disconnect
Primary : RN&RT Secondary: Buddy Nurse Tertiary : T L
Alarm Active
SERVO-i
Effort : Team Leader
ExternalINCONSISTENT_PATIENT_EFFORT
Power Lost
Primary
: RT No Consistent
Secondary:Patient
RN Tertiary
Alarm Active, but
Silenced
Alarm Active Primary : RT
ExternalLEAKAGE_FRACTION_HI
Power Low
Secondary:
Tertiary : Team Leader
SERVO-i
Leakage
fractionRN
too high
Alarm Active, but Silenced
Alarm Active Primary : RT
Hardware
Fault
RN Tertiary : Team Leader
SERVO-i
HIGH_PRIORITY
HighSecondary:
Priority Alarm
Alarm Active, but Silenced
Internal Battery Empty
Primary : RT
Secondary: RN Tertiary : Team Leader
SERVO-i
EXPIRTION_VOLUME_LO
LTV
Internal Battery Low
Primary : RT
Secondary: RN Tertiary : Team Leader
Oxygen Pressure Low
Primary : RT
Secondary: RN Tertiary : Team Leader
• The Servo-1 has 52 Alarms which can be sent the Vocera
In the discovery phase of the project 157 alarms total were identified, the go
Badge the other models VNS 500 73 Alarms and LTV 27
live number is 28 alarms
Alarms.
SERVO-i
Alarm Active
Alarm Active, but Silenced
Alarm Active
HELIOX_ADAPTER
Alarm Active, but Silenced
Alarm Active
EDI_SIGNAL
Alarm Active, but Silenced
Alarm Active
EDI_INVALID
Alarm Active, but Silenced
Alarm Active
RR_AND_HR_COUPLING
Alarm Active, but Silenced
Alarm Active
INCONSISTENT_PATIENT_EFFORT
Alarm Active, but Silenced
Alarm Active
LEAKAGE_FRACTION_HI
Alarm Active, but Silenced
Alarm Active
HIGH_PRIORITY
Alarm Active, but Silenced
EXPIRTION_VOLUME_LO
Exp. Minute volume too low - alarm
Why Arkansas Children’s Hospital
Chose Connexall
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
Check Heliox adapter
Unreliable Edi signal
Check Catheter position - Edi Invalid
Check Catheter position - RR and HR coupling
No Consistent Patient Effort
Leakage fraction too high
• Leader in the Middle Ware Space for clinical and nonHigh Priority Alarm
clinical systems
• Connexall investment and development with the
• The Servo-1 has 52 Alarms which can be sent the Vocera
majority
of clinical
manufacturers
Badge the
other models
VNS 500system
73 Alarms
and LTV 27
Alarms.
• Connexall develops software for legacy and new
platforms within the same clinical system
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
Alarm Active
Alarm Active, but Silenced
Alarm Active
HELIOX_ADAPTER
Alarm Active, but Silenced
Alarm Active
EDI_SIGNAL
Alarm Active, but Silenced
Alarm Active
EDI_INVALID
Alarm Active, but Silenced
Alarm Active
RR_AND_HR_COUPLING
Alarm Active, but Silenced
Alarm Active
INCONSISTENT_PATIENT_EFFORT
Alarm Active, but Silenced
Alarm Active
LEAKAGE_FRACTION_HI
Alarm Active, but Silenced
Alarm Active
HIGH_PRIORITY
Alarm Active, but Silenced
EXPIRTION_VOLUME_LO
Exp. Minute volume too low - alarm
Check Heliox adapter
Unreliable Edi signal
Check Catheter position - Edi Invalid
Check Catheter position - RR and HR coupling
• Independent not owned by a Clinical System manufacturer
SERVO-i
SERVO-i
SERVO-i
No Consistent Patient Effort
Leakage fraction too high
High Priority Alarm
• Excellent Professional Service and Implementation Team
The Servo-1
has 52 Alarms which
be sent the
Vocera and best practices
• • Clear
Understanding
ofcan
Clinical
Alarms
Badge the other models VNS 500 73 Alarms and LTV 27
toAlarms.
avoid Alarm Fatigue
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
Alarm Active
Alarm Active, but Silenced
Alarm Active
HELIOX_ADAPTER
Alarm Active, but Silenced
Alarm Active
EDI_SIGNAL
Alarm Active, but Silenced
Alarm Active
EDI_INVALID
Alarm Active, but Silenced
Alarm Active
RR_AND_HR_COUPLING
Alarm Active, but Silenced
Alarm Active
INCONSISTENT_PATIENT_EFFORT
Alarm Active, but Silenced
Alarm Active
LEAKAGE_FRACTION_HI
Alarm Active, but Silenced
Alarm Active
HIGH_PRIORITY
Alarm Active, but Silenced
EXPIRTION_VOLUME_LO
Exp. Minute volume too low - alarm
Check Heliox adapter
How did Connexall Improve Patient
Care at ACH:
Unreliable Edi signal
Check Catheter position - Edi Invalid
Check Catheter position - RR and HR coupling
The opening of a new Hospital Wing created growth
and the addition of 17 private
No Consistent Patient Effort
rooms for the NICU. Without clinical alarms going to a mobile device, an RN was
SERVO-i
Leakage fraction too high
required to sit at a central station to monitor critical
patient alarms. These rooms were
SERVO-i
High Priority
Alarmneeded a more quiet
originally designed to take care of the sickest babies
who
environment to heal and grow however the lack of alarm integration it was not possible
and it was used as a step down unit .
SERVO-i
• The
Servo-1
52 Alarms
can be from
sent the
Vocerato 40. With the size of the
The
CVICU
unit has
expanded
also which
with growth
20 rooms
otherthat
models
VNS 500
Alarms
and LTV
27Assist and Code blue to be
unitBadge
it wasthe
critical
the Nurse
Call73
system
include
Staff
sentAlarms.
to a mobile device. The nurse call integration improved family patient satisfaction
and clinical emergency response
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
SERVO-i
Alarm Active
Alarm Active, but Silenced
Alarm Active
HELIOX_ADAPTER
Alarm Active, but Silenced
Alarm Active
EDI_SIGNAL
Alarm Active, but Silenced
Alarm Active
EDI_INVALID
Alarm Active, but Silenced
Alarm Active
RR_AND_HR_COUPLING
Alarm Active, but Silenced
Alarm Active
INCONSISTENT_PATIENT_EFFORT
Alarm Active, but Silenced
Alarm Active
LEAKAGE_FRACTION_HI
Alarm Active, but Silenced
Alarm Active
HIGH_PRIORITY
Alarm Active, but Silenced
EXPIRTION_VOLUME_LO
Exp. Minute volume too low - alarm
Check Heliox adapter
Unreliable Edi signal
Project Success:
Check Catheter position - Edi Invalid
Check Catheter position - RR and HR coupling
No Consistent Patient Effort
Leakage fraction too Services
high
The Connexall Project Management and Professional
is a must!
High Priority Alarm
Connexall’s technical expertise solved an issue with the nurse call system that
the vendor had not been able to solve in over 8 months.
The
Connexall
Project
Team’s
knowledge
of clinical alarms helped
• The
Servo-1
has 52
Alarms
whichpractical
can be sent
the Vocera
guidethe
theother
Hospital
in the
right
toand
avoid
Badge
models
VNS
500direction
73 Alarms
LTValarm
27 fatigue.
Alarms.
Excellent on site go live support worked in unison with Clinicians and other
clinical systems for a smooth go live experience on all shifts.
Thank you