• Respiratory care · Apr 2020

    Observational Study

    Respiratory Volume Monitoring in the Perioperative Setting Across Multiple Centers.

    • Chunyuan Qiu, Eugene Cheng, Shawn R Winnick, Vu T Nguyen, Fang-Chen Hou, Sally Shou Yen, Gonzalo D Custodio, Jennifer H Dang, Diana LaPlace, Atef Morkos, Elena P Chung, and Vimal N Desai.
    • Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California. chunyuan.x.qiu@kp.org.
    • Respir Care. 2020 Apr 1; 65 (4): 482-491.

    BackgroundThe prevalence of nuisance (technical) alarms is the leading cause of alarm fatigue resulting in decreased awareness and a reduction in effective care. The Joint Commission identified in their National Patient Safety goals alarm fatigue as a major safety issue. The introduction of noninvasive respiratory volume monitoring (RVM) has implications for effective perioperative respiratory status management. We evaluated this within the Kaiser Permanente health system.MethodsThis observational study was conducted at 4 hospitals in the Kaiser Permanente system. Standard data from RVM, pulse oximetry, and capnography were collected postoperatively in the post-anesthesia care unit (PACU) and/or on the general hospital floor. Device-specific alarm types, rates, and respective actions were recorded and analyzed by non-study staff.ResultsRVM was applied to 247 subjects (143 females, body mass index 32.3 ± 8.7 kg/m2, age 60.9 ± 13.9 y) providing 2,321 h. RVM alarms occurred 605 times (0.25 alarms/h); 64% were actionable and addressed, 17% were not addressed, 13% were self-resolved, and only 6% were nuisance. In a subgroup, RVM completed all 127 h of monitoring, whereas oximetry with capnography only completed 51 h with 12.9 alarms/h (73% nuisance). The overall RVM alarm rate was significantly lower than with either pulse oximeters or capnography monitors. We saw a nearly 1,000-fold reduction in nuisance alarms compared to capnography and a 20-50-fold reduction in nuisance alarms compared to pulse oximetry.ConclusionsOur study indicates that alarm fatigue due to nuisance alarms continues to be a clinical challenge in perioperative settings. Among the 3 common technologies for respiratory function monitoring, RVM had the lowest rate of overall technical alarms and the highest rate of compliance. Furthermore, with early interventions, none of the subjects monitored with RVM suffered any negative outcomes.Copyright © 2020 by Daedalus Enterprises.

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