Together with the alarm coach, we made a good assessment in advance for a workable starting point.
Sander Hoogland, HiX Coördinator Pediatrics, Rhena Neonatology, ASZ, Dordrecht
Since July 2024, the Medical Alert System (MAS) has been live at the Rhena Neonatology department of the Dutch Albert Schweitzer Hospital (ASZ) in Dordrecht. This implementation supports the three ambitions of the hospital: ‘The healthy professional, the healthy patient and the healthy organization’. Fewer unnecessary alarms from connected medical equipment burden healthcare staff less with stimuli, which ensures a calmer working environment.
“Creating a quiet high care department where the devices themselves produce as little noise as possible with minimal stimuli for both patients and their parents,” describes Sander Hoogland, HiX Pediatrics Coordinator, as the ultimate situation. With this project, ASZ is taking an important step towards a quieter healthcare environment. We look back on this process with Sander Hoogland.
Preparation for MAS
The Rhena Neonatology department of the ASZ is temporarily housed in the Children’s Department due to the renovation of their own department. This means a double adjustment: working in closed spaces and dealing with new medical alarms. Sander: “We used to sit in the same room as the children and then you quickly hear and see what is going on. Now we have to trust that the right alarms are actually being received.”
The return to a closed unit with 15 beds, neonatal suites and an isolation room offers the ideal opportunity to optimally use the Medical Alert System (MAS). Sander: “As we are now, it is a nice testing ground for the situation we will soon find ourselves in.”
Strict monitoring is important: you really have to be able to blindly trust the technology that everything is going well.
The first steps
“For Neonatology, where vulnerable newborns require intensive care, a VOS MOS (Nursing and Medical Call System) is essential to receive alarms outside the rooms on the caregivers’ mobile phones. In addition to this system, an additional step is required to connect medical devices such as surveillance monitors, infusion pumps and ventilators,” Sander explains. Itemedical took care of this and installed the Medical Device Data Gateway (MDDG) software so that validated measurements are entered both in EPD HiX and in the MOS of IQMessenger. Sander: “This is necessary to continue working safely.” This was followed by a three-month baseline measurement in which the MDDG collected data on the alarm situation, such as the number of medical alarms per type of device, alarm priorities and conditions and the duration of these alarms. Itemedical’s alarm coach analyzed this data to set up safe alarm filtering and delay together with the project team.
Insight into alarm situation
Sander: “The Neonatology department houses vulnerable children who need intensive care and their parents are closely involved. These patients move a lot, which often causes false alarms that parents also receive at the bedside. Strict monitoring is important: you really have to be able to blindly trust the technology that everything is going well.” The challenge lay in determining which alarms the itemedical gateway MDDG forwards to nurses’ smartphones. Sander: “We switched from a situation in which healthcare workers hear and see everything, to filtering alarms and determining acceptable delays. We discussed this in sessions with the itemedical alarm coach. This gave us insight and formed a good starting point for an efficient approach to alarm reduction. The collaboration regarding alarm coaching went well.”
The first experiences
“Of course it takes some getting used to,” says Sander. “We are replacing years of working methods in one go and you have to rely on the technology and that takes time. Yet it is going fairly smoothly. I find that nurses generally feel confident that they are receiving the correct relevant alarms. We have a team that immediately indicates this if it is not the case. I also liked that unnecessary alarms resolve themselves thanks to a safe delay.”
Evaluation shows that a set delay for medium priority alarms from surveillance monitors resulted in 46% fewer alarms, and for low priority alarms even 74% fewer. This gave Sander confidence in the new approach and created more support among nurses for not wanting to receive all alarms directly on their telephone. Colleagues respond positively to the number of relevant alarms received. “It is doable, and together with the alarm coach we made a good assessment in advance for a workable starting point. Of course, we still have to fine-tune it further, but I have every confidence in that,” says Sander.
Finetuning alarm reduction
Inspection of the alarm data revealed a number of ‘surprises’. Sander: “Yes, we want to know everything. Whether the temperature is too high or too low, whether the incubator opens or closes or fails – everything triggers an alarm. You register some alarms unconsciously and follow them automatically, such as with the mattress of a heated bed. That alone made it a useful exercise to investigate this.”
“We are using medical technology to look further into how we can safely turn off the alarm on infusion pumps. If the pump is in a closed room where only parents are present, is the alarm sound still useful? But we have to be 100% sure that the alarm will go through.” Reducing stimuli in these high care units is important, not only for the staff and patients, but also for parents. “For parents who have been in the ICU with their child for a long time, continuously hearing alarms may trigger a form of re-experiencing, even if the alarm does not come from their own child. Suppressing unnecessary alarms helps prevent this,” Sander adds.
The increasing burden of care creates an overload of stimuli and we want to do something about that.
Fewer stimuli, healthier staff
Sander: “The renovation is not only important for our patients, but also for the staff. The increasing burden of care creates an overload of stimuli, and we want to do something about that. It fits in with the hospital’s vision: a healthy employee through fewer stimuli, while you remain in control of patient care. The challenge lies in fine-tuning which alarms you receive and how quickly. If you properly arrange who primarily receives the relevant alarms and who the buddy is, you prevent unnecessary alarms and reduce stimuli.”
The future
What is the ultimate situation according to Sander? “That we create a quiet high care department where the medical devices produce as little noise as possible with minimal stimuli for both patients and their parents. I have high expectations for future healthcare. Once we have acclimatized to our new department, we like to take the next step to turn off the sound of certain devices. In that situation, it is no longer necessary for all monitors to spread an alarm across the units, for example.”
About Sander Hoogland
In addition to Neonatology nurse, Sander Hoogland is HiX Coordinator of Pediatrics of the Neonatology department at the Albert Schweitzer Hospital in Dordrecht. Since 2017, he has been supervising the digitalization of all care processes for this department. With his practical experience and IT expertise, Sander is involved in the MAS process as a substantive expert. He contributes ideas to the design and further refinement of alarm reduction with the focus on better care for both patients and healthcare providers.