Quality improvement initiative improves use of ventilator alarms amongst children with chronic respiratory failure

1. Using a stepwise, interdisciplinary approach, an algorithm was developed to improve the rates of safety alarms set on ventilators of children with chronic respiratory failure seen at an outpatient clinic.

2. Implementation of the algorithm and a standardized clinic workflow resulted in a 95% rate of critical alarms set compared to 63% prior to the study initiation.

Evidence Rating Level: 2 (Good)

Click to read the study in PEDIATRICS

Relevant Reading: Performance of mechanical ventilators at the patient’s home: a multicentre quality control study

Study Rundown: Children with chronic respiratory failure requiring mechanical ventilation are at high risk for mortality at home due to their underlying medical conditions and technology-dependence. Ventilator alarms are an important tool to alert caregivers of potentially catastrophic events such as tracheostomy tube plugging or accidental decannulation. However, only limited data are available to guide clinicians in how to best set these critical alarms. Researchers at Cincinnati Children’s Hospital created a quality improvement (QI) initiative aiming to improve the percentage of ventilator-dependent patients with critical alarms set at pulmonology clinic visits. During the study period, there were over 1,200 clinic visits. An algorithm was created for the two main ventilator types and focused on specific critical alarms (circuit disconnect, low minute ventilation, low tidal volume, and apnea alarms). These alarms were chosen based on simulations performed with a tracheostomy tube and lung model in the hospital. In addition to implementation of the algorithm, other aspects of the QI initiative included interdisciplinary engagement and standardization of clinic workflow. The percent of critical alarms set increased from 63% to 95.1% after the second iteration of the algorithm was implemented. This study was not designed to measure clinical outcomes of the improved alarm implementation, and increased ventilator alarms may actually result in “alarm fatigue.” Thus, future studies should address the real-world impact of improved alarm settings. This study serves as a valuable framework for other centers to use to help take care of this vulnerable patient population.

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