Unit-wide notification of ventilator disconnections.
The alarms generated by mechanical ventilators when patients become disconnected can blend in with other typical sounds of the intensive care unit. Ventilator alarms that go unnoticed for extended periods of time often result in permanent patient harm or death. We developed a unit-wide system to monitor ventilator disconnection alarms. When a disconnection is identified, the system takes control of every computer in the patient's intensive care unit and generates an enhanced audio and visual alert. This system was tested in four ICUs at LDS Hospital. Acceptance by medical personnel was very high and patient safety was improved through early intervention that avoided prolonged hypoxia. In addition, the system facilitated root cause analyses and new safety strategies.
Evans
R Scott
RS
Medical Informatics/Information Systems, LDS Hospital, Intermountain Health Care, Salt Lake City, Utah, USA.
Johnson
Kyle V
KV
Flint
Vrena B
VB
Kinder
A Tupper
AT
Hawley
William L
WL
Lyon
Charles R
CR
Vawdrey
David K
DK
Thomsen
George E
GE
D004868:Equipment Failure; D006801:Humans; D007362:Intensive Care Units; D008838:Microcomputers; D012122:Ventilators, Mechanical