Boston Medical Center (Boston, MA) was selected as a finalist for ECRI Institute's 6th Health Devices Achievement Award for its development of a self-contained, cart-based patient monitoring training system. The cart was designed to improve clinicians' familiarity with the monitoring system, and to better educate them about system changes that were implemented to improve the management of clinical alarms.

The Health Devices Achievement Award recognizes outstanding initiatives undertaken by member healthcare institutions to improve patient safety, reduce costs, or otherwise facilitate better strategic management of health technology. ECRI Institute announced the winner and two other finalists for the 6th award in September 2011. Learn about the other submissions that achieved recognition. 

The Concept

This is the second year in a row that Boston Medical Center (BMC) of Boston, Massachusetts, has been a finalist for the Health Devices Achievement Award. Last year, BMC was recognized for its project to standardize alarm defaults for telemetry. One of the hurdles the staff encountered in implementing that project was the lack of an effective way to train staff about the alarm default changes. The work they undertook to create a better way of educating clinicians about system changes and improving their overall familiarity with the system has, like the original alarm project, caught our eye.

BMC's solution is a self-contained, cart-based patient monitoring training system that is used both to validate alarm policy changes and to train clinicians on these changes. The system was built using existing monitoring hardware and patient simulators, and recreates key elements of managing a patient on telemetry, such as admission/discharge, alarm setting, alarm annunciation, event review, and storage of patient data. Furthermore, the system is designed to facilitate use within a large urban campus—BMC focused on keeping the system's size and weight down, as well as making it easy and safe to move.

The system was instrumental in a two-day education program at BMC. The education team, including a representative from the monitoring vendor who was on-site to answer any questions, visited each of the care areas. As questions arose, the team was able to use the mobile education system to demonstrate relevant features rather than just answering in the abstract.

The system is also instrumental in orienting staff to upcoming changes in alarm protocols. With the cart, clinicians are able to practice with a functional system in their normal work area, without having to worry about compromising patient care by practicing on—and inadvertently making improper adjustments to—a monitor that is normally used on patients. BMC has found the system to be extremely helpful in educating staff about new alarm defaults, since staff can compare the current defaults to the new ones. BMC also expects the system to become an important part of developing future changes, as it allows those changes to be tested before being put into place.

Jim Piepenbrink, director of BMC's department of clinical engineering, had one piece of advice for facilities that may be considering a similar project: The design and ergonomic features are essential aspects of such a system. "We had to ensure that the cart could withstand transportation across campus, was not too heavy to move, and that the devices were secured to the cart to prevent issues during transport." Piepenbrink added, "We had the education staff evaluate the use of the cart so that they could provide feedback on the various features that would make it a useful system." 

Best Practices

Other hospitals that have, like BMC, chosen to address alarm fatigue by making device-related changes may find that a mobile system could be a useful way to educate staff about those changes. In BMC's case, the cart is composed of monitoring hardware, but hospitals could develop such educational systems for other alarming devices such as ventilators or infusion pumps.

Stepping back a bit, BMC's approach could be a model for clinician education in general, not just for alarm-related issues. When a hospital places relevant hardware on a mobile cart and takes that system to the care areas instead of pulling staff out of their work environment, education becomes a part of patient care and not a separate activity, and clinicians learn about new policies in the context in which they will be implemented.