Telemetry: Less is More. The Application of Practice Standards to Electrocardiographic Monitoring of Surgical Patients

Background: Effective utilization of resources and attention to a healthy work environment are at the forefront of nursing leadership agendas. The practice of telemetry stewardship supports a healing environment for patients and reduces alarm burden on staff. The literature is replete with studies in medical units regarding reduction of alarm burden using telemetry stewardship. However, there are no existing, prospective studies addressing the impact of telemetry utilization on alarms in surgical units. Objectives: This quality improvement (QI) project applied the best available evidence and provider preference to encourage telemetry stewardship and identified the associated impacts of appropriate telemetry monitoring on patients and staff. The unintended consequences of overuse of electrocardiographic (ECG) monitoring in the project unit included interruptions to care and alarm fatigue for patients and staff. Methods: A nurse-led interdisciplinary evidence-based QI project based on the 2017 American Heart Association (AHA) revised practice standards (Sandau et al., 2017) was implemented over ten weeks in a surgical unit in an academic medical center. Pre and post educational intervention aggregate data was obtained from the electronic health record (EHR) and standard reports. Perception of alarm fatigue and baseline adoption of standard practices were obtained using a nationally recognized survey. Results: The percentage of patients on the monitor did not change in response to the intervention (p = .12), and there was no significant reduction in alarms per patient per day(p = .07). Results of the perception of alarm fatigue survey, while not clinically significant (p = .56), provided a baseline for the scholarly project and future QI projects. There was no increase in adverse patient events during the project. Conclusion: A nurse led interdisciplinary strategy using the AHA revised practice standards can be safely applied to a complex surgical population to create a common platform to address the burden of inappropriate telemetry monitoring on patients and staff

Addressing the Problem of Alarm Fatigue: Enhancing Patient Safety through Cardiac Alarm Customization

The global aim of this project was to improve patient safety on the Surgical Unit at an acute care facility in Southern California through enhanced cardiac alarm customization. Alarms are intended to enhance patient safety. However, unnecessary and non-actionable alarms contribute to alarm desensitization and fatigue, lessening response time to critical alerts. Alarm fatigue has become a growing patient safety concern and is included as one of the Joint Commission’s 2015 National Patient Safety Goals. Assessment data on the Surgical Unit revealed lack of alarm customization and inappropriate default settings. The framework for the project focuses on the CNL curriculum element of Care Environment Management and the CNL functions in the role of Information Manager. The specific aim of this project was to reduce the number of cardiac alarms by 20% on the Surgical Unit by August 8th, 2015. Nurses were provided education on the problem of alarm fatigue and evidenced based guidelines including alarm customization. Alarm default settings were adjusted to more appropriately match the patient population. Six hours of alarm data was collected prior to and after implementation. A 32% reduction in cardiac alarms was observed following intervention, exceeding the goal of 20%. Pre and post intervention data indicated a need for further education regarding lead management, due to the high volume of artifact related alarms. Future work will also focus on evaluating patient and nurse satisfaction

Evidence-Based Cardiac Monitoring: A Practice Change

Background: Overuse of cardiac monitoring (CM) in acute care settings contributes to increased healthcare spending and cost of services for patients. Additionally, inappropriate use of CM can contribute to wastefulness of healthcare resources, increases in hospital staff workloads, and can be improved with best evidence-based practice recommendations. A Midwest acute care hospital lacked an evidence-based, systematic method to define care for patients requiring CM. Objective: The purpose of the project was to pilot an evidence-based CM change initiative, determine feasibility for sustainment, and propose next steps for adoption of the change initiative across non-emergency department, non-intensive care inpatient CM units at a Midwest, acute care hospital. Method: The project involved piloting an evidence-based practice change that focused on the appropriate use of CM. The practice change consisted of education for ordering providers and nurses on the current American Heart Association\u27s (AHA) and American College of Cardiology\u27s (ACC) CM guidelines (2017), nurse/provider communication, and utilization of a CM clinical tool in daily practice. Data was collected regarding appropriate CM orders, duration of time patients were maintained on CM, and the number of patients maintained on CM until discharge from the hospital over a two-week pre-implementation period and a six-week post-implementation period for comparison. The results of the study were then used to develop evidence-based recommendations for implementing a hospital-wide, CM practice change. Results: There was a significant decrease in the number of inappropriate CM orders over the duration of the project. Inappropriate CM orders were reduced from 35.0% to 12.1% (p = 0.0019). Additionally, there was a significant decrease in the number of patients maintained on monitoring until the time of discharge, 95.0% to 66.7% (p = 0.0121). The approximate cost savings for delivering CM services to patients over the duration of the project was $11,222.40 and$97,528.00 over a year. Estimated cost of services included patient monitoring, CM equipment, and upkeep of equipment. Approximate cost savings for RN wages over the duration of the project was $2,394.00 and$20,805.00 over a year. Conclusions: Implementation of an evidence-based practice change significantly decreased the number of inappropriate CM orders as well as the number of patients maintained on CM at the time of discharge from the hospital. Recommendations for sustainability of the practice change include incorporating the use of the AHA/ACC\u27s CM guideline in the electronic ordering system (EOS), use of evidence-based CM guidelines in daily practice, discussion of CM in daily interdisciplinary rounds, continued education for staff on AHA/ACC CM guidelines, and utilization of unit charge nurses to replicate the pilot study findings throughout the organization

Satellite antenna management system and method

The antenna management system and method allow a satellite to communicate with a ground station either directly or by an intermediary of a second satellite, thus permitting communication even when the satellite is not within range of the ground station. The system and method employ five major software components, which are the control and initialization module, the command and telemetry handler module, the contact schedule processor module, the contact state machining module, and the telemetry state machine module. The control and initialization module initializes the system and operates the main control cycle, in which the other modules are called. The command and telemetry handler module handles communication to and from the ground station. The contact scheduler processor module handles the contact entry schedules to allow scheduling of contacts with the second satellite. The contact and telemetry state machine modules handle the various states of the satellite in beginning, maintaining and ending contact with the second satellite and in beginning, maintaining and ending communication with the satellite

Open MCT Web Tutorials

No abstract availabl

Symbolic Reachability Analysis of B through ProB and LTSmin

We present a symbolic reachability analysis approach for B that can provide a significant speedup over traditional explicit state model checking. The symbolic analysis is implemented by linking ProB to LTSmin, a high-performance language independent model checker. The link is achieved via LTSmin's PINS interface, allowing ProB to benefit from LTSmin's analysis algorithms, while only writing a few hundred lines of glue-code, along with a bridge between ProB and C using ZeroMQ. ProB supports model checking of several formal specification languages such as B, Event-B, Z and TLA. Our experiments are based on a wide variety of B-Method and Event-B models to demonstrate the efficiency of the new link. Among the tested categories are state space generation and deadlock detection; but action detection and invariant checking are also feasible in principle. In many cases we observe speedups of several orders of magnitude. We also compare the results with other approaches for improving model checking, such as partial order reduction or symmetry reduction. We thus provide a new scalable, symbolic analysis algorithm for the B-Method and Event-B, along with a platform to integrate other model checking improvements via LTSmin in the future

Design of an Autonomous Platform for Search and Rescue UAV Networks

This project designed and implemented a platform for use in a system of unmanned aerial vehicles (UAVs) capable of human assisted-autonomous and fully autonomous flight for search and rescue applications to improve the speed, efficiency, and safety of search and rescue to benefit both the victims and the rescuers alike. To accomplish this, the platform was designed to be lightweight with long endurance, equipped with specialized search and rescue sensors, and utilizes the paparazzi autopilot system, which is an open source, Linux based autopilot package for flight stability and autonomous control

Challenges Using the Linux Network Stack for Real-Time Communication

Starting in the early 2000s, human-in-the-loop (HITL) simulation groups at NASA and the Air Force Research Lab began using the Linux network stack for some real-time communication. More recently, SpaceX has adopted Ethernet as the primary bus technology for its Falcon launch vehicles and Dragon capsules. As the Linux network stack makes its way from ground facilities to flight critical systems, it is necessary to recognize that the network stack is optimized for communication over the open Internet, which cannot provide latency guarantees. The Internet protocols and their implementation in the Linux network stack contain numerous design decisions that favor throughput over determinism and latency. These decisions often require workarounds in the application or customization of the stack to maintain a high probability of low latency on closed networks, especially if the network must be fault tolerant to single event upsets