NAVIGATING THE HEALTHCARE LANDSCAPE TOGETHER JENNIFER FRUITTICHER, RN CLINICAL PRODUCT SPECIALIST

Transcription

1 NAVIGATING THE HEALTHCARE LANDSCAPE TOGETHER JENNIFER FRUITTICHER, RN CLINICAL PRODUCT SPECIALIST

2 PRESENTATION OBJECTIVES: Provide a better understanding of Capnography vs. Pulse Oximetry Define Respiratory Compromise and the complications associated with disease process Recognize organizations recommending capnography as a standard of care Examine capnography case studies and results of capnography utilization Show technology available and benefits to hospitals/clinicians

3 RESPIRITORY COMPROMISE KNOWS NO BOUNDARIES

4 WHY CAPNOGRAPHY? July 2010 Thursday, July 15 th Admitted to the hospital for severe sore throat. Treatment with oral analgesics was not relieving pain. Friday, July 16 th Put on a PCA pump with opioids; monitored intermittently by spot check oximetry and vitals. Saturday, July 17 th Amanda was was found unresponsive and resuscitation efforts were unsuccessful. Name: Amanda Abbiehl Age: 18 Diagnosis: Severe pain from throat infection Monitoring: Intermittent SpO 2 and vitals 4 Medtronic Outcomes Pledge Program

5 WHAT S THE DIFFERENCE? CAPNOGRAPHY PULSE OXIMETRY Measures ventilation (CO2) Measures oxygenation Detects hypoventilation immediately Detects hypoxemia Early indicator of hypoventilation Late indicator of hypoventilation Should be used WITH pulse oximetry Should be used WITH capnography 5 Presentation Title (Edit on Slide Master) June 1, 2015 Confidential, for Internal Use Only

6 RESPIRATORY COMPROMISE A COMMON, COSTLY & DEADLY PROBLEM Affects 30% of post-op patients 7% of Medicare patients suffer respiratory compromise $18K additional cost per patient 29x more likely to die than the general patient population 1. Shander A, Fleisher LA, Barie PS, Bigatello LM, Sladen RN, Watson CB. Clinical and economic burden of postoperative pulmonary complications: patient safety summit on definition, risk-reducing interventions, and preventive strategies. Crit Care Med. 2011;39(9): Agarwal SJ, Erslon MG, Bloom JD. Projected incidence and cost of respiratory failure, insufficiency and arrest in Medicare population, Abstract presented at Academy Health Congress, June Canet J, Gallart L. Postoperative respiratory failure: pathogenesis, prediction, and prevention. Curr Opin Anaesthesiol. 2014;20(1): Burt CC, Arrowsmith JE. Respiratory failure. Surgery (Oxford). 2009;27(11):

7 POST-OP INDUCED RESPIRATORY DEPRESSION A CLOSED CLAIM ANALYSIS Anesthesia Closed Claims Project- Dr Lee and Dr Caplan Database of 9,799 claims 357 Acute Pain Claims of 357- Resp Depression judged possible, probable, or definite 88% of RD occurred in the first 24 hours after surgery 77% resulted in severe brain damage or death 55% of RD claims associated with death 22% of RD claims associated with brain damage

8 POST-OP INDUCED RESPIRATORY DEPRESSION A CLOSED CLAIM ANALYSIS Anesthesia Closed Claims Project- Dr Lee and Dr Caplan 97% were judged as preventable with better monitoring Time between last nursing check and discovery of RD 2 hours in 42% of claims 15 mins in 16% of claims Anesthesiology 2015 Vol 122,

9 OPIOD Opioid INDUCED Induced Respiratory RESPIRATORY Depression DEPRESSION Patients are at the greatest risk for respiratory failure in the first 24 hours postoperatively 75% of deaths related to critical respiratory events occur in the first 24 hours postoperatively [7] 81% of critical respiratory events occur in the first 24 hours postoperatively [7] 77% of naloxone reversal of postoperative narcotics for pain management occur in the first 24 hours postoperatively [8] 7. Ramachandran SK, Haider N, Saran KA, et al. Life-threatening critical respiratory events: a retrospective study of postoperative patients found unresponsive during analgesic therapy. Jf Clin Anesth. 2011;23(3): [ View Abstract ] 8. Taylor S, Kirton OC, Staff I, Kozol RA. Postoperative day one: a high risk period for respiratory events. Am J Surg. 2005;190(5): [ View Abstract ]

10 Respiratory Compromise Prevention Capnography Solutions

11 CAPNOGRAPHY GROWING AT AN ACCELERATED RATE statements in 8 years 7 statements in 3 years 33 statements from Oct 2010 Apr statements in 11 years (~1 per year) (> 9 per year) 11

12 RECENT RECOMMENDATIONS AND GUIDELINES FOR CAPNOGRAPHY USE November American Heart Association (AHA) Guidelines for CPR and ECC Continuous qualitative waveform capnography is now recommended for intubated adult patients throughout the peri-arrest period July Standards for Moderate or Deep Sedation Procedural Sedation Practices-ASA Adequacy of ventilation shall be evaluated by continual observation of qualitative clinical signs and monitoring for the presence of exhaled carbon dioxide August APSF Postoperative Monitoring with Opioids Use Continuous electronic monitoring of oxygenation and ventilation should be available and considered for all patients September Joint Commission Sentinel Event Alert In addition to monitoring respiration and sedation, pulse oximetry can be used to monitor oxygenation, and capnography can be used to monitor ventilation 12 Covidien Respiratory and Monitoring Solutions October 20, 2016

13 RESPIRATORY DEPRESSION - SAO 2 AND SUPPLEMENTAL O 2 Becker DE, Casabianca AB. Anesth Prog 2009;56:14-22.

14 CAPNOGRAPHY & REMOTE MONITORING RESULTS (CONT.) PROVIDENCE ST. PETER HOSPITAL, OLYMPIA, WASHINGTON Source: Jensen, D et al. Capnographic Monitoring Can Decrease Respiratory Compromise and Arrest in the Post-Operative Surgical Patient. Respiratory Therapy. Spring 2016;11(2):

15 CAPNOGRAPHY & REMOTE MONITORING RESULTS (CONT.) PROVIDENCE ST. PETER HOSPITAL, OLYMPIA, WASHINGTON 65% reduction in code blues over 24 months Zero high-risk patients on capnography experienced a code blue event since program initiation. Cost effectiveness ratio : codes/month = approx. 17 codes per year saved Estimated cost of $50,412 per code Total savings > $850K/yr Expansion to other at-risk populations in progress Source: Jensen, D et al. Capnographic Monitoring Can Decrease Respiratory Compromise and Arrest in the Post-Operative Surgical Patient. Respiratory Therapy. Spring 2016;11(2):

16 GENERAL CARE FLOOR Capnography Monitoring Clinical Evidence 100% Reduction 1,2 Candler/St. Joe s Savannah, GA Three opioid-related events two years pre-microstream capnography monitoring implementation Post-implementation - no events in 11+ years (2012 data) Based on avoided adverse events over 5 years, $1.87M savings 78% Reduction 3,4 Wesley Medical Center Wichita, KS 31% rate of severe adverse events prior to Microstream monitoring 7% post-implementation in year one with immediate 78% reduction in severe adverse events By year three, 1.5% incidence 85% Reduction 5 Bellin Hospital Green Bay, WI After implementation of high risk protocol inclusive of etco 2 monitoring, 85% decrease in emergent Narcan administration 1. Danello SH, Maddox RR, Schaack GJ. Intravenous Infusion Safety Technology: Return on Investment. Hospital Pharmacy 2009; 44:(8) , Maddox R. Clinical Experience with Capnography Monitoring for PCA Patients. APSF Newsletter Winter Fox D, Wencel M. Integral Role of Respiratory Therapists in a Comprehensive Pain Management Program using End Tidal CO 2 Monitoring AARC Congress Respiratory Care 2011;56: Fox D, AARC Webcast etco 2 Monitoring: Riding the Wave, April Weber P. High Risk Patient Protocol: Preventing Respiratory Complications AARC Congress Respiratory Care 2011;56: Medtronic Outcomes Pledge Program

17 GENERAL CARE FLOOR Capnography Monitoring Clinical Evidence 100% Reduction 1 St. Francis Grand, NE 100% reduction in transfers to higher level of care for respiratory suppression with PCA narcotics post Microstream capnography implementation 100% Reduction 2,3 Wesley Medical Center Wichita, KS 12.5% incidence of severe adverse drug events, progressing to Code Blue, prior to Microstream capnography monitoring implementation One year post-implementation: 0% 65% Reduction 4 Providence St. Peter Olympia, WA 65% reduction in Code Blue events over the 24 month period following implementation of Microstream capnography monitoring 1. Pohlenz P, Woodward K, Rosacker L, Nickels B,. Capnography Monitoring For Patient Controlled Analgesia AARC Congress Respiratory Care 2011;56: Fox D, Wencel M. Integral Role of Respiratory Therapists in a Comprehensive Pain Management Program using End Tidal CO 2 Monitoring AARC Congress Respiratory Care 2011;56: Fox D, AARC Webcast etco 2 Monitoring: Riding the Wave, April Jensen D, Williamson, J, Allen M, et al. Capnographic Monitoring Can Decrease Respiratory Compromise and Arrest in the Post-Operative Surgical Patient. Respiratory Therapy Spring Volume 11 No. 2, P Medtronic Outcomes Pledge Program

18 THE CAPNOSTREAM 20P PATIENT MONITOR Microstream etco2 and Nellcor SpO 2 monitoring Crisp, clear full-color display Customizable display settings Neonatal to adult patient modes Easy-to-use, turn and click user interface Smart Capnography algorithms Trend reporting options Multiple connectivity options Handheld options also available 18

19 Vital Sync Virtual Patient Monitoring Platform Vital Sync Reinventing What s Humanly Possible.

20 HOW DOES VITAL SYNC WORK? CONNECTED DEVICES Nellcor Pulse Oximeters Microstream Capnography Monitors Puritan Bennett Ventilators Newport Ventilators Version 2.5 : Added BIS & INVOS Version 2.6: Add Wearable Wireless HOSPITAL NETWORK Vital Sync Informatics Manager Vital Sync Virtual Patient Monitoring Platform (VPMP) CONNECTIVITY EMR CIS ADT Alarm Forwarding Systems Remote & Mobile Monitoring (desktops, tablets, smart phones, laptops, Workstations on Wheels, central station) REPORTS Device-Level Patient-Level System & Administrative APPLICATIONS Workflow Apps Clinical Apps 20

21 VITAL SYNC - PATIENT TILE VIEW 21

22 VITAL SYNC - DETAILED CAPNOGRAPH VIEW 22

23 VITAL SYNC TM REPORTS Patient-specific ventilation report Patient-specific oxygenation report Ventilator Associated Condition report Ventilator Associated Event report Alarm frequency (by device or by unit/floor) Alarm duration (by time of day) Alarm recognition (by time of day) Setting change frequency (by device) Average days on ventilator (by unit/floor) Number of monitored patients (by day) Custom Reports 23

24 THANK YOU