This post was updated on 2014-09-26 with technical clarifications provided by GE Healthcare Life Care Solutions.
A few years ago I worked in a consulting role for a small SaaS company. When you work on-site with your customers to deliver software and services, it’s easy to find yourself with conflicting goals. Customers will always ask for as much service as you’ll provide while the responsibility of a software company is to provide a superior product for the lowest cost to the company. Compound these requests from multiple customers – all demanding the most of your time – and you’ll quickly realize that you need a time management tool.
The biggest challenge to managing requests like this isn’t about how to manage your time – it’s about how to manage the time and perception from others. Something that you consider to be a top priority can be trivial to someone else (and vice versa). While I was in business school, we read Stephen Covey’s book “The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change”. The book focuses on personal wellness from a variety of angles but the main takeaway for me was learning the distinction between Important and Urgent and how to apply this to yourself and others.
First, not everything that you are working on is Important. Even fewer things are Urgent. Once you’ve swallowed that bit of humility, you can start to prioritize your tasks so you are more effective. I saw a great derivation of the Important vs. Urgent matrix that gives examples of the types of tasks that fall into each category.
(1) Credit: http://lateralaction.com/articles/urgent-versus-important/
(2) Credit: http://www.mindfulpurpose.com/everyday-mindfulness/mindfully-doing-what%E2%80%99s-important
One common point for most of the Urgent examples is an interaction with another person like someone giving you a project deadline or calling you on the phone. If another person is not involved as a sender or receiver, then it’s probably not Urgent.
In my experience, when you consider too many things Urgent then you’ll get a reputation of “crying wolf”. And this isn’t because these things aren’t Urgent to you… they just aren’t Urgent to other people. While writing this blog, I came across this quote:
The most effective people make their important things, your urgent ones. The most ineffective people do the exact opposite.
The topic of Important vs. Urgent has become a common one around our offices with the work we’re doing in Alarm Management. How does a nurse determine which alarms are Important vs. Urgent? What kind of information would a nurse need to make a decision on the priority of an alarm? Which systems should be responsible for alerting a nurse of the priority? The device, the middleware, the end-point device, other software? How do you manage alarm priorities to avoid alarms “crying wolf” (aka alarm fatigue in the Alarm Management industry)?
While each device has unique parameters for determining the priority of an alarm, MIC has referenced the ASM Consortium EEMUA 191 Guidelines and grouped these priorities into four categories that can be generalized to any device: Critical, High, Medium, and Low. To give a comparison, the equivalent of each of these priorities for a GE Solar™ or Dash bedside monitor is listed below, mapped to the new CARESCAPE™ model. The CARESCAPE priorities reference the IEC 60601-1-8 Alarm Standards.
|GE Priority Name (Solar or Dash/CARESCAPE)||MIC Priority Name||Example Alarm Type|
In the practical Alarm Management world today in an ICU, the Important vs. Urgent matrix looks like this:
It is impossible for a nurse to adequately manage alarms in this situation since nearly everything is the most Important and Urgent of alarms. Thinking back to managing your own time and the difference between Important and Urgent, Urgent items often include an interaction with another person.
In the case of Alarm Management, Urgent alarms are related to an immediate deterioration or significant change in condition of the patient. Depending on the patient population, BRADY and HR HI are good example alarms that require a care provider to go to the patient’s bedside to check on the patient. In developing rules, processes, and guidelines for managing alarms, it’s realistic to work towards an Important vs. Urgent matrix like this:
Our ambitions with Alarm Management are to improve the messages delivered to the care providers and reduce the noise at the patient’s bedside. Nurses should not be expected to manage the priority of these alarms on their own. Technology must apply proper routing and notification so nurses can respond effectively.
MIC relies on the data from the bedside monitors to tell the story about the alarm situation, but the data does not paint the picture and provide the full context on its own. On-site collaboration with the care providers and alarm management teams help everyone to understand how to use management tools along with data-driven changes to make the most meaningful improvements to Alarm Management at your hospital.