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Vol. LXVI, No. 19
September 12, 2014

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NINR Director’s Lecturer Focuses On Change

Dr. Barbara Drew of the University of California, San Francisco

Dr. Barbara Drew of the University of California, San Francisco

Photo: Ernie Branson

Dr. Barbara Drew clearly identifies with NINR’s mission of building the scientific foundation for clinical practice. A professor of physiological nursing and clinical professor of medicine in cardiology at the University of California, San Francisco, she began her recent NINR Director’s Lecture by asking: “How do you judge whether a program of clinical research is successful?” Her answer: clinical research is successful if it changes clinical practice. In her presentation, “Electrocardiographic Monitoring: Two Decades of Discovery,” Drew shared several examples of how her NINR-supported work has changed clinical practice related to cardiac monitoring techniques over the past 20 years.

“Dr. Drew is a real pioneer in the area of electrocardiography,” said NINR director Dr. Patricia Grady. “Her work has resulted in the modification of the way we approach clinical monitoring, ECGs and the monitors themselves and how these results are interpreted.”

In one of her studies, Drew did a retrospective analysis of Holter monitor data after the untimely death of a young man who had received cardiac monitoring during his hospital stay. The analysis showed unstable ST segments in the overnight hours, indicating an acute coronary syndrome that could lead to acute myocardial infarction. No one saw these changes on the monitors in the ICU because they weren’t using the ST-segment monitoring function, even though that feature was available. As a result of Drew’s findings, ST-segment monitoring is now the default setting for the monitors in the cardiac care units where she works.

A subsequent study that Drew conducted, the NINR-funded ST SMART study, was a “pre-hospital” ECG program where data for cardiac patients was automatically transmitted from the ambulance to the emergency department using cell phone transmission while patients were en route to the hospital. This new method of communicating ECG monitoring data made a huge difference. In the first month, one study subject showed a “door to balloon” [treatment] time of 46 minutes on a Sunday, compared to a pre-study average of 105 minutes. Six years later, the county that was involved in the research still maintains a pre-hospital ECG program.

In addition to influencing clinical practice, Drew’s research has shaped technological innovation. Her work has influenced the development of commercial cardiac monitors, including the introduction of multi-lead ECG monitoring and QT interval monitoring and strategies to reduce clinical alarm fatigue.

Drew describes alarm fatigue as a “current patient safety crisis.” In an analysis of patient alarm data, she found an average of 187 audible alarms per bed, per day in the adult intensive care units where she conducted her research. A large percentage of alarms were false positives. This contributes to alarm fatigue causing clinicians to ignore the alarms, which could result in patient death. Drew identified the need for nurse scientists to study this problem and how to reduce the number of false alarms, through improved algorithms and technology and a change in practice. She noted the importance of engaging interdisciplinary teams for this work, saying, “We have a wonderful group of engineer scientists, computer scientists, math scientists and nurse scientists working on the problem of alarm fatigue.”

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