These days seems like every medical device company is trying to do its own secondary alarm management, and each day there seems to be a new alarm management/middleware provider entering the space – and of course there is a lot of hype surrounding all of these devices and applications.
When sorting through all of the hype (or smoke and mirrors), and making sure that you don’t run afoul of the Joint Commission mandates on alarm management here are some things you should be asking:
• How many places have you done this before and how long have you been doing this?
• Do you have references that share my profile (e.g., academic, acute-care, rehab) and will discuss their experiences with your product?
• How many different device manufacturers and models are you connected to today and have in production? – Don’t be sold on futures!
• How many different communication platforms are you connected to today and have in production? – Don’t settle for email output or SIP phone calls only!
• Are there any major device manufacturers or communication providers that don’t work with your system?
• Does your system support IHE-compliant alarm input?
• Can I begin with a point-to-point implementation and add input and output connections as my project expands or must I buy a one-size-fits-all application?
• Can your system support multiple sites from a single data-center?
• Is your system software-based or must I install a proprietary appliance?
• Does your system have auto-failover and can the system be deployed across multiple sites for disaster-recovery risk mitigation?
• Can your system correlate disparate sources of information and create a virtual alarm? (e.g., correlate fall risk in ADT to smart-bed configuration to discern an alarm condition)
• Can your system merge disparate data elements from different systems (e.g., patient name or MRN, attending physician, restrictions) from ADT to nurse call alert before routing to a caregiver?
• How robust is your HL7 integration? (e.g., can you receive and route critical labs and/or stat orders?)
• Can your system accept assignments from external information systems, and can it publish assignments to other systems if acting as the central point of associating alerts to caregivers?
• Does your system support Active Directory for associating communication devices and numbers to individuals?
• Is reporting a standard offering or charged item? Are there limitations to the size of the database from which reports are generated?Hospitals are complex technology environments and are never homogeneous. Once you connect your nurse call and physiological monitoring systems to route alerts to mobile care givers your work has not ended, it has just begun. Don’t choose a system that limits your flexibility to keep working because it is limited in number and types of integrations its supports or is built for a single purpose.
Alarm fatigue: a patient safety concern.
Sendelbach S, Funk M.
Author information
• Sue Sendelbach is Director of Nursing Research, Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407
Abstract
Research has demonstrated that 72% to 99% of clinical alarms are false. The high number of false alarms has led to alarm fatigue. Alarm fatigue is sensory overload when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms. Patient deaths have been attributed to alarm fatigue. Patient safety and regulatory agencies have focused on the issue of alarm fatigue, and it is a 2014 Joint Commission National Patient Safety Goal. Quality improvement projects have demonstrated that strategies such as daily electrocardiogram electrode changes, proper skin preparation, education, and customization of alarm parameters have been able to decrease the number of false alarms. These and other strategies need to be tested in rigorous clinical trials to determine whether they reduce alarm burden without compromising patient safety.
Novel Approach to Cardiac Alarm Management on Telemetry Units.
Whalen DA, Covelle PM, Piepenbrink JC, Villanova KL, Cuneo CL, Awtry EH.
Author information
Abstract
BACKGROUND::
General medical-surgical units struggle with how best to use cardiac monitor alarms to alert nursing staff to important abnormal heart rates (HRs) and rhythms while limiting inappropriate and unnecessary alarms that may undermine both patient safety and quality of care. When alarms are more often false than true, the nursing staff’s sense of urgency in responding to alarms is diminished. In this syndrome of “clinical alarm fatigue,” the simple burden of alarms desensitizes caregivers to alarms. Noise levels associated with frequent alarms may also heighten patient anxiety and disrupt their perception of a healing environment. Alarm fatigue experienced by nurses and patients is a significant problem and innovative solutions are needed.
OBJECTIVE::
The purpose of this quality improvement study was to determine variables that would safely reduce noncritical telemetry and monitor alarms on a general medical-surgical unit where standard manufacturer defaults contributed to excessive audible alarms.
METHODS::
Mining of alarm data and direct observations of staff’s response to alarms were used to identify the self-reset warning alarms for bradycardia, tachycardia, and HR limits as the largest contributors of audible alarms. In this quality improvement study, the alarms for bradycardia, tachycardia, and HR limits were changed to “crisis,” requiring nursing staff to view and act on the alarm each time it sounded. The limits for HR were HR low 45 bpm and HR high 130 bpm.
RESULTS::
An overall 89% reduction in total mean weekly audible alarms was achieved on the pilot unit (t = 8.84; P < .0001) without requirement for additional resources or technology. Staff and patient satisfaction also improved. There were no adverse events related to missed cardiac monitoring events, and the incidence of code blues decreased by 50%.
CONCLUSIONS::
Alarms with self-reset capabilities may result in an excess number of audible alarms and clinical alarm fatigue. By eliminating self-resetting alarms, the volume of audible alarms and associated clinical alarm fatigue can be significantly reduced without requiring additional resources or technology or compromising patient safety and lead to improvement in both staff and patient satisfaction.
