The proliferation of alarms on patient monitoring devices is one of the biggest patient safety challenges hospitals face. Though alarms provide clinicians with valuable insight into the status and health of their patients, the incessant noise can overwhelm them and desensitize them to alerts, causing the alarm fatigue plaguing many hospitals.
While hospitals have made progress in managing these alarms, most aren’t successfully addressing the challenges presented by alarm fatigue. Nor are many hospitals in compliance with public safety goals for alarms established by The Joint Commission in 2014. The Association for Advancement of Medical Instrumentation (AAMI) devoted the entire Spring 2017 issue of its peer-reviewed member magazine, Horizons, to clinical alarm management.
We sat down with David Condra, our founder and executive chairman, to discuss alarm management—including issues of patient safety, compliance, staffing effectiveness and morale—and hear his thoughts on immediate and long-term solutions for addressing alarm fatigue.
Amplion: Three years ago, The Joint Commission created public safety goals around alarms, and over the last two years, the organization has conducted audits of hospitals. Yet problems with alarms persist. Can you give us the current status on where providers stand on this issue?
DC: Hospitals have discovered how challenging it is to address the problem of alarms on their own. The Joint Commission tells hospitals, “You’ve got to do this,” but no one has come up with a reasonable way for hospitals to do something meaningful, even if they were willing to spend a lot of money.
Some hospitals have been able to spend money on research studies. Most of the data they have pulled has come from units with full-time patient monitors connected to monitoring servers—such as in ICUs, CCUs or post-anesthesia care units. But then the providers had to ask themselves: “What do we do with this data? How do we use it to establish policies? How do we train nurses?” The problem has been much harder to fix than anyone thought it would be.
Amplion: So, this sounds like an ongoing compliance problem. What are the underlying patient safety, staff effectiveness and morale issues that persist as alarm problems continue?
DC: We know that patients in a critical care unit are surrounded by as many as 20 advanced medical devices. Many of these devices—such as ventilators, infusion pumps, compression stockings and vital sign monitors—contain multiple alarms. And none of them talk to one another.
Thousands of alarms might sound in an average day in an ICU. Nurses answer, on average, a false positive alarm every 90 seconds. Amplion’s own research shows that 9 times out of 10, caregivers respond to alarms that end up not being significant.
Alarms are always in the background—and that’s one of the sources of alarm fatigue. Most clinicians don’t know where alarms are coming from unless they are standing right beside them. Unless they are really perceptive, they probably don’t even know what kind of device the alarm is coming from. Or maybe they can recognize the device, but they don’t know what that particular alarm means. Is that a low pressure alarm? Or is that an alarm signaling that an IV is out of fluids?
The resulting cacophony can be dangerous. If every device is alarming all the time, it’s impossible to always know whether the most critical situations are being communicated to the right caregiver at the appropriate time.
And staff morale and effectiveness are constantly under threat. Nurses have layers of responsibility that create layers of stress. The constant sound of alarms certainly adds to that stress.
Amplion: What do you see as a long-term solution?
DC: The problem is not going to be completely addressed until there is an effective standard in place for appropriate data communications from the devices. Right now, in order to get a medical device approved by the Federal Drug Administration, a device must make a sound when it goes into alarm mode.
The interoperability challenges at the device level are significant. We need to get to a place where providers can say to medical manufacturers, “We will not be buying a device from you unless it communicates the data it contains in a standardized way.” This would alleviate the burden on nurses to be the ones who program thresholds on devices. Here’s an example of how that might work: A doctor places an order in an electronic medical record (EMR) that a patient’s oxygen level should never fall below 91. The EMR would connect to the patient’s room and all of the devices in it, including the pulse oximeter, which would automatically be set to alarm for levels below 91. The alarm setting would be applied from the patient’s EMR, rather than having to rely on the nurse.
Amplion: AAMI recently released a set of approaches to improving clinical alarm management by intelligently alerting clinicians when a patient needs intervention. How can providers institute those approaches right now to create better alarm management?
DC: What hospitals can do right now is use an alarm communication system to pull alarm output from a device and route that message to the right person.
In the Amplion Alert platform, alarm management is integrated with a nurse call system, so hospitals don’t have to add yet another system. Amplion’s nurse call platform knows what device is plugged into the jack in our system. It knows when that alarm goes off, what device it is, what room that patient is in and who the patient’s RN and aides are.
With time thresholds customized from the hospital’s own data, the platform can be set to alert the appropriate caregiver at the appropriate time. For example, if a ventilator alarms, a hospital’s alarm management system might be set up to hold a message for eight seconds—in case the patient is merely coughing into a ventilator and doesn’t need assistance. However, if the platform is still alarming after eight seconds, a message can be sent to the patient’s respiratory therapist. If the platform is still alarming after 15 seconds, a message can be sent to every respiratory therapist on the floor. At the same time, an RN is messaged.
This kind of proper alarm escalation—that lowers the fatigue that comes with too frequent audible alarms—helps ensure patient safety and staff effectiveness.
Condra shares more insights on alarm fatigue and alarm management in this recent Nashville Medical News article, including how hospitals can find the right communications technology to address the issue and how to get staff to support the solution. Schedule a free consultation with us to learn how our data-driven alarm management platform can help your hospital improve patient safety, outcomes and staff morale.