Monitor alarms are essential to patient safety across the healthcare field and, in many cases, are lifesaving. They are designed to alert clinicians to changes in the patient’s condition that may indicate the need for intervention. However, the number of alarms encountered by clinicians on a day to day basis has risen, which makes it difficult to distinguish clinically-significant alarms and transient events. This has created a serious challenge for clinicians: alarm fatigue.
The Issue
Alarm fatigue occurs when clinicians become overwhelmed by the high number of patient alarms and fail to respond to potentially critical patient alarms. The issue is recognized by many clinical organizations as a significant hazard to patient safety and care. In fact, the ECRI Institute has published the “Top 10 Health Technology Hazards” list annually since 20101 and “alarm hazards” has been on the list since its inception, topping the list in 2012 and 2013.2
In 2013, The Joint Commission released a Sentinel Event Alert on “Medical device alarm safety in hospitals.”3 The Joint Commission recognizes this issue as a “frequent and persistent problem” with 98 alarm-related events reported between January 2009 and June 2012 – 80 resulting in death and 13 in permanent loss of function. They also cite alarm fatigue as “the most common contributing factor” to alarm-related events.
As a result, The Joint Commission has made a number of recommendations to address the issue, including the implementation of The Joint Commission National Patient Safety Goal, in two phases. Phase I requires hospitals to establish alarms as an organization priority and identify the most important alarms to manage based on their own internal situations. In Phase II, hospitals will be expected to develop and implement specific components of policies and procedures.
With these recommendations in mind, there is a clinical need to develop more intelligent alarm management strategies to reduce clinically-insignificant alarms while identifying alarm conditions that require intervention. Device manufacturers are taking significant steps to develop smarter alarm management systems and remote patient monitoring systems that have the potential to reduce clinically insignificant alarms while alerting caregivers to clinically-significant events.
Smart Alarm Management
Reducing “nuisance” alarms starts with the accuracy of the monitor – a monitor providing erroneous readings will generate false alarms. It is estimated that 85-99 percent of alarms do not require an intervention. Clinically-insignificant alarms can be triggered for multiple reasons, including setting the alarm thresholds “too tight,” default alarms not adjusted to individual patient needs, or sensors that are not correctly applied. 1,4 Therefore it is critically important for all clinical personnel to have a thorough working knowledge of the use of patient monitoring technology. Device manufacturers need to ensure that training courses and resources are available to clinical personnel to ensure appropriate use of patient monitoring devices.
Additionally, it is important that clinicians utilize technology that is closely tied to the patient’s physiologic needs. For example, certain “cardiac-based” oximetry devices use sophisticated algorithms that qualify when conditions are appropriate for posting of the computed Sp02 and pulse rate values.5 If the signal is significantly affected by ‘noise’ caused by venous blood and other tissue, the monitor won’t post the erroneous reading. This type of technology requires less signal processing, preventing signal over-processing which can mask true patient events from being displayed.
Remote Patient Monitoring
In addition to receiving accurate readings, it’s essential for clinicians to be able to quickly and easily identify clinically significant events. Clinicians caring for patients on a hospital’s general care floor and in the intensive care unit are inundated with patient monitor information. Remote monitoring systems help busy clinicians manage the constant stream of alarms from bedside devices by allowing them to observe patient data from a central location or on the care floor using a pager/smart phone.
By providing remote visibility to alarms and information from bedside devices, clinical caregivers are better able to prioritize their responses to better manage the needs of patients.
Alarm fatigue is recognized by multiple clinical organizations as a significant challenge to patient safety, leading to a significant number of patient deaths and injuries. It is critically important for device manufacturers to unite around the issue of alarm management. There is a need to develop more intelligent alarm management systems to reduce clinically-insignificant alarms while identifying alarm conditions that require intervention. Designing patient monitoring solutions with the busy clinician in mind, device manufacturers can help to reduce clinically insignificant alarms and, in turn, ensure a patient’s safety during a hospital stay.
Erich Faust is director, US Marketing, Respiratory Function, Covidien.
References
1. ECRI Institute. Top 10 Health Technology Hazards. Available at: https://www.ecri.org/Forms/Pages/ECRI-Institute-2013-Top-10-Hazards.aspx.
2. ECRI Healthcare Risk Control. Clinical Alarms. Executive Summary. Critical Care 5. May 2008.
3. The Joint Commission. Medical device alarm safety in hospitals. Sentinel Event Alert. April 8, 2013; issue 50. Available at: http://www.jointcommission.org/assets/1/18/SEA_50_alarms_4_5_13_FINAL1.PDF.
4. Graham KC, Cvach M. Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms. Am J Crit Care. 2010;19(1):28-35.
5. Covidien. Pulse oximetry monitors. Available at: www.covidien.com/rms/pages.aspx?page=OurProducts/Oximetry/Monitors&product=3.
