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alarm fatigue
12
NOV / DEC 2013
I
Healthcare Journal of NEW ORLEANS
of those issues from those alarms that are
non-threatening to patient lives to those that
are threatening, to try to distinguish between
different sounds and volumes.”
Most, if not all area hospitals have already
achieved that first component of NPSG
06.01.01, which is to establish alarm system
safety as a hospital priority and have estab-
lished task forces engaged in meeting the
second component, which is to identify the
most important alarm signals to manage.
“We got a team together of clinicians, our
risk manager, nursing representatives from
different areas, and our biomed department
to look at how to tackle this, said Toups. “We
formed a teamand created an audit tool that
helps identify equipment with alarms and
we’ve looked at the proposed patient safety
goal that the Joint Commission has out and
kind of tasked our charge based on those
goals. They request that you evaluate your
equipment and target high risk areas first so
right nowwe are concentrating on CCU and
ICU and then we’ll move on to the NICU after
we complete the assessment of those areas,
because those really are high risk areas for
alarmmanagement.”
Obviously not all alarms are critical and
not all of them indicate a patient is in distress
or imminent danger. However all alarms
have the potential to contribute to the “noise”
that might disguise a more critical alarm.
“If it’s an alarm someone can ignore, then
you have to wonder why it’s an alarm that’s
going off,” said Toups. Hospitals are tasked
with identifying where potential problems
may exist, assessing the risk to the patient
should the alarm be missed, determining
which alarms are necessary and which are
just adding noise, and evaluating internal
Management Director.
Under the new National Patient Safety
Goal, by January 1, 2016, hospitals must
have established policies and procedures
for alarmmanagement. At aminimum those
must include:
• Clinically appropriate settings for alarm
signals
• When alarm signals may be disabled
and by whom
• When alarm parameters can be set or
changed and by whom
• Monitoring and response to alarmsignals
• Alarm maintenance, i.e. accurate set-
tings, proper operation, detectability.
Hospital staff and other licensed practitio-
ners must also be educated as to the purpose
and proper operation of the alarm systems
for which they are responsible.
This last element is a key one. It can be a
difficult lesson for clinicians: just because
we can monitor something, doesn’t always
mean we should. Instead the monitors and
their associated alarms should be meaning-
ful. Many hospitals are now engaged in creat-
ing or tweaking protocols for whenmonitors
will be used and what parameter limits will
be assigned for those monitors.
Every piece of medical equipment comes
with default settings based on industry stan-
dards, but those defaults are seldomused in
a clinical setting. Instead, depending on the
type of facility, the kind of unit, and ideally,
the patient himself or herself, new parame-
ters are entered that will capture the changes
requiring a nurse’s attention. Standardiza-
tion of these parameters for each unit and
throughout the hospital make it easier to
educate staff as to what alarms mean and
what action is required. Obviously there will
be instances when those standard param-
eters will have to be adjusted for an atypical
patient so that, for example, a patient with
an existing rapid heart rate is not triggering
an alarm set for more standard heart rates.
“When you look at cardiac monitors and
things like that people are very unique and
one size doesn’t always fit all,”explained East
Jefferson General Hospital (EJGH) Interim
Chief Nursing Officer and Vice President of
Sharon Toups
Chief Operating Officer,
St. Tammany Parish
Hospital
Sherry Collura
Patient Safety
Director, North Oaks
Medical Center
Diane Surla
Risk Manager, Slidell
Memorial Hospital
Ruby Brewer
Interim Chief Nursing
Officer and Vice
President of Quality,
East Jefferson
General Hospital
“We have a lot of alarms that we use
for managing patients just to alert
caregivers. But when you have so
many sometimes it gets confusing.”
incident history related to alarms.
“I think as a nurse we get so used to
hearing those things that we kind of tune
them out after a while so that’s why this is
even more important to try and eliminate
the alarms that are unnecessary and stan-
dardize the ones that we really need so that
when something’s alarming we are paying
attention to it,” said Cindy Johnson, Slidell
Memorial Hospital (SMH) Quality and Risk