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NOV / DEC 2013
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Healthcare Journal of NEW ORLEANS
same weight.There are generally three levels:
crisis, which requires immediate response;
warning, which may alert nurses to things
like a change in rate, rhythm, level; and
advisory, which alert staff to things like an
IV medication being completed, etc. Unlike
crisis alarms, warning and advisory alarms
can often self-reset after the bump or spike
returns within parameters or after a certain
time frame. The problem is that sometimes
those warning alarms may bemore clinically
meaningful than staff realize. One benefit to
newer technology is that many devices allow
facilities to capture data on alarm incidence,
false positives, and response times to help
hospitals address their alarm management
in a more scientific manner.
Sometimes, however, the tweaks are not
intuitive. For example, during a quality
improvement alarm management initiative
at BostonMedical Center to improve patient
safety on general medical/surgical units by
reducing the number of clinically insignifi-
cant audible cardiac monitor alarms, the
team found that therewere a large number of
warning alarms for heart rate and arrhythmia.
Thesewere not always immediately addressed
and would also self-reset. A review of alarm
history data indicated that some alarms and
opportunities for intervention had been
missed. Since these were important, but not
critical alarms, it might have made sense to
adjust parameters tomake them less sensitive.
Instead, BostonMedical Center staff raised the
acuity of these alarms from“warning”to “cri-
sis.”By doing so, those alarms soundedmore
infrequently, but required more immediate
response.Addressing themmore aggressively
considerably reduced the level of background
noise in the unit, made other warning alarms
and system alerts that had been in danger
of being drowned out more audible, and,
as an unexpected bonus, increased patient
satisfaction.
Tweaking was also necessary at Slidell
Memorial, when newly installed IV pumps
featured alarms that were very different from
what was in place previously.The nurses iden-
tified that they were far more sensitive than
they needed to be and that was significantly
increasing the number of alarms going off
in the unit. The vendor was called in to work
with the biomedical department to adjust the
pumps and reduce unnecessary alarms.
Many monitors and other medical equip-
ment may also emit system alert alarms that
indicate a problemwith the equipment such
as a low battery, a malfunction, leads-off,
etc. So addressing equipment maintenance
and simple things like changing out batter-
ies, leads, and electrodes more regularly can
also reduce the number of alarms sounding
in a unit and help reduce the possibility of
alarm fatigue.
As hospitals across the state and the
country go through the steps of reevaluating
their alarm policies and parameters it is
likely some more defined best practices will
emerge. As mentioned, manufacturers, too,
are being called on to help with standardiza-
tion of monitoring equipment and alarms.
Of course, technology continues to evolve
so hospitals are also tasked with finding and
utilizing the best equipment they can, tailor
it to their patient population, integrate it with
existing technology, and keep staff educated
as to how to use it safely and effectively. “We
are just trying to use the technology we have
as awhole to allowour nurses to spendmore
time at the patient’s bedside,”said Johnson. “If
we can manage the technology more effec-
tively it helps them spend more time taking
care of patients. The plan is to have all of our
policies and the education of our staff in place
by January.”
Toups embraces the newNational Patient
Safety Goal. “I think it is an opportunity for
us to kind of evaluate our processes and
see where we could improve safety for the
patient and caregivers. You know if you have
too many false alarms on your fire alarm
people start to ignore them.”
“So far we’ve found that we don’t have
alarm fatigue issues at a level that staff could
potentially overlook something,”saidWelch.
“It’s a quiet enough environment that I think
the alarms we have at this point are man-
ageable and meaningful to our staff. I think
we’ve done a great job in our environment
tominimize the possibility which is what this
whole focus for Joint Commission is about.”
“I’ve been in nursing for 34 years and as
technology has grown and we have somany
more and different types of alarms, you have
to manage them. It’s something in nursing
that we have looked at for a very long time,”
said Brewer. “We take it very seriously and
it’s one of those things, the good, the bad, and
the ugly. Do your patients understand why
you are doing it, is the training and educa-
tion piece in place? Ultimately it is about
patient safety.”
n
alarm fatigue
photo courtesy Ochsner Health System