Anyone who has spent time in a hospital-as a patient, visitor, family member or medical professional-knows that they can be noisy, frantic places. Contributing to the cacophony is what’s known as “alarm fatigue,” or the deadening effect on medical personnel of the myriad sounds issuing from monitoring devices, particularly in critical care units. We first wrote about alarm fatigue last year. If you’re exposed to these beeps and whines long enough, you become desensitized to them.
They’re the electronic Boy Who Cried Wolf.
That’s a hazard for patients who rely on the optimal operation of these machines to remain alive. As noted in a story on MedCityNews.com, many monitor alerts don’t necessarily communicate a specific, urgent condition; they communicate an abundance of information, some of it much more important than the rest. So their sheer volume-in number and sound-that health-care professionals are supposed to interpret and respond to can increase the risk that an important alert will be missed until it’s too late.
MedCity refers to a report from last year by the ECRI Institute that called alarm fatigue a top health technology hazard for hospitals. ECRI is an independent, nonprofit research organization devoted to improving the safety, quality and cost-effectiveness of patient care. The FDA as well has begun to study the problem of alarm fatigue in an effort to improve training for alarm safety and standards.
MedCity interviewed Dr. Joseph Frassica, chief medical officer of Philips Healthcare (manufacturers of medical devices and consumer health products), who serves on an alarm steering committee with other members representing the Joint Commission (which accredits hospitals), the FDA, device manufacturers and medical professionals. The committee is developing recommendations for resolving alarm fatigue, and a timeline to implement them.
Frassica said the risks of alarm fatigue have been around since the invention of the EKG machine, which studies and records the electrical activity of the heart. Now that the FDA has boosted the profile of alarm fatigue, the medical community is looking at the amount of information machines generate and how to prioritize patient alerts.
Four ideas have emerged:
1. More specific alarms. “[N]o longer is it OK to have very sensitive alarms that are nonspecific,” Frassica told MedCity, referring to the need for the sensitivity to signify an urgent condition. “Most of the industry is working on building more specificity into their systems.”
2. Customizable or flexible alarm settings. More patient-specific and/or provider-specific alarm settings are under review that would enable institutions to set parameters and thresholds to match their own scoring criteria. The idea is to help caretakers to detect subtle signs of patient deterioration earlier and to generate a log so that nurses taking a blood pressure reading every shift, for example, can report an early warning score to a central system. That addresses the possibility of crucial information being missed when shifts change. Health-care organizations would review alarm logs to see which ones have a high volume and to define parameters that would generate an alert or alarm.
“We know that most of our monitoring systems are built for very sick patients so the triggers are cued to patients that are likely to have an event,” Frassica told MedCity. “If you take that monitoring and put it on patients who are not as sick, alarms might be triggered by patient activities that are nonactionable events, like shaving or [using the bathroom].”
3. More interaction among medical device alarms. This is about intelligent machine design. This is about devices that map data from different sources to render a visual display that helps clinicians identify trends in a patient’s condition quickly at one glance.
4. Creating an alarm escalation plan. Johns Hopkins Hospital in Baltimore eliminated duplicate alarms and used the experience of nurses to develop a system to triage alarms via their pagers. It also switched some alarms from alerting by sound to alerting by display. The ECRI Institute recognized Johns Hopkins for its efforts at addressing alarm fatigue.
Reducing alarm fatigue remains in its infancy, but at least there’s an industry-wide recognition that it threatens patient safety and generally can impair the quality of care. It also reinforces the wisdom of hospital patients having an advocate at their bedside for the duration of their stay.
For more information, see our newsletter, “Protecting a Loved One in the Hospital.”