By DAVID CONDRA
Imagine that your home security system sounds an alarm at random intervals multiple times of the day, often for no urgent reason. Do you think after a while you'd pay less and less attention - or react more slowly - to the alarm?
Now imagine you're a hospital nurse with hundreds of alarms sounding on your floor for various reasons - many with little-to-no urgency. Except patient lives are now on the line.
A Patient Safety Issue
Alarm fatigue - growing so accustomed to hearing countless patient alarms that caregivers begin to tune them out or slow down their reaction to them - is a serious threat that puts patients' safety at risk while impacting the stress level of every caregiver and their care environment.
It is so serious that in 2013 The Joint Commission (TJC) added clinical alarms to their list of national patient safety goals. And the problem continues to make the ECRI's (formerly the Emergency Care Research Institute) list of top 10 health technology hazards.
A 2015 study of the alarms at one typical medical/surgical hospital in the United States found that, in most cases, only 10 percent of alarms were actionable. Which means that caregivers were spending time responding to alarms that, nine times out of 10, were non-actionable.
Of course, the care team had no way of knowing the severity of the situation until they tracked down where the sound was coming from and physically entered the room. So, it's probably logical that after responding repeatedly to non-actionable alarms in a patient's room, a nurse might naturally assume that any given alarm from that room might also be a false positive: until it isn't ... and an event occurs.
Many hospitals are now harnessing new technology and data capture to get a handle on the burgeoning safety problem. Hospital staffs hear hundreds of alarms per patient per day. As heavy workloads increase the likelihood of burnout, nurses are more at risk for developing alarm fatigue. The challenges contributing to the issue are threefold:
- Equivalent alerts for unequal levels of urgency make it difficult for caregivers to respond appropriately to emergency situations.
- The absence of a unified system of alarm management engenders miscommunication, or lack of communication, between caregivers.
- As alerts go unheeded, further alarms are created, worsening the problem.
Without a unified way to monitor, prioritize and escalate alarm activity to the appropriate person, the nursing team has no choice but to depend on its sense of hearing to differentiate between the beeps and bings of various alarming devices. Unfortunately, as alarm fatigue grows, care facilities see decreased HCAHPS and patient satisfaction scores, as well as increases in injury-producing falls and patient call volume, thus worsening the problem.
There are four key steps facilities should take to address alarm fatigue, ease the care burden on nurses and staff, and improve patient quality, safety and experience.
- Hospital executives must fully understand the magnitude of the alarm issue in their facility. That requires an accurate, detailed assessment of the number of alarms that staffs are exposed to each day, segmented by device, alarm type and duration.
This begs the question, where does alarm data come from? Some devices can be connected through a common server, but more often than not, alarm data is being housed inside the specific device. Right now, that means someone has to physically go to each piece of equipment and download or print something out of the memory. Then there are the devices that are not connected and don't store any information - what about them?
Standardized medical device connectivity has been a major challenge for hospitals since so many different equipment vendors can be involved. The Nashville-based Center for Medical Interoperability has established a coalition of leading hospital organizations with the goal of changing how medical technologies work together.
Conquering alarm fatigue depends on systematically tracking and analyzing alarm volume over time. Alarm management technology currently on the market can do this, eliminating the need to manually collect such data while ensuring accuracy.
- The facility must develop a team and a plan to address the problem. The team should be multidisciplinary, including hospital leaders, physicians, nurses, as well as members of the Safety, Quality, Risk Management and Biomedical departments.
One important component of the plan will be figuring out which alarms are actionable and which are not. In other words, having a way to identify and filter out false alarms and/or those with clinically appropriate wait times before they must be addressed.
The team then needs to easily configure alarm parameters to match any new alarm protocols, collect more data, tweak parameters and repeat as needed to optimize every alarming device. Another example where technology and data are helping hospitals achieve and sustain success.
- After identifying the magnitude of the problem, consider adopting communications technology that will help address it. Hospitals need a standardized way to not only capture data but also deliver patient alarms to the right caregiver at the right time rather than having caregivers go room-to-room chasing phantom sounds.
Leading-edge alarm management tools today can rout specific alarm messages from specific rooms to the specific caregiver who knows when he/she receives that message it is their patient and something they need to pay attention to with the appropriate sense of urgency. These same tools can also unite alarm data into visualized, actionable reports that can be accessed and analyzed on demand.
- Hospitals must then foster a culture of openness to new technology. Problems could arise when staff members do not respond well to technology changes, despite the potential of these solutions to make their jobs easier.
"Culture is probably the hardest part of alarm management because staffers are used to doing things in their own way," explained Rikin Shah, a senior consultant at ECRI Institute. "Thus, it is important to explain the benefits of new technologies and the ways in which they can improve staffs' ability to provide quality care (and better ensure patient safety). Culture change can be difficult, but with determination and clear goals, it can be done."
When all is said and done, alarm fatigue is not about improving patient satisfaction or HCAHPS scores or less stressful work environments - all three of which can be addressed by today's alarm management systems. It's about ensuring the safety of patients.
Alarm fatigue is a real danger. But by leveraging technological advances and a strategic, data-driven approach to address it, hospitals can better ensure patient safety, significantly decrease adverse medical events, increase HCAHPS and patient satisfaction scores and greatly improve employee work environments.
David Condra is founder and executive chairman of Amplion Clinical Communications, which works with hospitals to combine smart technology and clinical workflow optimization to improve patient outcomes while avoiding alarm fatigue. Condra has more than 35 years of healthcare technology expertise and sits on the Association for the Advancement of Medical Instrumentation (AAMI) subcommittee on alarm management. firstname.lastname@example.org