Managing alarms on physiologic monitors, like pulse oximeters that measure blood oxygenation and capnography that assesses the adequacy of ventilation, is a critical patient safety issue. As the first comprehensive national survey of patient-controlled analgesia practices by the Physician-Patient Alliance for Health & Safety found, 90 percent of hospitals believe that reducing false alarms would increase use of patient monitoring devices.
In its recent report, “Top Ten Health Technology Hazards for 2015,” ECRI Institute has named alarm hazards as the number one health technology hazard for the 4th year in a row, indicating progress on this issue has been dismal. Alarms may impede patient safety and clinician workflow:
Inappropriate alarm configuration practices—that is, the selection of values or settings that are inappropriate for the circumstances of the patient’s care—could lead to (1) caregivers not being notified when a valid alarm condition develops, or (2) caregivers being exposed to an excessive number of alarms, specifically ones that sound for clinically insignificant conditions (e.g., those that don’t require a staff response).
To better manage alarms, ECRI says clinicians and health providers need to implement appropriate alarm configuration policies and practices to minimize alarm-related adverse events:
Strategies for reducing alarm hazards often focus on alarm fatigue—a condition that can lead to missed alarms as caregivers are overwhelmed by, distracted by, or desensitized to the numbers of alarms that activate. However, alarm fatigue should not be the only factor that healthcare facilities consider when working toward improving the management of clinical alarm systems, as required in the Joint Commission’s new National Patient Safety Goal on alarm safety. In ECRI Institute’s experience, alarm-related adverse events—which can involve missed alarms or unrecognized alarm conditions—can often be traced to inappropriate alarm configuration practices. Thus, we encourage healthcare facilities to examine alarm configuration policies and practices in their alarm improvement efforts, if they have not done so already.
ECRI provides four examples of inappropriate alarm configuration practices:
- Failing to reset the medical device to the default alarm limits when a new patient is connected to the device. In this circumstance, the alarm limits used for the previous patient will be used for the new patient.
- Choosing inappropriate alarm limits for monitored parameters (e.g., heart rate, SpO2). Limits that are set too wide will prevent an alarm from activating until after the patient’s condition has deteriorated. Limits that are too narrow, on the other hand, can lead to excessive alarm activations, thus burdening staff with alarms for conditions that are not clinically significant (leading to alarm fatigue).
- Selecting alarm priority levels that do not match the seriousness of the condition and the required speed of response. An alarm for a condition that requires immediate attention, for example, should not be set to activate at a low priority.
- Not using certain arrhythmia alarms even though the patient is at risk of experiencing an arrhythmia that might require clinical intervention.
So, don’t let alarms or alarm fatigue stop you from monitoring. Develop and improve alarm configuration policies and procedures.