Alarm Fatigue

ECRI’s Advice on Alarm Management Ensure proper settings of secondary notifications

ECRI Institute’s Marc Schlessinger, RRT, MBA, FACHE, who is senior associate at their applied solutions group, recently spoke with the Physician-Patient Alliance for Health & Safety (PPAHS) on how to improve alarm management. The interview can be heard on the clinical education podcast, “Improving Patient Safety and Reducing Alarm Fatigue: The Right and Wrong Way to Use Continuous Surveillance Monitoring.”

Michael Wong, JD (Founder/Executive Director, PPAHS) noted the work that ECRI has done to help improve patient safety and reduce alarm fatigue citing ECRI’s recent “Top 10 Health Technology Hazards for 2018:”

“ECRI Institute has done a lot of work and awareness about alarm management and, recently published their top ten health health technology hazards for 2018. Number four on this list deals with how missed alarms may result from inappropriately configured secondary notifications devices and systems.”                               

ECRI Top 10 Health Technology Hazards for 2018: https://www.ecri.org/Resources/Whitepapers_and_reports/Haz_18.pdf

In the podcast, Mr. Shlesinger discusses the importance of setting notification to improve alarm management:

“alarms have been our top ten technology list for probably the last four years in various degrees. The current 2018 list deals with secondary notification and the improper use of secondary notification, or the improper settings of secondary notification [which} … can be anything from a one way pager to a iPhone-type smartphone device, and really anything in between including annunciator boards, nurse call systems, etc.

“The true value comes when the devices are used properly. When we do an integration for middleware and secondary alerting devices at a hospital, the most common request is that pretty much every alarm goes to the device initially, which is totally the wrong approach. So, what we try to do is convince the nurses and respiratory therapists that the only alarms they really want to see and hear on their personal devices are critical alarms and actionable alarms. However, again, you don’t want to just take the ventilator or the physiologic monitor, and make every alarm go to your device, because, at that point, you’re doubling your alarm fatigue, because not only is the device alarming and the central station alarming, you then have the alarm on the person.“

Continuous Surveillance Monitoring of Sleep Apnew Patients in a Medical-Surgcal Unit http://www.aami-bit.org/doi/pdf/10.2345/0899-8205-51.3.236?code=aami-site

ECRI Top 10 Health Technology Hazards for 2018: https://www.ecri.org/Resources/Whitepapers_and_reports/Haz_18.pdf

Mr. Shlesinger also discussed other factors for improving patient safety and reducing alarm fatigue, even the architectural layout of the the nursing unit and escalation patterns:

“You have to look at this staffing schedules, you have to look at the architectural layout of the nursing unit, the time of day, this has to do with escalation patterns. Escalation is, if I’m the respiratory therapist – the primary person – and I get a ventilator alarm and I don’t acknowledge that alarm in so many seconds, it needs to go to the next respiratory therapists or perhaps the nurse, depending on their care model.

“Escalation patterns are very unique to each unit and, eventually, it has to automatically go to someone who can act and take care of the patient. And, it is very important that the timing of the escalation pattern is correct. We’ve been in institutions where, on such alarms, when a lead is off. Which many hospitals do not consider a critical alarm, where it is a 20 to 25 minute escalation pattern – that’s much too long, because leads off on a physiologic monitor means you’re not monitoring the patient.”

                      

Featured in the podcast with Mr. Schlesinger are: 


  • Leah Baron, MD is chief of the department of Anesthesiology at Virtua Memorial Hospital; and
  • Maria Cvach, DNP, RN, FAAN is director of policy management and integration for Johns Hopkins Health System.

The clinical education podcast can be viewed on the PPAHS YouTube channel by clicking here.

The clinical education podcast was made possible by an unrestricted educational grant from Bernoulli Health.

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