Middleware helps mitigate alarm fatigue, but real-time data can be elusive

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Concerns about alarm fatigue haven't disappeared, but middleware has emerged as a critical tool.

Alarm fatigue is a persistent concern for hospitals across the country, generating attention from patient safety organizations, accreditors and federal regulators alike.

A one-size-fits-all solution to alarm management has been elusive, but hospitals have made some progress by integrating middleware to siphon out unnecessary alarms and by forming committees to look at the bigger picture of alarm management and clinician workflow, according to the Association for the Advancement of Medical Instrumentation (AAMI). This week, the association released a new issue of its peer-reviewed journal, Horizons, devoted entirely to clinical alarm management.

Researchers noted that successfully implementing middleware requires a focused approach that addresses which devices can benefit from an extra layer of software, how those notifications are transmitted, and whether software should include automated escalation. In one case study, a New Britain, Connecticut, hospital saw an immediate reduction in nonactionable ventilator alarms after implementing middleware.

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Others highlighted middleware’s ability to integrate data from both medical devices and EHRs. In some cases, middleware offers the opportunity to create dashboards that integrate real-time data that can identify instances of “alarm flood.” But experts say real-time clinical alarm data is still elusive for many hospitals that continue to develop interventions based on historical data sets.

Patient safety organizations have repeatedly pointed to concerns surrounding alarm fatigue and the implications for patient harm. There are countless case studies involving hospitals that have managed to reduce alarms, sometimes following the implementation of a new EHR system. But most experts agree that alarm management requires an individualized approach.