Technical failure and alarm fatigue continue to plague hospitals but three steps are all that organizations need to take to make alarms safer and more effective, according to an opinion piece published in the Journal of the American Medical Association.
Alarms are a vital feature of any hospital, but they can also threaten patient safety. Medical alarms are a "frequent and persistent" safety hazard, according to an alert from the Joint Commission, which named clinical alarm safety as one of its 2014 National Patient Safety Goals.
When first introduced, hospitals used medical alarms primarily for a handful of high-risk patients and successfully prevented complications, write Vineet Chopra, M.D., who works with the patient safety enhancement program at the Center for Clinical Management Research, Ann Arbor (Mich.) VA Medical Center, and Laurence F. McMahon, Jr., M.D., who works at the department of internal medicine at the University of Michigan Health System in Ann Arbor.
"Encouraged by these benefits, the medical community expanded this model to other low-risk populations. The consequence of this well-intentioned generalization is epitomized in the din of chirps, beeps, bells, and gongs that typify hospitals today," they write. "It is thus not surprising that concerns regarding safety have emerged, even in populations for whom these protective devices were once considered most valuable."
They suggest hospitals take three actions to solve the problems associated with alarms:
Create an "alarm priority" and scrap auditory or visual alarms that do not "signify a clear or potential risk … in the context of its implementation." Hospital leaders should also eliminate alarms that allow clinicians to mute them, they write, as "the existence of such an option is a tacit admission of the limited effectiveness of the device in question."
Tailor alarms to the workflow. "It is also important to consider how and when alarms manifest, as systems that alert must be separated from those that inform," they write. "Thus, many alerts need not be auditory, immediate or activated in a patient room."
Integrate the alarms rather than isolate them from one another. For example, the authors write, "low blood pressure alarm means little in isolation to a clinician. If, however, the blood pressure reading is also accompanied by a rapid heart rate and knowledge that these trends represent deviations from baseline, a meaningful message is created."