Why it's time for an immediate hospital alarm intervention
May 23, 2016
By Jeanne Venella
In any hospital, clinical alarms have two basic purposes: to alert caregivers that intervention is required because a patient’s medical condition is deteriorating, or to remind caregivers that care needs to be delivered. Given the number of alarms and the decibel level on some units, it would be completely understandable to assume that most acute care staff operate in a constant state of emergency. The truth is that the overwhelming majority of alarms endured by nurses, respiratory therapists and other caregivers have nothing to do with a patient’s medical condition. However, the fatigue and desensitization that results from caregivers responding to hundreds — or even thousands — of alarms every day is a clear and documented threat to patient safety.
In fact, the problem is so severe that the ECRI Institute has placed the lack of clinical alarm management among its Top 10 Health Technology Hazards several years running. In 2013, the Joint Commission made clinical alarm management a priority with its 2013 National Patient Safety Goal (NPSG.06.01.01), mandating that hospitals take definitive steps to implement policies and procedures to safely reduce and prioritize clinical alarms.
Technology can help get alarms under control — but it is not enough. Clinical and IT leadership, including nurses, respiratory therapists, biomedical engineers and information technology staff, must come together to develop the policies and standards necessary to bring meaning and action back to clinical alarms.
One of the major challenges in alarm management is separating clinically relevant alarms from non-actionable alarms (i.e., a sensor on a patient detached momentarily). However, the number of alarm-enabled medical devices on the market today, narrow alarm limits and inaccurate default settings can make alarm management a complex endeavor.
Going beyond alarm reduction
Reducing the volume of clinical alarms sounding daily may be the primary benefit of clinical alarm management, but it is far from the only one. The process undertaken by the Hospital for Special Care (HSC), located in New Britain and Hartford, Conn., saw a dramatic reduction in the number of non-actionable alarms (80 percent), but it also enabled the hospitals to collect and distribute real-time data from 100- plus ventilators (each with its own set of alarms) and pulse oximeters for enhanced, continuous patient surveillance, and leverage data to assess caregiver responses to patient incidents.
For example, prior to implementing its platform, HSC depended on individual recollections from clinical responders after an alarm incident. Today, HSC has a clearer picture of every event. HSC can use the data provided by its platform to sort out the story behind any incident, increasing accuracy on occurrence reporting and resolution.
In addition, alarm data is used in reporting to HSC’s Performance Management Audit Committee, which monitors ventilator management performance and helps identify potential areas of improvement. HSC has also enjoyed greater automation in processes that used to be done manually, such as ventilator checks, which frees up respiratory therapists to focus more on the patient rather than the ventilator.
Addressing clinical alarm hazards in all their forms requires a holistic approach, free of the well-known departmental and data silos that hinder patient care and optimal clinical workflows. Technology certainly plays a critical role in alarm reduction and prioritization, but enterprise alarm management is a classic example of interdisciplinary leadership, involving clinical, IT, biomedical engineering and other departments. Alarm management is also much more than simply reducing non-actionable alarms. It’s a gateway for more seamless care and a way for hospitals to leverage hard data to make continuous improvements to their care and response processes.
About the author: Jeanne Venella is chief nursing officer at Bernoulli, and has spent her career transforming nursing care and improving processes. In combination with her Doctor of Nursing Practice degree, Venella brings both day-to-day operational experience and classroom theory to Bernoulli clients. Her areas of expertise include adult and pediatric emergency nursing, organizational throughput, patient flow and efficiency, process improvement, change management, departmental designs, redesigns, and physical plant layouts.
In any hospital, clinical alarms have two basic purposes: to alert caregivers that intervention is required because a patient’s medical condition is deteriorating, or to remind caregivers that care needs to be delivered. Given the number of alarms and the decibel level on some units, it would be completely understandable to assume that most acute care staff operate in a constant state of emergency. The truth is that the overwhelming majority of alarms endured by nurses, respiratory therapists and other caregivers have nothing to do with a patient’s medical condition. However, the fatigue and desensitization that results from caregivers responding to hundreds — or even thousands — of alarms every day is a clear and documented threat to patient safety.
In fact, the problem is so severe that the ECRI Institute has placed the lack of clinical alarm management among its Top 10 Health Technology Hazards several years running. In 2013, the Joint Commission made clinical alarm management a priority with its 2013 National Patient Safety Goal (NPSG.06.01.01), mandating that hospitals take definitive steps to implement policies and procedures to safely reduce and prioritize clinical alarms.
Technology can help get alarms under control — but it is not enough. Clinical and IT leadership, including nurses, respiratory therapists, biomedical engineers and information technology staff, must come together to develop the policies and standards necessary to bring meaning and action back to clinical alarms.
One of the major challenges in alarm management is separating clinically relevant alarms from non-actionable alarms (i.e., a sensor on a patient detached momentarily). However, the number of alarm-enabled medical devices on the market today, narrow alarm limits and inaccurate default settings can make alarm management a complex endeavor.
Going beyond alarm reduction
Reducing the volume of clinical alarms sounding daily may be the primary benefit of clinical alarm management, but it is far from the only one. The process undertaken by the Hospital for Special Care (HSC), located in New Britain and Hartford, Conn., saw a dramatic reduction in the number of non-actionable alarms (80 percent), but it also enabled the hospitals to collect and distribute real-time data from 100- plus ventilators (each with its own set of alarms) and pulse oximeters for enhanced, continuous patient surveillance, and leverage data to assess caregiver responses to patient incidents.
For example, prior to implementing its platform, HSC depended on individual recollections from clinical responders after an alarm incident. Today, HSC has a clearer picture of every event. HSC can use the data provided by its platform to sort out the story behind any incident, increasing accuracy on occurrence reporting and resolution.
In addition, alarm data is used in reporting to HSC’s Performance Management Audit Committee, which monitors ventilator management performance and helps identify potential areas of improvement. HSC has also enjoyed greater automation in processes that used to be done manually, such as ventilator checks, which frees up respiratory therapists to focus more on the patient rather than the ventilator.
Addressing clinical alarm hazards in all their forms requires a holistic approach, free of the well-known departmental and data silos that hinder patient care and optimal clinical workflows. Technology certainly plays a critical role in alarm reduction and prioritization, but enterprise alarm management is a classic example of interdisciplinary leadership, involving clinical, IT, biomedical engineering and other departments. Alarm management is also much more than simply reducing non-actionable alarms. It’s a gateway for more seamless care and a way for hospitals to leverage hard data to make continuous improvements to their care and response processes.
About the author: Jeanne Venella is chief nursing officer at Bernoulli, and has spent her career transforming nursing care and improving processes. In combination with her Doctor of Nursing Practice degree, Venella brings both day-to-day operational experience and classroom theory to Bernoulli clients. Her areas of expertise include adult and pediatric emergency nursing, organizational throughput, patient flow and efficiency, process improvement, change management, departmental designs, redesigns, and physical plant layouts.