by
Sean Ruck, Contributing Editor | July 20, 2011
From the July 2011 issue of HealthCare Business News magazine
Additionally, manufacturers are rarely chased down by the FDA to complete inquiries into the cause of death when it comes to alarm issues, so the eight cited cases may be lower than the reality.
Alarm fatigue can also financially impact facilities. Beyond the lawsuits brought on by bereaved family members, having nurses constantly responding to and investigating nuisance alarms lowers workplace efficiency.
The hazards on a one to ten scale
Alarm fatigue ranks high on the dangers to watch for among hospital staff. In fact, ECRI Institute ranked alarm hazards as number two on its “Top 10 Health Technology Hazards for 2011” list, just one space behind radiation overdose and other dose errors during imaging procedures.
Beyond deaths, it’s important to factor in the effects on quality of patient care and comfort. While reports of deaths serve to grab national attention, understanding how many nuisance alarms occur, or how many actionable alarms occur, but are not acted on immediately, helps to define the scope of the problem.
“It’s hard to say exactly, but between 150 and 400 alarms can occur per patient, per day and that’s just physiological alarms,” says Kelly Graham, patient safety analyst for ECRI Institute’s Patient Safety Organization. “The problem is determining which of those alarms are false or nuisance alarms and which you need to respond to,” she says.
Budget cuts, along with a continuing nursing shortage, have exacerbated the problem in some hospitals. For some nurses, the better part of a shift may be devoted to investigating one alarm after another according to Graham.
Solutions lead to problems
In trying to prevent alarms from going unheeded, some facilities have bedside alerts sent to the on duty staff’s mobile phones. But when everyone on duty gets the alert, there’s the risk that each individual will assume someone else on the shift will handle it. “In that case, these facilities have the best intentions, but it’s creating white noise in the background,” says Mark Meyers, senior associate of the applied solutions group with ECRI Institute. If the alarm is going to a specific person, there is a better delineation of responsibility,” he says.
The sensory overload can lead to desensitization and ultimately worsen the issue all the bells and whistles are trying to prevent. According to Meyers, alarm fatigue troubles are on a steady increase. “For example, as more alarms come in with different and new bedside devices, there’s more alerts being created, making the problem worse,” he says.
Jose Morillo
ALARM FATIGUE. AN ENEMY EASY TO FIGHT
July 23, 2011 11:10
Never until now, nurses and medical personal was as expose to alarms detectors as now. Multiparameter monitors make possible measure almost any bilogocal parameter and asign, even automatically, alarms parameters for each one.
Two big problems are still present with alarms: 1.- Misadjusted alarms parameters that make it activate all time. 2.- Electrode, Transducers misconnections.
Both problems have solution. A correct alarm adjustment must consider the normal fluctuation of any parameter, human body is not a swiss clock. We must adjust alarms to levels that indicate a warning condition. It will mean a wider window of adjustment and a significative reduction of flase alarms (those alarms that haven't a clinical importance.
AN intelligent algoritm design can make monitors evaluate the alarm condition in a scale. Rarely the human parameters are independ one each other. Often a HR is follow or anteceded by an Arterial pressure variation, SpO2 or temperature variation. An "intelligent" monitor can evaluate, for example, HR from ECG and SpO2 at the same time two difference between an emergency condition and a loose transducer or electrode. it can consideer HR variation vs. Artery Pressure and/or SpO2 to determine a danger trend and launch a real alarm.
An intelligent ECG monitor can use as few as just 2 electrodes. Basically a ICU monitor is following Heart Rate, waveshape has no alarm itself. All alarm condition mean a frequency variation, soo 2 electrode are enough to check it. Always in case of doubt an ECG is maded with a full 12 electrodes ECG.
SpO2 and NIBP can be acopled. SUre a significative wave amplitude variation on SpO2 can mean an Arterial pressure variation. Monitor can launh a NIBP measurement to confirm BEFORE launch an alarm.
Parameter inter relations have no limits. A doctors and Biomedical team can make a new generation of Intelligents monitors.
Go ahead!
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