by
Sean Ruck, Contributing Editor | July 20, 2011
From the July 2011 issue of HealthCare Business News magazine
Kelly Graham,
patient safety analyst,
ECRI Institute
An emphasis on patient privacy is also adding fuel to the fire. The prevalence of private patient rooms is resulting in a loss of centralization for patients and an increased burden for staff as they now have to travel room to room to respond to alarms. “It’s a significant issue,” says Meyers. “In a NICU, in the past, a nurse could turn around and ask for help from a coworker and everything was right there. Now, with single patient private rooms that coworker may not be there to help. In private rooms, you have to consider the architectural layout as well as staffing patterns for an alarm management plan to be successful.”
Successfully alert
How hospitals deal with patient alarms can vary widely, according to Meyers. The approach can even differ from floor to floor in the same hospital.
This makes implementing successful strategies as hard as nailing hospital Jell-O to the wall. It’s not just the alerts that have to be considered. Based on Meyers’ experience conducting onsite patient safety reviews of alarm management systems, to be successful, a hospital needs to take into account its technology, culture, infrastructure and practice.
“For instance, with infrastructure, can a nurse see patients easily or do they have to walk to see them?” he asks.
Things that work for some hospitals won’t work for others. Some facilities have a centralized system with staff dedicated to watching alarms all day. Others have a decentralized system with certain staff responsible for certain areas. Meanwhile, alerting all valid shift staff to patient alarms actually might work for some small care areas, but this method is not generally recommended. However, for any alarm management method to be effective, guidelines must be established to determine which staffer should respond to the appropriate alarm. “So nurses should only be alerted to clinically actionable alarms,” Meyers says.
“Low battery alarms, on the other hand, might go to a different member of the staff,” Meyers adds.
In fact, hospitals operating efficiently shouldn’t be troubling staff with any low battery alarms at all —Meyers recommends changing batteries on a regular basis. Another way hospitals may avoid excessive and unnecessary alerts is to make sure the clinician adjusts monitors to each individual under their watch. For instance, a heart rate monitor on a marathon runner needs to be adjusted to take into account the much lower heart rate that might signal a problem in the average patient, says Meyers.
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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