The Joint Commission's sentinel event database, a voluntary reporting system, contains 98 reports of alarm-related events between January 2009 and June 2012, 80 of which resulted in death, and 13 of which resulted in serious injury. And the U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database includes more than 560 alarm-related patient deaths occurring between January 2005 and June 2010.
In its newly issued sentinel alert, the Joint Commission included a list of recommendations, such as drafting guidelines for tailoring alarm settings and conducting regular equipment inspections.
That kind of alarm-management strategy is critically important but difficult, especially as technology grows ever more complex, said Michael Argentieri, vice president and senior investigator for ECRI Institute, a Plymouth Meeting, Pa.-based safety group. ECRI has consistently featured device alarms on its annual list of top health technology hazards, most recently ranking them No. 1 for 2013.
According to Argentieri, the hospitals that have made gains in alarm safety “are sitting down and establishing guidelines for which alarms are critical, and they're configuring systems to accurately capture alarms across devices and care areas.”
“Without high-level administrative direction and IT involvement, it's not likely that you'll have the proper configuration for your monitors,” he said.
Compounding the problem is uncertainty about how to appropriately set alarm parameters, said Mary Logan, president of the Association for the Advancement of Medical Instrumentation, an Arlington, Va.-based professional group, which has been a vocal advocate of better alarm safety.
“Without research to tell us which alarms matter most and which ones don't, it's very hard to make that call,” Logan said. The AAMI Foundation's Healthcare Technology Safety Institute recently collaborated with researchers from Johns Hopkins University, Baltimore, to develop a study design looking at clinically relevant alarm parameters and are seeking research funding, she added.
Some hospitals have seen success by using alarm integration platforms, which essentially route alarms to the correct clinician—often through pagers or cellphones. If that person doesn't respond to the alarm, the system will escalate the alarm and send it to a backup person.
That's the system in place at Johns Hopkins, said Maria Cvach, the hospital's assistant director of nursing and clinical standards and an expert on alarm safety.
“It's still relatively new technology, and it's interesting because hospitals can define their own rules and pathways,” Cvach said.
She said integration platforms still need to be paired with an effective alarm-management system. Otherwise, nurses will still continue to be exposed to the same or even greater frequency of alarms. Johns Hopkins has proceeded cautiously when it comes to using high-demand Wi-Fi networks to carry alarms. “Life-critical alarms still go through pagers, and I don't think we'll give that up anytime soon,” Cvach said.
In the future, Cvach says she would like to see alarms that are more predictive as opposed to reactive, meaning they collect patient data and issue notifications of deteriorating condition long before a patient reaches the serious status that most alarms indicate.
Avinash Konkani, a doctoral candidate in the department of industrial and systems engineering at Oakland University, Rochester, Mich., predicted that in the future, most device alarms will be “smart,” relying on artificial intelligence capabilities to indicate physiological changes in patients.
“Ideally, we hope these smart alarms are available in the next five to 10 years,” said Konkani, who co-authored an October 2011 study in the Journal of Critical Care about noisy intensive-care environments. “That's the best way to control these nuisance alarms.”
For now, however, little progress has been made, said Tobey Clark, director of instrumentation and technical services at the University of Vermont, Burlington, and president of Healthcare Technology Foundation, a not-for-profit safety group. The foundation conducted two alarm safety-related surveys of healthcare professionals—one in 2006 and another in 2011—and found nearly the same results, he said.
For instance, in 2011, 76% of respondents said nuisance alarms occurred frequently, compared with 81% in 2006. And there was no change in the percentage of respondents—78%—who said nuisance alarms reduced trust and led caregivers to inappropriately shut off alarms.
“Not a whole lot has changed,” said Clark, who predicted results would be similar if the survey were conducted today.
He did remain optimistic that the latest move by the Joint Commission would make the issue even more of a priority for hospitals.
The Joint Commission has also included alarm management as a proposed National Patient Safety Goal for 2014. If finalized, it would make adherence to alarm-related standards part of the hospital accreditation process. The Joint Commission had an alarm-related safety goal a decade ago, which lasted a year, but that goal was later incorporated into the group's environment-of-care standards.
“Back then, we really had no idea what we were dealing with,” said Cvach of Johns Hopkins, who contributed feedback on the newly proposed safety goal and said she expects a decision from the Joint Commission by October or November on whether it plans to finalize it.
“Once we had metrics and we understood that nurses heard hundreds of alarms per bed per day, we realized it was unrealistic for them to manage that quantity,” she said.
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