Medical Device Alarm Safety Importance
Recognizing the need to eliminate alarm fatigue
By Paul Grekowicz
The number of medical devices with alarm systems is overwhelming: ventilators, blood pressure monitors, infusion pumps, pulse oximeters, and central station monitors are only a few of such devices. These system devices and equipment are necessary, scanning for potentially dangerous changes in a patients’ condition and vital signs. However, these devices present many challenges for health care organizations since they often have alarms with similar sounds. Furthermore, many times they are false alarms or don’t require action.
Alarm fatigue is reported to be the most common contributing factor in alarm-related sentinel events, according to The Joint Commission, a national quality control group. Their April 2013 Sentinel Event Alert reports that medical devices pose a number of issues for health care organizations when their alarms sound alike, when default settings are not adjusted, and responding to alarm signals is ignored. These events are now recognized as underreported events that occur in all health care settings.
Alarm Fatigue – a Frequent and Persistent Problem
The sheer number, several hundred alarm signals per patient per day, can cause nurses, clinicians, and other workers to become overwhelmed or desensitized by the constant barrage of noise. This is clinical alarm fatigue.
Health care staff oftentimes respond by turning down the volume on the devices, shutting them off, or simply ignoring them – actions that can have serious, potentially fatal, consequences. A failure to respond to appropriate alarm signals in a timely manner has resulted in many alarm-related events. Of these, some have included death or permanent loss of function. The most common injuries or death related to alarm system issues includes those from falls, ventilator use, medication mistakes, and delays in treatment.
Factors that Contribute to Alarm-Related Injuries or Death
- Alarm fatigue – the most common contributing factor
- Alarm settings not customized to the individual patient or patient population
- Alarm settings not integrated with other medical devices
- Equipment malfunctions
- Inadequate staff training on proper usage of equipment
- Lack of staff to respond or support alarm signals
Silent Alarms Assist with Alarm Fatigue
The Joint Commission offers recommendations to health care organizations to reduce patient and resident harm related to alarm system issues. One area to consider is acoustics. It’s important to assess the acoustics in patient and resident care areas – do they allow critical alarm signals to be audible? In some care areas, eliminating audible alarms and utilizing silent alarms can have many benefits.
Save Time and Increase Care Work
Silent alarms will signal through the system, for example at a nurse’s station, and will eliminate the need to be within earshot of the patient or resident. Unnecessary interaction is significantly reduced. Time saved can be used for actual care work and active interaction with patients and residents.
Improve Environment and Occupant’s Satisfaction
Noisy environments add to patients’ and residents’ anxiety and make rest, comfort, and healing more difficult. The use of silent alarms can improve these conditions, and with satisfied customers and relatives, the working atmosphere improves. Reducing stress levels through the use of silent alarms, staff to have more control of their work situations. When more time is left for care work, efficiency at the workplace is enhanced. Smooth communication improves colleagues working collaboratively and the staff can plan daily tasks and goals easier. Satisfaction of one’s work provides for a positive environment and less staff turnover.
Other Strategies to Help Reduce Alarm Related Safety Issues
The Joint Commission is exploring many other ways to address this problem, including the possible development of a National Patient Safety Goal. If this happens, hospitals will be required to make alarm safety a priority as a condition of accreditation.
Other recommendations include:
- Have a process in place for safe alarm management and response
- Establish guidelines for alarm settings on alarm-equipped medical devices used in high-risk areas and high-risk clinical conditions
- Create guidelines for customizing alarm settings and limits for each patient or resident
- Inventory all alarm-equipped medical devices and identify default alarm settings and limits
- Inspect and maintain alarm-equipped devices to provide for accurate and appropriate alarm settings, detectability, and proper operation
- Provide proper ongoing training and education of the clinical care team
- Form a cross-disciplinary team to address alarm safety and the potential impact of alarm fatigue in all patient and resident care areas
- Share your stories and information about your organization’s alarm-related incidents, lessons learned, and prevention strategies with appropriate organizations, such as The Joint Commission and the FDA