The beeping, bleating and buzzing of the monitors in a patient room are notorious. Some of them are meant to be truly alarming and others offer a mere warning or perhaps an FYI. But knowing which is which can be daunting for caregivers and virtually impossible for worried patients and visiting friends and family members.
Even a medical device expert, James Keller Jr., vice president of health technology evaluation and safety, ECRI Institute, has beenconfused by hospital alarms, in his case while his mother was in critical care after a heart attack.
The Joint Commission has cranked up the pressure on hospitals to do something about the many alarms that can go off in a their room and produce troubled situations for caregivers, patients and patient families.
The commission recently released plans to create a National Patient Safety Goal aimed at reducing the phenomenon, known as alarm fatigue, which if effective could improve care, ease the minds of patients and their families and make for a happier, more satisfied workforce. The move follows the Joint Commission's issuance of a Sentinel Event alert on the issue, summarized in this infographic.
The Joint Commission's new National Patient Safety Goal requires that starting July 1, 2014, hospital and critical access hospital leaders establish alarm system safety as a priority, while during 2014 take specific steps to identify the most important alarm signals to manage.
Then, as of Jan. 1, 2016, policies and procedures for managing those alarms should be in place, with several requirements, such as ensuring there are clinically appropriate settings for the alarm signals and determining who has authority to change the settings.
Boston Medical Center essentially has already gone through that process in a successful pilot project that now is being applied in other parts of the hospital. The medical center yielded big dividends from its effort to make its cardiac alarms less frequent and more effective on a telemetry unit in the medical and surgical department.
At a Joint Commission webinar in May, executives for Boston Medical Center detailed how it rejiggered its 16 arrhythmia alarm levels, 10 system alarms, five parameter alarm levels and its default heart rate limits.
It was not an easy task from both a strategic and operational viewpoint, requiring a lot of analysis and data that weren't easily accessed. The pilot produced a counterintuitive change in elevating the seriousness of alarms related to three heart rate measures that were the biggest source of excessive noise. Previously, at the less serious levels, generally the alarms, if ignored, would automatically reset.
"We increased the acuity on arrhythmia alerts and heart rate from warning to crisis," says James Piepenbrink, director of the department of clinical engineering at Boston Medical, in a transcript of the webinar. "We observed that while the number of alerts dropped drastically, we also had greater response to alerts because those that sounded were all actionable, and the staff were now keenly listening for alarms. Because of the rapid decrease in noise on the unit, they could hear them and act appropriately."
The results from the pilot seem almost too good to be true. The number of audible average weekly alarms fell 89 percent to 9,967 after the pilot from pre-pilot average of 87,823.
In addition to improving clinical care, nurses and patients were happier. "We went from an extremely loud beeping, noisy unit down to nothing, and to the point where it actually made us a little uneasy," says Patricia Covelle, R.N., director of critical care nursing.
"We were afraid that the monitors weren't working," Covelle says. The monitors were an irritant and they no longer seem that way, Covelle says.
And patient satisfaction scores rose for the unit amid the quieter atmosphere.
That could be good news for the patients and their caregivers across the country if other hospitals are able to mirror those results in trying to meet the new National Patient Safety Goal.