Anyone who has spent time in a hospital – whether as a patient, visitor or employee – knows the place is a cacophony of bells, buzzers and alarms. The tones ring out so often that patients can have trouble sleeping, and staff report hearing the noises in their dreams. It's so relentless at times that many just block out the sounds – an approach that concerns patient and workplace safety advocates.
"Alarm fatigue has a multitude of negative impacts on patient safety, satisfaction and healthy work environments for health care professionals," said Yan Xiao, PhD, of the Baylor Scott & White Health (BSWH) Office of Patient Safety. "For many years the approach has been on ample warnings with loud sounds. Little attention was paid to human factors."
In 2013, BSWH formed an Alarm Management Committee with members representing human factors and biomedical engineering, nursing, patient safety and accreditation. The committee conducted a pilot study of patient monitor alarms in three units (Dialysis, ICU and Telemetry) at the Baylor Regional Medical Center in McKinney and in one unit (ICU) at the Baylor University Medical Center at Dallas (BUMC). In one month, 351,574 alarms – or 11,341 per day – were recorded at the three units in McKinney. In one day, 7,908 alarms were recorded in one ICU at BUMC.
Another significant source of alarms is infusion pumps, with 14,641 alarms on average per day across 12 of the BSWH North Texas Division facilities.
"These numbers demonstrated the challenges and opportunities with reducing alarm fatigue and alarm associated noise," Dr. Xiao said.
Clinical alarms have been identified among the top technology hazards by the ECRI Institute, and the Joint Commission established alarm safety as a national patient safety goal. The goal requires hospitals to identify the most important alarms and establish policies to manage alarms by January 2016.
"The safety goal allows each entity to identify the most important alarms based on their own needs," said Molly Hicks, RN, MSN, the director of patient safety at Baylor. "This will be done gathering input from medical staff and clinical departments."
Baylor's Alarm Management Committee, which Hicks said collaborates with system councils and patient centeredness representatives, has identified three major considerations toward achieving the
- Data collection: Most alarm devices do not have a centralized data depository. For example, to set alarm thresholds for continuous pulse oximetry monitors, it is important to measure how frequent alarms occur at what levels.
- Suboptimal user interface design: It is difficult for users to set alarms on some of the devices.
- Lack of centralized monitoring functionality for some of the devices (such as infusion pumps), which can route alarms outside patient rooms.
At least two U.S. hospitals – Cincinnati Children's Hospital Medical Center and the University of California, San Francisco (UCSF) – recently published papers about the approaches they have developed to reduce the number of false cardiac alarms specifically.
Cincinnati Children's implemented a standardized process to decrease the number of daily cardiac alarms from 180 to 40; the approach also increased caregiver compliance from 38 percent to 95 percent. At UCSF, more than 2.5 million alarms were recorded in just one month. Researchers there suggested that medical equipment should focus on using all available electrocardiogram (ECG) leads, which could help separate false alarms from positive ones.
Dr. Xiao said, in the long term, improvement opportunities exist in dialogue with device vendors on the ease of use and data integration, implementation at facilities, and robust in-service training. In the short term, however, the Alarm Management Committee is focusing on initiatives that are practical. For example, at McKinney, new default settings for infusion pumps were used and an education program was implemented. The efforts resulted in a 10 percent to 25 percent reduction in several types of infusion pump alarms.
Some facilities have clinical alarm policies already in place. In fact, Grapevine's policy was submitted to the Joint Commission as a model policy for other organizations.
Now the Committee will work over the next two years to develop a system level policy.
About Baylor Scott & White Health
As the largest not-for-profit health system in the state of Texas, Baylor Scott & White is empowering customers to live well by reimagining traditional healthcare — creating more convenient, personalized and informed experiences. It serves more than three million customers through 53 hospitals, including flagship academic medical centers in Dallas, Fort Worth and Temple; the Baylor Scott & White Research Institute; 1,300+ access points; 59,000+ team members; and its leading digital platform — MyBSWHealth. The system's award-winning employer solutions include Baylor Scott & White Health Plan, Baylor Scott & White Quality Alliance and Levanto — a company offering digitally enabled health products. Founded as a Christian ministry of healing more than a century ago, Baylor Scott & White's mission is to promote the health and well-being of all individuals, families and communities. For more information, visit: BSWHealth.com