At the recent AAMI Annual Conference, one of several sessions devoted to alarms was a roundtable discussion organized by AAMI’s Health Technology Safety Institute and the Healthcare Technology Foundation, which was facilitated by Tobey Clark of the University of Vermont, Tom Bauld of the Veterans Healthcare Administration, and Izabella Gieras of Huntington Memorial Hospital.
Alarms are one of those recurring challenges that have seen considerable attention and little measurable progress. One of the core issues is excessive false or unnecessary alarms. This in turn leads to alarm fatigue which is characterized by staff not responding to alarms that can actually be heard, and failing to psychologically “hear” alarms, i.e., without a deliberate decision to ignore them. An associated problem, driven by the desire to reduce false alarms, is silencing or manipulating (e.g., extra-wide limits) alarms that should not be silenced or manipulated. In some cases, whether alarms can be heard by those who need to hear them is also an issue. The Joint Commission, among others, has focused on alarms with a National Patient Safety Goal in 2003, and more recently with a Sentinel Alert and an expected 2014 NPSG. AAMI has focused on alarms several times, and the HTF has undertaken and published two studies on alarm problems and utilization.
Alarm improvement initiatives have included technical efforts to reduce false/nuisance alarms (e.g., delays and filters), monitor watchers to augment clinical staff, and additional communication methods such as staff-carried smartphones. It is notable that some of these involve third-party products, i.e., middleware, rather than necessarily being a fundamental part of the medical device generating the alarms. Lacking in these efforts is a careful analysis of what needs an alarm, who can set/reset them, what is the necessary response time for these alarms, and whether there is an adequate number of staff to respond to alarms regardless of how they are communicated. The latter is one aspect of the alarms challenge bridging technical, human factors, clinical, and administrative boundaries.
A focus of the roundtable was to pursue what those present are doing, and how their efforts are working. The key questions were:
- How can clinical engineering/healthcare technology management be leaders in improving alarm management?
- What is the most significant improvement at your facility?
- How can administrative leadership recognize the importance of alarm hazards amid competing priorities?
- What are you hearing from other administrators?
- What support and feedback are you getting?
- What are the impediments to implementing an alarm committee?
- Do you have the tools to measure the number of alarms occurring? If so, what are the results—what type of data, by unit?
- How will your institution determine effective default alarm settings?
- How do you prioritize alarms at your hospital? Is this done by unit or over the enterprise?
- Who has that authority at your institution to establish policies and procedures for managing alarms, disabling alarms and changing alarm parameters?
- Who should be monitored?
- What are the biggest challenges in providing effective training?
- How have you addressed these challenges?
- What alarm improvement methods have you deployed, and how are you measuring effectiveness?
These are not simple questions, and it is their complexity rather than disinterest that has made alarms a challenging problem. But aren’t challenging problems, and their solutions, exactly what we want to be addressing?
William Hyman, ScD, is professor emeritus of biomedical engineering at Texas A&M University. He is also the immediate past president of the Healthcare Technology Foundation. He lives in New York where he is adjunct professor of biomedical engineering at The Cooper Union. Hyman may be contacted at firstname.lastname@example.org.