A few years ago, I went to visit a friend in the hospital in a brand-new facility with state of the art everything. As a nurse, I was excited to see all the new technology (along with my recuperating friend, of course). As I walked into the gleaming building, I couldn’t help but wonder if I had I stumbled into a luxury hotel. The building was exquisitely appointed with lovely artwork, lush plants, inviting furniture, warm lighting, and a trendy coffee shop. We certainly had come a long way from hard plastic chairs in a cold, cramped waiting areas smelling of harsh disinfectant.
After a gracious volunteer gave me directions to my friend’s unit, I trekked through the new space noting how quiet and peaceful the non-patient care areas were – even the elevator “ding” was politely muffled so as not to sound too harsh.
My friend’s inpatient care unit was behind closed double doors. When the doors opened, I was hit by a massive wave of noise: tones, bells, rings, voices, and beeping from every direction. As I expected, the health care technology on the unit was the top of the line and there was a lot of it. Almost every medical device and monitoring system was making some sort of noise, showing a light or message – the din and activity reminded me a bit of a casino. While the hospital was beautiful and designed to be physically comfortable, I questioned how a patient could actually rest to heal in that environment, and how the care team could concentrate with all the noise and interruption.
The Reality of Alert/Alarm Fatigue
Alarm/alert fatigue is a serious problem in health care. Some recent statistics:
- 72% to 99% of clinical alarms are false
- 85% to 99% of alarms do not lead to required interventions
- Some health systems report that they record an average of one million alerts and alarms going off in a single week
- Many children’s hospitals report over 5,000 alarms per day, 95% of which are false
- Intensive care units report an average of 350 to 750 alarms per patient per day
How many of us have headed home after a busy 12+ hour shift and still hear phantom sounds going off in our head long after we leave the hospital? Alarm/alert fatigue can cause cognitive overload for a patient’s caregivers and desensitize staff to excess noise surrounding them. The NPSG.06.01.01 of the Joint Commission Governance states that there needs to be an improvement in the safety of clinical alarm and alert systems.
The concern first surfaced in 2012 as a top technology hazard, then became Goal #6 in the National Patient Safety Goals in 2014. Goal #6 aims to reduce the harm associated with clinical alarm systems and make improvements to ensure that alarms and alerts in the patient environment are heard and responded to on time.
Alert and alarm management has been a key focus of the NPSG ever since. Alerts, alarms, and notifications come from physiological monitors, ventilators, nurse call systems, emergency notifications, fire and safety, paging, and more. With so many different alarms making noise, relaying information to caregivers, it’s nearly impossible to distinguish which ones actually require attention and are actionable. Caregivers are inundated with too much information that may or may not be relevant. They simply cannot respond to every alarm, putting patient care at serious risk.
Addressing the Challenge
One of the most effective ways to manage alerts/alarms and promote safety is by leveraging communication technology platform to streamline notification processes and improve communication effectiveness. Technology should help after all, not hurt. PatientSafe believes healthcare IT must support clinical workflow, enabling care givers to practice at the top of their license, and to take the most effective, appropriate care action for every patient, every time. As such, your communication platform should integrate with nurse call systems, electronic medical records, voice and text networks, and physiological patient monitoring systems to unite disparate inputs, data, and processes into more automated and efficient workflows that can be executed at the point of care.
Using communication technology that delivers critical closed-loop notifications to the appropriate caregiver so that they can take immediate action is a key component to alarm and alert management. Closed-loop notifications utilize bidirectional communication processes to eliminate gaps between caregivers and providers so that appropriate patient care is provided in a timely manner and potential communication failures are prevented. PatientSafe’s approach in structuring and implementing a CC&C platform considers each of the following components:
- Consistent assignment ownership to ensure correct real-time notifications to the right caregiver every time
- Prioritization of alarms, alerts, and other patient care notifications
- Evidence-based best practice design of safe alert and alarm closed-loop workflows
- Effective change management practices to make change stick
- Positive outcome targets at the point of care based on specific patient care use cases
- Regular evaluations to provide optimization of the CC&C environment
Another aspect to alert/alarm management is that physiological alarms are often non-actionable. These nuisance alarms are caused by alarm parameters being set too broadly or incorrectly, notifications going to too many caregivers, or unclear staff response workflows. The alarm may not be relevant to the caregiver receiving the notification or they may be unsure as to the right response. To overcome these issues at our health system partner sites, PatientSafe conducts comprehensive alert and alarm assessments, identifying key use cases for improvements with clinical leadership and frontline teams. Notifications are evaluated based on their appropriateness, urgency, and actionability. Then the alert/alarm notification and response workflows are redesigned, mobile-enabling them to ensure:
- Appropriate notifications get to the right caregiver in an efficient and timely manner
- Actionable alerts and alarms can be quickly addressed
- Nuisance alarms such as unnecessary escalations to additional caregivers or non-urgent group alerts are reduced
- Notifications are sent to each caregiver’s mobile device to reduce noise, interruptions, and distractions in the care environment
- Patient care can be delivered more efficiently and effectively
Safely managing alerts, alarms, and notifications will always be a challenge in health care, but by employing the right communication platform, the care team is given the tools to consistently follow best practice processes and care for patients in the most effective way possible.
Thank you for reading this blog! We all have many personal stories around our nursing practice and we learn from each other by sharing our experiences. What are your thoughts on collaborative communication driven by technology? How have multiple health care technologies impacted your ability to deliver safe, effective care? Please share your stories and comments below.