It’s been more than a year since alarm fatigue was categorized as the top health technology hazard facing hospitals. More recently, it became the focus of an initiative led by the U.S. Food and Drug Administration.
Philips Healthcare Chief Medical Informatics Officer Dr. Joseph Frassica sits on an alarm steering committee with members representing the Joint Commission, the U.S. Food and Drug Administration, physicians, nurses, device manufacturers and other experts. It is developing a charter to provide a set of recommendations for this issue, along with a timeline for carrying it out. Frassica spoke with MedCity News about the complexities of alarm fatigue, what the company has done to address the issue and challenges the healthcare industry faces in the effort to make improvements.
Too much information Alarm fatigue is the effect of a cacophony of alerts generated from monitoring devices, particularly in a critical care setting, on healthcare professionals in that environment. Many monitors have alerts that don’t necessarily reflect a specific, urgent condition. But the combination and number of urgent and non-urgent auditory alerts healthcare professionals are expected to interpret can increase the risk that an important alert will be missed until it’s too late.
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The risk posed by alarm fatigue has been around since the invention of the EKG machine, observes Frassica. But since the FDA made it a priority, some of the focus has shifted to taking a look at the amount of information being generated. It’s also looking at what can be done to prioritize patient alerts. Although some patients may not be experiencing a pressing emergency, subtle changes in their condition flagged up in an appropriate way could help healthcare professionals better monitor their progression.
1. More specific alarms. “What has changed is, no longer is it OK to have very sensitive alarms that are non-specific.” said Frassica. “Most of the industry is working on building more specificity into their systems.”
2. Customizable or flexible alarm settings. One solution is to take a more personalized approach, not only for patients but for providers as well. Philips’ IntelliVue Guardian Early Warning Score allows institutions to set parameters and thresholds to match their own scoring criteria. An action list can be configured and offers caregivers instant recommendations, according to the company’s website. It is designed to help clinicians to detect subtle signs of patient deterioration earlier. It also allows a log to be kept so that a nurse taking a blood pressure reading every shift can give an early warning score that gets reported back to a central system. That way, crucial information doesn’t get missed when shifts change. An alarm audit log allows healthcare organizations to look at alarms and see which ones have a high volume. It could be used to decide the parameters that would generate an alert or alarm.
“We know that most of our monitoring systems are built for very sick patients so the triggers are cued to patients that are likely to have an event,” Frassica said. “If you take that monitoring and put it on patients who are not as sick, alarms might be triggered by patient activities that are non-actionable events, like shaving or [using the bathroom].”
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3. More interaction between medical device alarms. Maria Cvach, Johns Hopkins Hospital’s assistant director of nursing, clinical standards, has called for more intelligent, interoperable alarm systems. Philips Healthcare has a system that can provide a map of a patient moving towards a myocardial infarction, the ST Map. It grabs data from several different and integrates it into a visual display to help clinicians identify trends in a patient’s condition quickly at one glance.
4. Creating an alarm escalation plan. In an interview for Health Leaders Media Cvach talked about how Johns Hopkins has dealt with alarm fatigue starting in 2006. It eliminated duplication of alarms and used the experience of nurses to develop a triaging alarm system through nurses’ pagers. It also switched from an auditory alarm on some systems to a visible alarm — something medical device companies have added as well. One component of this process was also consulting with the leadership of nursing units in the hospital, asking them how they would like the system to work. Cvach and a team from Johns Hopkins were recognized for their work in alarm fatigue by the ECRI Institute earlier this month.
“We still have a ways to go helping healthcare organizations look not just at technology but also workflow, and how patients are affected,” said Frassica. “We think this is a global issue that needs policies for clinicians to be part of it so it’s a big task.”
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