Few areas of clinical communication are as significant to patient care than alarm management. Caregivers are constantly bombarded by hundreds of alarms every day. Unfortunately, caregivers may become desensitized to those alarms over time, resulting in alarm fatigue and severe consequences for their patients.
To delve into this topic, VUE16 presented a lively panel discussion today entitled, “Managing patient monitor alarms, middleware settings and smartphone alerts.” John Elms, President of Connexall, moderated this session with an emphasis on the clinical, rather than technical, considerations of alarm fatigue.
To begin the session, John asked each panelist to identify the driving force behind their decisions to tie their unified communication solutions from Voalte with their event notification solutions of Connexall.
Mary Ann Connor, Director of Nursing Informatics at Memorial Sloan Kettering Cancer Institute, said, “We were at the end of life with the paging devices we were using. They were not only handling our alarms, but also our waveforms as well. We developed an alarm management committee who wanted to make sure we kept our alarms, as well as our waveforms at the bedside. ”
Anne Niziolek, Nurse Manager at UConn Health said, “We had pagers at the end of life, as well. We knew we needed something new. We felt the necessity to find the best single solution for our nurses.”
Candice Friestad, Director of Clinical Informatics at Avera Health, followed up by saying, “When we first started looking to incorporate a new alarm strategy, our nurses had as many as five devices. They asked us, ‘Can we please get just one device that will do the work we need?’ We agreed with them. Purchasing one device that only performed one function did not make much sense. So, we created a short pilot program using the Voalte and Connexall solution with both our nursing and pharmacy staff. After just one month, the staff asked, ‘You aren’t going to take this away from us, are you?’ We knew then that we had to take the implementation house-wide.”
John then turned the conversation to the topic of The Joint Commission’s regulations on alarm fatigue and how vendor partners ought to work with providers to ensure compliance.
Mary Ann said, “We are demanding, but passionate, with our vendors and they have been fantastic. We have worked closely with our alarm management committee to develop our new alarm rules and to test them to gather new data that we take back to our vendors so that they may have a better understanding of our needs. We will continue to do that because we are seeing a decrease in our alarms in a meaningful and safe fashion.”
Anne followed by saying, “We are only six months into our implementation, so we are still making many adjustments. Voalte and Connexall are helping us one step at a time and our nurses are seeing positive results, and we are seeing things like their alarm avoidance on the decline.”
“Not all alarms are equal,” John stated to the panel, “and I was wondering how your organizations have altered alarm structure within your individual units.”
Candice answered, “We have made such alterations regarding our sepsis alarms. The government guidelines related to sepsis is not generally agreed upon and some of our physicians feel they are not clinically valid. So we developed our own set of rules that surpass those of the government, where we use Voalte to send reminders to our staff after a second lactic acid draw on a patient, and we have seen some very positive outcomes for our patients.”
Candice agreed that such modification to alarm notifications are reasonable. “It makes sense to change your alarm structure based upon acuity. For example, your alarms within your palliative care units should be very different from your alarms within your cardiac care units. We need to decrease nuisance alarms in comfort care settings and increase our monitoring in other, more critical, areas of our organizations.”
To conclude the session, John poised the question of whether mobile devices may soon become the primary alarm source, contrary to FDA guidelines.
Mary Ann answered, “I have heard some of our staff members ask ‘Do we need a central space? Everyone is mobile.’ I agree with the sentiment, but I think we can have it both ways. There always needs to be a single, primary place for alarm notification, but I can see how in the future that place may end up being a mobile device.”