Customers attending last week’s Voalte User Experience conference, VUE18, confirmed that alarm fatigue is still a major concern. Hospitals continue to grapple with how to reduce the high frequency of unnecessary alarms caregivers receive in clinical settings and the dangers to patients associated with the resulting alarm fatigue among clinicians. Reducing harm from such alarms is one of The Joint Commission’s 2017 Hospital Patient Safety Goals, since alarm fatigue has been cited as a major contributing factor in sentinel events.
The problem occurs throughout critical care settings. Patient monitoring devices at some hospitals transmit tens of thousands of alarms daily, but as little as 10 percent of these alarms need clinical intervention. This often causes clinicians to adjust settings, turn off alarms or simply ignore them, which can have serious or fatal consequences.
So how can hospitals minimize alarm fatigue while still providing necessary, clinically relevant information? What strategies, resources and practices are needed to effectively implement and manage alarms and alert notifications? Three keys to success are proper planning before implementing a new alarm/alert system, ongoing refinement once the new system is in place and ensuring that all parties (including patients) understand the system.
- Get input. It’s vital to understand caregivers’ workflow and information needs. Strategies and new alarm technologies must be aligned with daily practices, and only clinicians can tell you how things actually work. Be sure to include clinicians early in the process to understand how workflows intersect with and affect the use of technology.
- Focus on clinically significant data. As one Voalte customer put it, “Information that’s not clinically relevant shouldn’t be going to caregivers’ smartphones.” The goal is to get right information to the right person at the right time.
- Look at alarm fatigue and how it affects quality of care. Use metrics to analyze the number of alarms per nurse per shift, the percentage of alarms that were escalated and the actionable percentage of alarms. You might also measure the impact on adverse events and HCAHPS.
- Refine alarm settings over time to minimize unnecessary disruptions. When a new alarm strategy is first implemented, in an effort to reduce risks, some types of alerts’ priority setting and/or volume is set too high. As time goes on, these settings should be evaluated and refined as needed. For example, after rollout, the NICU at Sarasota Memorial increased high heart alarms, adjusted oxygen saturation parameters, decreased alarms for disconnection, and added patient size and disease profiles in the cardiac monitoring system – refinements that resulted in a 33 percent reduction in alarms.
- Allow caregivers to determine relevance. At the University of Kansas Health System, nurses can adjust telemetry alarm parameters at a central monitor to determine which alarms come to their mobile devices. Nurses have guidelines, but can customize alarms to make them more actionable without a physician order.
- Collect and assess data. Evaluating alarm information from a workflow perspective can help hospitals identify issues related to lead changes, staffing and bedside care. Sarasota Memorial used its alarm system data in determining a new apnea and bradycardia protocol that required a 10-second duration before the alarm would count as an incident.
Educate both caregivers and patients.
- Train clinicians on why – not just how. Prior to rollout and whenever changes are implemented, it is important to make sure clinicians understand what the new technology’s capabilities are, how it will be used and what it aims to accomplish. Doing so helps foster trust that the changes will improve patient care and outcomes.
- Make alarms and alerts part of onboarding. Sarasota Memorial considers alarm management as important as charting for all new hires. Nursing managers meet with NICU nurses one-on-one to explain the objectives, the alarm escalation process, and tips such as changing leads daily, which cuts nuisance alarms by as much as 60 percent. Bedside nurses receive extensive training for new upgrades. And annual competency reviews include alarm management.
- Make data readily available. University of Kansas Health implemented alarm dashboards for staff to further drive change. When the staff viewed data from a small test of changes in the health system’s ICUs, the “numbers spoke volumes.”
- Educate patients, too. Patients and family members need to know that smartphones are clinical tools – that their nurses aren’t texting friends or looking for Facebook updates. Patient communication might include flyers in the rooms, information in welcoming packets and talking points given to the staff that include the benefits of the system to patients.
More effective alarm management practices through efforts such as these can help minimize alarm fatigue – thereby safeguarding patients and improving outcomes – while also increasing both nurse and patient satisfaction.
Malaciah Jones is Sr. Program Manager of Clinical Solutions at Voalte.