Clinical Alarm Management: Past, Present, & Future

Clinical Alarm Management: Past, Present, & Future

When it comes to a natural disaster like a hurricane, sound alarm management notifies people in time should they need to evacuate a high-risk area. Similarly, clinical alarm management refers to how a healthcare team responds to unfavorable changes in a patient’s condition. A good patient outcome requires striking a balance between over-responding to situations that don’t need any response beyond monitoring the patient and under-responding to situations that require further attention. 

The trigger for initiating a clinical alarm protocol can be either human, such as a nurse noticing a patient in distress, or technological, such as a change in a patient’s heart rate captured and relayed. Good clinical alarm management requires a cohesive and flexible plan that accounts for many possibilities. A commonly used tool is alarm management software.

The need for alarm management

Clinical alarms are far from perfect. Numerous reports have documented cognitive overload from the combination of alarms, alerts, and notifications from multiple devices. ECRI Institute listed alarm, alert, and notification overload as the sixth Health Technology Hazard for 2020 [1]. Proper alarm management is essential, especially when it comes to improving the patient experience and reducing [2]: 

  • Workplace distractions
  • Fatigue among employees and providers
  • Limited concentration contributing to alarm fatigue

In a hospital setting, alarms may result from multiple patients. When a nurse becomes confronted with alarm after alarm, it can be challenging to know which patient needs assistance straight away. Similarly, in a neonatal intensive care unit (NICU), alarms are more common than not amongst these fragile patients, so nurses in this environment need to pay close attention to those alarms [3]. We must be careful, though, because more alarms don’t always translate to better care. Overuse of medical alarms can lead to the widely recognized problem of alarm fatigue [4].

Typical clinical challenges with alarm management

The main problems associated with poor clinical alarm management include:

  • False alarms. In a recent study on alarm management in an intensive care unit, over 60 percent of alarms were false alarms [5]. Another article reported false alarm rates ranging from 72 to 99 percent [6]. The sheer number of these alarms can lead to desensitization among nurses. Patient movement is the largest contributing factor to false alarms [7].
  • Non-actionable alarms. Most alarms in hospital settings are non-actionable, with only between 5-13 percent being actionable [8]. These non-actionable alarms contribute to caregiver desensitization and alarm fatigue. Defining non-actionable alarms and actionable alarms remains challenging.
  • Nursing shortages. There are fewer nurses responsible for more work, especially during the ongoing COVID-19 pandemic. At the same time, worn-out nurses are more prone to alarm fatigue. 

Reduce Nurse Interruptions: Intelligently Managing Alerts & Alarms

How Intelligently Managing Alerts Improves Nurse Retention, Workflows, and Patient Safety

How Intelligently Managing Alerts Improves Nurse Retention, Workflows, and Patient Safety

How alarm fatigue harms clinical workflow

A nurse’s day is repeatedly interrupted by alarm after alarm. It’s easy to become overwhelmed and fail to recognize an alarm as requiring action by a nurse. This major industry-wide challenge doesn’t result from a lack of training but is usually due to the overuse of alarms in a clinical setting. Every change in a patient’s condition comes with a different set of alarm functions, which may or may not be relevant to a nurse’s job.

Nurses are overwhelmed by the sheer number of alarms interrupting their workflow. Despite a comprehensive background in patient management and regular refresher training, the problem of alarm fatigue persists.

In addition to impacting clinical workflow, there are several negative consequences for patients relating to alarm fatigue [9, 10]: 

  • Disrupted communication for patients and family members 
  • Disrupted sleep patterns for patients 
  • Missed patient instability by physicians and nurses
  • Progressive physiologic stress
  • Metabolic impairments
  • Late rescue strategies (including readmission or intubation)
  • Death

Providers who miss alarms due to alarm fatigue suffer from guilt, self-blame, and even post-traumatic stress disorder [11]. More and more, nurses are overwhelmed with alarm fatigue, thereby impacting their ability to care for their patients. 

How can alarm fatigue be reduced?

Alarm fatigue is a significant issue for healthcare workers. It can lead to worse outcomes and preventable health problems for the patient. One solution for reducing alarm fatigue is using a modern clinical communication tool. Other ways of eliminating alarm fatigue in healthcare providers include:

Elements of proper alarm management implementation

The response to clinical alarms is complex, so your system for clinical alarm management must include room for flexibility and changes. The ability to redirect alarms to another caregiver, reduce alarm frequency, and integrate with various medical devices and cell phones is essential. 

Does your clinical alarm management solution effectively help reduce alarm fatigue and improve overall patient care? There are several elements to look for in a reliable alarm management system, which include:

  • Fast system-wide updates
  • Mobile device capability to allow for faster response times
  • Auto-escalations to activate the next available provider
  • Context-rich notifications that include:
    • The patient’s name
    • The current patient location
    • Alert priority
    • Precautions
    • Any alarm limits
  • Integration with devices and software from multiple manufacturers  
  • The ability to use your own IT personnel to save time
  • Actionable data insights for front line managers and supervisors

Conclusion

An effective alarm management program improves patient care, saves time and money, reduces alarm fatigue, and uses technology to improve the quality of life for healthcare providers. Decreased alarm fatigue means nurses can more effectively care for their patients. TigerConnect’s clinical alarm management software accomplishes all of these goals and more. Our software includes integration with hospital bed monitors, physiological monitors, and alerts for critical labs. Check out our on-demand webinar, Reduce Nurse Interruptions: Intelligently Managing Alerts & Alarms today to learn more.

References

  1. Special Report: Top 10 Health Technology Hazards for 2020. [Internet]. ECRI Institute. 2019 Oct. 18. Available from: https://elautoclave.files.wordpress.com/2019/10/ecri-top-10-technology-hazards-2020.pdf 
  2. Woo M, Bacon O. Alarm Fatigue. In: Hall KK, Shoemaker-Hunt S, Hoffman L, et al. Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Mar. 13. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555522/
  3. Criscitelli T. Alarm Management: Promoting Safety and Establishing Guidelines. AORN Journal. 2016;103(5):518-521. doi:10.1016/j.aorn.2016.03.008
  4. Johnson KR, Hagadorn JI, Sink DW. Alarm Safety and Alarm Fatigue. Clinics in Perinatology. 2017;44(3):713-728. doi:10.1016/j.clp.2017.05.005
  5. Kannus P, Sievänen H, Palvanen M, Järvinen T, Parkkari J. Prevention of falls and consequent injuries in elderly people. Lancet. 2005;366(9500):1885-1893. doi:10.1016/S0140-6736(05)67604-0
  6. Cho OM, Kim H, Lee YW, Cho I. Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses. Healthc Inform Res. 2016;22(1):46. doi:10.4258/hir.2016.22.1.46
  7. Sendelbach S, Funk M. Alarm Fatigue. AACN Advanced Critical Care. 2013;24(4):378-386. doi:10.4037/NCI.0b013e3182a903f9
  8. Drew BJ, Harris P, Zègre-Hemsey JK, et al. Insights into the Problem of Alarm Fatigue with Physiologic Monitor Devices: A Comprehensive Observational Study of Consecutive Intensive Care Unit Patients. Tereshchenko LG, ed. PLoS ONE. 2014;9(10):e110274. doi:10.1371/journal.pone.0110274
  9. Hravnak M, Pellathy T, Chen L, et al. A call to alarms: Current state and future directions in the battle against alarm fatigue. J Electrocardiol. 2018;51(6S):S44-S48. doi:10.1016/j.jelectrocard.2018.07.024
  10. Winters BD, Cvach MM, Bonafide CP, et al. Technological Distractions (Part 2): A Summary of Approaches to Manage Clinical Alarms With Intent to Reduce Alarm Fatigue. Critical Care Medicine. 2018;46(1):130-137. doi:10.1097/CCM.0000000000002803
  11. Mira JJ, Lorenzo S, Carrillo I, et al. Lessons learned for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations. International Journal for Quality in Health Care. 2017;29(4):450-460. doi:10.1093/intqhc/mzx056

Tags: , , , , ,