Actionable Alarms Counter Alarm Fatigue

One pilot that worked well at Hopkins was the use of a monitor watch—a nurse or trained technician sitting at a monitor in a critical care unit. That nurse was able to communicate with other nurses and troubleshoot alarms?perhaps suggesting a battery should be changed or new electrodes were needed. The result, after two weeks, was that the number of alarms initially dropped from 500 alarms per patient per day to less than 300 per patient per day. (In a subsequent effort, it dropped to less than 200 alarms per patient per day.)

However, the high costs of using a nurse as a monitor precludes using this initiative more often throughout the hospital, Cvach says. “Relying on technology alone with a human interface is sort of like an air traffic controller—you have these wonderful algorithms, but you still need that human who sits there and interprets it.”

At the 636-bed Huntington Hospital in Pasadena, CA, the decision was made last fall to test a technological facelift on one floor: replacing nurses’ separate wireless phones and pagers that alerted them to alarms and code blues—with one device.

“The picture I try to paint is a nurse standing there with bulging pockets because of all the information she needs to do her job; she is maybe carrying up to four things,” says Ron Rutherford, RN, Huntington’s director of informatics. “There were too many bells and beeps requiring attention.”

The hospital, working with a new company called Voalte of Sarasota, FL, began the pilot by initially deploying iPod touch devices that nurses could use to monitor alarms on the floor. This was combined with texting—which had the added benefit of making the hospital unit quieter when nurses communicated with each other.

In addition, nurses “have the ability to know immediately, wherever they are, that an alarm is happening,” Rutherford says. “As far as the quality of those alarms, it changes the way it receives an alarm because they can get it in real time.”

Most recently, a switch to iPhones was made to permit the nurses to speak to each other as well. “We’re trying to put more functionality into the single devices,” he says.