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Clinical Alarm Safety Improvements are a Team Effort

Analysis  |  By Jennifer Thew RN  
   September 27, 2016

The Joint Commission has called for improvements in clinical alarm safety, but nurses can't do it on their own. They need the help of device manufacturers, hospital leaders, and quality and risk management specialists.

When was the last time you responded to the sound of a car alarm? The noise may have been irritating, but it probably didn't raise enough concern to warrant a call to the police.

"When car alarms first came out, we heard those and were like, 'Hey, someone's ripping that guy's car off!'" says Michele M. Pelter, RN, PhD, assistant professor at University of California, San Francisco School of Nursing and director of the ECG monitoring research lab in the school's department of physiological nursing.

"And then we realized, well no it isn't [being stolen]. Somebody bumped it, or it's the wind, or a motorcycle went past. And so we now ignore those."

But in healthcare, ignoring alarms can be dangerous or even deadly.

From 2009 to 2012, 98 alarm-related sentinel events, 80 of which resulted in death, were reported to The Joint Commission.

In 2014, the organization added clinical alarm safety to its list of national patient safety goals, and in January 2016, phase two of the goal's implementation was rolled out. Hospitals are now expected to create policies and procedures to improve clinical alarm safety.

'They Don't Hear It'

"The Joint Commission got involved because the alarms are getting turned down or silenced," Pelter says. "We think, too, that there is an assimilation [that occurs] and the noise just becomes background noise. The nurses just don't even acknowledge it. They don't hear it. It's nothing new to them."

Often called alarm fatigue, the issue around clinical alarm safety goes beyond clinicians just tuning-out alarms they are constantly hearing. In addition to not responding to alarms because they've become background noise, nurses will also ignore alarms they do hear because they are often false.

"If all morning it's been false and we take that risk of saying, 'The chances are it's going to be false,' we push the envelope," Pelter says.

Disabling or turning down the volume on alarms is not a solution.

"This term, 'alarm fatigue' is going to change over time as we understand what that really means. I think it's a complex concept that we're still trying to understand," says Pelter. "I think that a lot of institutions, they don't know what to do with it, it's such a new patient safety goal to measure."

Nurses Need Help

As the SON's representative on UCSF Medical Center's, Clinical Alarm Management (CALM) Committee Pelter has gained some insights into the complexities of clinical alarm safety.

Even though nurses are on the front lines trying to manage alarms, one group on its own cannot be expected to solve the problem on its own.

While it helps to identify a key person to coordinate the improvement process, hospital leaders, physicians, nurses, and members of the safety, quality, risk management, and the biomedical departments should all be involved because decreasing the number of alarms may require changing alarm parameters, which are often left on the manufacturer's default settings.

"You want to get all sides of what the risk of change to all these parameters is and what do we gain from it," she says.

It also pays to reach out to device manufacturers for support, since they may be able to provide data or reports to help an organization make informed decisions about parameter changes, Pelter says. They can also assist with the technical aspect of making a change across an organization as it can be difficult to adjust alarm parameters.

"The monitoring companies have made it pretty hard. There [are] many steps to it, and it can be confusing," Pelter says of changing parameters.

Monitoring companies also need to be a part of improving alarm safety including adjusting alarm algorithms based on feedback from their users or evidence-based practice.

"The monitoring companies don't just update their software like our cellphones do, and that is something that we really want to push [them] to do," she says. "Why can't we have updates that make alarms better?"

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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