Monitoring vital signs and locations of ambulatory patients is imperative in overcrowded emergency departments and disaster scenes, on-site or during transportation. Spend any time in a hospital patient care area, and you will quickly begin to hear the assortment of beeps, rings, chirps, and alerts of the various alarms that are in place to keep patients safe? But are they keeping patients safer?
Continuous monitoring is ideal in many settings where patients cannot be well monitored after triage. An ICU nurse will hear as many as 350 alarms per patient per day (APD), and nurses outside the critical care area may receive up to 182 APD. Surprisingly, many of the overwhelming numbers of alarms heard by clinicians are false alarms or non-actionable. They do not require any action by the clinician, nor do they alert the clinician to a critical issue; they essentially deprive them of valuable time at the bedside.
These incessant numbers of alarms over time begin to do the opposite of what they are designed to do. Instead of keeping patients safe, they can put patients at risk as clinicians develop alarm fatigue and potentially miss critical vital alarms. Alarm-associated deaths are responsible for an estimated 200 deaths per year.
In response to the vast number of alarms that are overwhelming clinicians, The Joint Commission added alarm management to prevent alarm fatigue and associated patient harm as one of the top patient safety goals for the first time in 2013. Where it has remained on the list for subsequent years and continues to remain today. Each year, The Joint Commission sets the National Patient Safety Goals®, and this year alarm management remains on the list as "Goal 6: Reduce patient harm associated with clinical alarm systems."
When implemented, smart alarms can reduce the number of alarms that a clinician hears for each patient and help to ensure that the alarms that are heard are meaningful and actionable.
The continued advancements in healthcare and its emergence with technologies implemented in the hospital will only continue to introduce more alarms and noise with each device implemented. It is essential to explore smart alarms and adopt better alarm management practices. Smart alarms are about more than just the mere reduction in the number of alarms but intelligence in the alarms themselves, which alarm only for clinically significant and actionable events.
The Visi Mobile System assists with alarm management and reduces alarms in care units by focusing on only actionable alarms. The surveillance monitoring protocol sets the alarm's parameters to filter out non-actionable alarms. Increasing the alarm parameters to a specific broader range reduces the non-actionable alarms a clinician receives and alerts them to only critical changes in the patient's condition without missing significant clinical events.
These alarm settings give clinicians an average of six alarms per patient per day (APD). The APD can be further managed by widening the alarm parameters when an alarm has notified a clinician of a change in vitals, and they are actively responding to the event. Clinicians can turn off atrial fibrillation alarms for known active atrial fibrillation patients while continuing to monitor and alarming for the development of Atrial Fibrillation with RVR, helping to make sure that alarms are appropriate and meaningful – actionable. Similarly, a sustained increase or decrease of MAP by thirty percent will alert the clinician to a significant change in the patient's blood pressure even if the blood pressure and MAP remain below the set alarm parameters.
All patients being monitored with ViSi mobile are also shown on a Remote Viewer Display, a central station that shows a comprehensive view of all patients, their ECG and SpO2 and respiratory waveforms, vital sign numeric trends, physiological alerts, as well as a graphical display of patients’ vital sign trends.
These changes in alarm management and implementations of smart alarms will increase patient safety and healthcare workers' satisfaction while improving the quality of patient care and the patient recovery experience. As technology advances, so must its alarms and alerts to prevent the negative consequences associated with them to clinicians and patients.
References:
- Setty M.D., Amar. (2018, January 4). The Road to Smarter Alarm Management for Hospitals in 2018 & Beyond. https://hitconsultant.net/2018/01/04/the-road-to-smarter-alarm-management/#.YK1gALVKiMo
- Gaines, Kathleen. (2019, August 19). Alarm Fatigue is Way Too Real (and Scary) For Nurses. https://nurse.org/articles/alarm-fatigue-statistics-patient-safety/
- (2021, January). The Joint Commission. National Patient Safety Goals® Effective January 2021 for the Hospital Program. https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2021/npsg_chapter_hap_jan2021.pdf
- (2013, December 4). CHPSO. National Patient Safety Goal on Alarm Management. https://www.chpso.org/post/national-patient-safety-goal-alarm-management
- (2020, February 13). The Medical Futurist. Artificial Intelligence Could Solve Alarm Fatigue in Hospitals.
https://medicalfuturist.com/artificial-intelligence-could-solve-alarm-fatigue-in-hospitals/