By John Bethune

Concord, NC—September 5, 2013. Speaking at the annual symposium of the North Carolina Biomedical Association, James Welch, CCE, told his audience of biomeds that clinical alarm management must be adopted as a priority by the highest levels of hospital administration. “Anyone with a ‘C’ in their title has to be involved in the process” of improving alarm safety, said Welch, vice president of clinical engineering and patient safety for Sotera Wireless.

Welch described the problems by noting that for physiological monitors alone, there are an average of 125 alarms per patient per day, which translates to “tens of thousands” of alarms daily per hospital. Less than 5% of those alarms, he said, are “clinically actionable.” Efforts to mitigate the problem are being made by a wide variety of groups, including manufacturers, FDA, AAMI, and The Joint Commission.

One of the first challenges biomedical departments will face as a result comes from the new National Patient Safety Goal on alarm management approved this year by The Joint Commission. Beginning in January 2014, hospitals will be obliged to begin inventorying all devices with alarms. Inventory control systems, Welch said, will need to include a field in each device record that indicates whether the device has an alarm and, if so, what the default alarm settings are. Noting the huge number of devices in each hospital, Welch said that he “can’t imagine how you folks are going to handle” this inventory challenge.

As biomeds work with other key stakeholders in their facilities, Welch said, they should employ two key strategies for reducing excessive alarms.

First, they should distinguish between what Welch called condition monitoring and surveillance monitoring. In the ICU, where patients’ conditions are more fragile, a higher level of nuisance alarms is acceptable. But in general care wards, where monitoring is generally not continuous, alarms can be more tightly restricted.

Second, alarm settings should be addressed both in terms of sensitivity (by adjusting alarm thresholds) and specificity (by increasing the delay before alarms sound). Using pulse oximetry as an example, Welch said that the alarm threshold could be safely reduced from 90% to 88%, and the delay in the alarm could be set at 15 seconds. According to data he cited, this could reduce the incidence of nonessential alarms by 85%.

Welch emphasized that there is no one-size-fits-all solution to the problem. “It is the role, in my view, of the biomedical engineering department to work directly with their internal customers,” he said, “to develop a strategy unique to their care environment.”