Nearly 3,000 alarms: That’s how many notifications just one patient set off in a little over a day while being continuously monitored during a study conducted at the Virtua Health System. That equates to more than one alarm per minute. When you factor in that nurses can be responsible for four to six patients during the day and seven to 10 during the night shift, it’s no wonder the condition known as “alarm fatigue” has become a serious problem in hospitals.
Those eye-opening numbers were part of a presentation delivered at a July 20–21 meeting of the National Coalition for Alarm Management Safety, which was launched by the Association for the Advancement of Medical Instrumentation (AAMI) Foundation in 2014. July’s meeting marked an effort to build on the coalition’s successes and broaden its portfolio of work.
During its initial two-year phase, the coalition—which has grown to comprise more than 40 U.S. hospitals that are leading the way in alarm management practices, device manufacturers and other health care technology vendors, the FDA, the Joint Commission, and professional societies—has made progress in finding solutions to reduce the overwhelming number of alarms. However, the issue is far from being resolved completely.
“There is still a lot of work to be done on alarm management,” says Marilyn Neder Flack, senior vice president of patient safety initiatives and executive director of the AAMI Foundation. “The coalition teams worked very hard over the last two years to make an impact on the number of alarms clinicians must respond to, and we’ve made great strides in developing tools for hospitals to use in reducing alarm fatigue. But every hospital still isn’t there. Everyone in this country deserves excellent healthcare, which is why we felt compelled to expand the coalition over the next two years?to make a difference.”
During last week’s meeting in Annapolis, Md, the coalition developed a roadmap for the next two years, committing to continuing to provide best practices and resources to hospitals, promoting data collection and evidence-based patient safety initiatives, and expanding its reach. During phase II, the group plans to:
- Develop a mentorship program in which hospitals with more mature alarm management practices can advise other hospitals.
- Add ventilator alarms to the group’s scope of work.
- Create guidelines, tools, seminars, papers, and other resources to help hospitals develop alarm defaults for particular profiles of patients and develop rules/algorithms for improving alarm notification from the primary device or through middleware to reduce clinician alarm fatigue.
- Help hospitals implement American College of Cardiology and American Heart Association guidelines to prevent unnecessary telemetry monitoring.
- Address alarm sounds to be used in future iterations of the International Electrotechnical Commission 60601-1-8 design standard.
- Develop basic guidelines to help clinicians better understand the parameters and defaults for physiological monitors and ventilators and why, when, and how to customize default parameters for particular patients.
To provide hospitals with a greater understanding of how to set and customize alarm default parameters, the Regenstrief National Center for Medical Device Informatics based at Purdue University in West Lafayette, Ind, will build a national database that will house basic default settings and those created for subsets of patients based on characteristics such as age or disease type. Once completed, this system will allow contributing organizations to benchmark their data and see how other hospitals have set their parameters.
For more information regarding this subject, visit AAMI’s Web site.