By C.A. Wolski
An alarm sounds—a patient is in trouble, but not because of her serious illness. Instead, the machine her clinicians are relying on to treat her has malfunctioned. The danger passes, the patient is safe again, and the machine is sent to the biomed shop because it’s “broken.” The incident ends there with no further investigation.
This is a common scenario in many healthcare enterprises today, resulting in inefficiency at the least and—very rarely, but possibly—death. And while such incidents can be attributed to numerous technological causes, at the root may be an even more significant issue: HTM’s lack of involvement.
Today’s hospitals are surprisingly noisy places, observes John Zaleski, EMT, NREMT, CAP, CPHIMS, PhD, chief informatics officer for Andover, Mass.-based Capsule Technologies, thanks to the nearly 350 equipment alarms per patient per day in the average ICU. Even worse? About 90% of these alarms are meaningless. “If 90% of anything is meaningless, then they’re worthless,” Zaleski says.
Many alarms are due to calibration errors or other device-related issues—an electrode needing to be changed or a pulse oximeter that has slipped off a finger—which have little impact on a patient’s health or safety. But alarms tied directly to a patient’s health, such as monitors that alert when oxygen levels have become dangerously low, or a patient’s heart is going into ventricular fibrillation, need to be clear so a nurse or clinician is cued to act.
In an ICU with patient-to-nurse ratios of 2:1 or 1:1, this cacophony of alarms can be reasonably managed, but on a hospital floor with ratios of 5:1 or more, it becomes more difficult, and may set up a dangerous precedent of dismissal. “If you have too many alarms, then you’ll have a ‘snowblindness’ effect and become desensitized,” Zaleski points out. “[On a general floor], you don’t have the same level of monitoring.”
Without making any significant changes to the operation, there are two options that administrators and clinicians are faced with: closer monitoring or widening alarm thresholds. In this case, it becomes a “balancing act,” notes Zaleski. But there is a third way: engaging biomeds. “There are many alarms, so you need to make them more actionable; make them ‘smart’ alarms so when they go off, they’re meaningful,” explains Zaleski.
The Role of HTM
Getting HTM professionals involved in the safety process means having more context about what the alarms mean, clearly defining if they’re due to a patient’s vital signs failing—or because the battery needs to be changed. “Context involves identifying whether the data collection at the time of the alarm is error-free—[for instance,] there’s no calibration or other types of errors related to equipment malfunctions, and what other findings are present within the sphere of the patient,” Zaleski says.
“From the perspective of automatically collected data, cardiorespiratory context in the form of the ‘A-B-Cs,’ or airway—breathing —circulation, would include respiration, pulse, oxygen saturation, blood pressure, and end-tidal carbon dioxide,” he adds. “Having knowledge of all five of these parameters is not guaranteed. But, the findings related to cardio-respiratory performance provide corroboration when true decompensation is experienced in a patient.”
Building more defined device alarms would involve collecting data related to the equipment, which HTM professionals can play an active part in helping to gather.
“Biomeds can ensure that the equipment is operating properly and that settings are appropriate for given applications,” says Zaleski. “For example, if a monitor is used on a pediatric patient, and there are specific configurations of these monitors for [kids, biomeds need to ensure] that the clinical staff are aware that the modes and settings are appropriate to those patients. [They can also] ensure that filters are changed, time settings are correct, network links are accurate, security settings are correct, maintenance is up-to-date, and equipment surfaces are clean and intact.”
As advocates for data collection throughout the enterprise, HTM professionals should have an understanding and be able to communicate the benefits of giving context to equipment alarms, he adds.
Moreover, Zaleski says that HTM professionals can address issues of alarms and their meaningfulness during the purchasing/implementation period: “[Biomeds can]ensure that notifications can be transmitted to different end-point technologies, that technical alarms or alarms pertaining to proper function of the equipment can be created as part of the smart alarms, and that alarms can be routed appropriately to both clinical and technical stakeholders.”
C.A. Wolski is a contributing writer for 24×7 Magazine. Questions and comments can be directed to chief editor Keri Forsythe-Stephens at firstname.lastname@example.org.