Sound the Alarm! Or Better Yet, Answer It

Posted on Mon, Apr 25, 2016
Sound the Alarm! Or Better Yet, Answer It

By Adam Corley, MD, FACEP, FAAEM
Imagine the case of a 60-year-old male with blunt head trauma from a falling tree branch. He survived the accident and was placed in an ICU for observation and treatment. As his condition worsened, cardiac and other monitors began to alarm. For over an hour, the alarms went unchecked until the patient coded.
The patient’s traumatic brain injury was complicated by anoxia, according to the Boston Globe and The Joint Commission, who reported this story. He was subsequently removed from life support and died.
Complications due to medical alarms or so-called “alarm fatigue” are not routinely reported to any regulatory or data-collecting agencies. However, voluntary reporting of sentinel events does occur. The Joint Commission reports that there were 80 alarm-related deaths between 2009 and 2012. According to the Food and Drug Administration, 566 alarm-related deaths occurred between 2005 and 2010. Given that the reports are uncommon and not mandatory, this undoubtedly represents only a fraction of the actual number of alarm-related complications.
Alarm fatigue is a true phenomenon that most people experience in their daily lives. Computer alarms, car alarms, house alarms and others are quite common. It’s very easy to dismiss the alarm without giving much though as to the nature or seriousness of the alert.
In healthcare, the problem is compounded. The Joint Commission estimates that the number of alarms per patient every day may reach into the hundreds, and 85 to 99 percent of clinical alarms don’t require intervention. A nurse caring for five or six hospitalized patients may hear thousands of alarms every day.
To combat alarm fatigue and other complications due to medical alarms, several things need to happen. The first step is to sound the alarm! Many of us in healthcare are unaware of the problem or underestimate its importance. Healthcare leaders and organizations need to develop strategies to reduce alarm fatigue.
Secondly, nurses, technicians, doctors and other hospital staff need to respond to alarms in a thoughtful, deliberate and consistent manner. Check every alarm, every time.
Physiological monitoring and clinical alarms should be used in a purposeful way. It does no good to collect data and set alarm parameters if they’re not going to be used. When used in an appropriate setting, clinical monitoring can be the difference between life and death. However, they are often placed unnecessarily and/or incorrectly, which uses precious resources and contributes to the problem of alarm fatigue.
Hospitals and biomedical engineers should focus on developing different alarm algorithms and alarm settings that both alert clinicians to changing or dangerous conditions and help reduce alarm fatigue and nuisance alarms.
Don’t hesitate to check alarms yourself. As doctors and APPs, we don’t always know the exact nature of every alarm, but if you hear an alarm notification and no one is responding, check on the patient yourself. If they don’t seem to need immediate intervention, let the nurse or tech know that you responded to the alarm and what you found.

Dr. Adam Corley
Dr. Adam Corley is a practicing emergency physician with more than 10 years of clinical and leadership experience. Dr. Corley serves as Executive Vice President for EmCare’s West Division. He also serves as the medical director for several EMS services and the Anderson County Texas Sheriff’s Department. Dr. Corley lectures and writes on a variety of topics, including decision science and behavioral economics, management of disruptive behavior in healthcare, conflict resolution and healthcare leadership.

Paul Mullinix

All Hands On Deck!!! I agree we all hold accountability for alarm notifications and ought to respond appropriately to alarms when alerted. As we all to some degree share the care for patients in our area of responsibility, having monitors (alarms) central to our work space as well as the patient care area seems to make the most sense. However, this design does lower the lassitude threshold. In my opinion I believe that as clinicians we would be more responsive and the threshold higher if alarms were 'personalized'.

2016 technology ought to have available devices that deliver a patient alarm to the clinician directly responsible for that patient's care. One might assert this idea only adds to the number of alarms already occurring. Which may have some validity. Nevertheless, I contend a personalized alert directly to the individual clinician adds a level of accountability and responsiveness.
4/25/2016 8:39:41 PM