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January 12, 2016

How three hospitals are tackling the deadly problem of alarm fatigue

Daily Briefing

Staff tuning out medical alarms can have terrible consequences for patient safety—but several hospitals are taking innovative steps to address the problem, Laura Landro reports for the Wall Street Journal.

Up to 90% of medical alarms don't require immediate medical attention, researchers have found. The constant beeping can result in staff suffering from "alarm fatigue"—in which they "ignore [the alarms], turn them off or just stop hearing them," Landro writes.

The consequences can be deadly. According to the Joint Commission, there were 138 alarm-system related deaths between 2010 and June 2015.

How 'alarm fatigue' may have to led to one patient death

"This is a preventable issue that is killing people," says Ronald Wyatt, the Commission's medical director for health care improvement. "Every year we see the numbers go up because of something related to alarm management."

Following a string of deaths due to alarm fatigue, the Commission required hospitals to prioritize alarm safety by January 2014, and this month is the deadline for hospitals to implement safety policies and educate staff on alarm issues, such as who has the authority to disable an alarm.   

But, Landro writes, some hospitals are "scrambling" to meet the safety requirements.

"Culture is probably the hardest part of alarm management because staffers are used to doing things their own way," says Rikin Shah, senior consultant at the ECRI Institute, a not-for-profit that focuses on patient safety.

ECRI: These are the 10 biggest patient safety problems for hospitals

Dialing down the noise

At the Children's Hospital of Philadelphia (CHOP), researchers found that 99% of alarms had no effect on patient care—and the more alarms ringing, the longer it took nurses to respond.

In response, CHOP implemented a secondary notification system that filters out low-priority alarms—like infants' heart rates increasing when they cry—and passes serious ones to a nurse's mobile device, and then to another clinician if the nurse is unresponsive. And every four hours, CHOP staff review patients with the most-frequent alarms and can alter devices' settings as needed.

Meanwhile, Boston Medical Center's cardiology unit last year reduced audible alarms by almost 90% by having nurses tailor alarm settings on a patient-by-patient basis, emphasizing alarms that indicate a need for critical, immediate attention or a patient's specific needs. The unit also used visual messages, rather than audible alarms, for nonserious heart rate changes.

How a Boston hospital cut audible alarms by 89%

And Children's Hospital of Pittsburgh of UPMC has replaced certain types of audible alarms altogether using a software that creates visual graphs and triggers mobile alerts if a patient needs attention—unlike loud alarms, which can only be heard by those within earshot.

"We don't have a lot of alarm fatigue," says Karen Kern, a pediatric oncology nurse at the hospital (Landro, Wall Street Journal, 1/9).

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