While this issue of Horizons was in production, I visited my grandparents in New York several times. Both were hospitalized, undergoing rehabilitation from hospitalization, or bouncing from one back to the other.
At a rehabilitation facility in his native Bronx, my grandfather was retelling an often-repeated story—how an Ann Arbor deli tried to charge him for a container of mustard in 1992. (I, for one, am willing to let Zingerman's off the hook.) This story is sacred, and I never know the last time I'll hear it. But interrupting his train of thought, breaking every beat, and distracting the twinkle in his eye, was a barrage of annoying and meaningless clinical alarms from his monitor and other patients within the facility.
If I didn't know better, I might have interpreted the clinical staff's lack of response to the alarms as indifference. Instead, I wondered if the nurses were trained to customize the alarm settings. If they were, did they feel empowered to do so?
The vast majority of clinical alarms are nonactionable. No matter how much noise they make, they rarely require clinical intervention. This is more than a mere nuisance for patients and their families. For clinicians, the barrage of false alarms can result in “alarm fatigue,” a desensitization to alarms that threatens quality of care and patient safety. In its annual rankings of healthcare technology hazards, ECRI Institute consistently ranks alarm management toward the top.
Alarm management issues came to the healthcare technology forefront during a 2011 summit hosted by AAMI and the Food and Drug Administration. Following the summit, the AAMI Foundation established the National Coalition for Alarm Management Safety. The Joint Commission approved its National Patient Safety Goal on Alarm Management (NPSG.06.01.01) with four elements of performance in 2014. Their work continues.
The issues surrounding clinical alarms are complex, and solving them will require input from nurses, physicians, healthcare technology management professionals, and hospital leadership. Some of the proposed solutions are technological, such as the use of secondary alarm notification systems (e.g., middleware) that can analyze, filter, prioritize, and route alarms. Other solutions are human, such as staff education to customize alarms, the training of monitor watchers, or changing a unit's culture.
The approaches outlined in this issue of Horizons represent several steps toward achieving the goal of successful clinical alarm management. These include:
Samantha Jacques (p. 16) considers the factors that affect the design of secondary alarm notification systems, including the use of middleware.
Shawn Forrest (p. 30) looks for lessons in the process industry to address alarm management challenges.
Judy Edworthy (p. 50) and colleagues consider the classification of audible alarms from diverse perspectives, including human factors, semiotics, clinicians, and the patient/layperson.
Laura De Vaux (p. 58) describes a project that reduced nonactionable alarms in the medical critical care unit at the York Street campus of Yale New Haven Hospital.
With the right approach and the right technology, clinical alarm management can improve patient care and ensure that every story gets told.
About this Issue
Clinical alarms are intended to improve patient care. They can arm clinicians with valuable physiological information, tip them off to the signs of a patient's deterioration, and route information to the person most able to help the patient. However, these alarms often result in a sensory clutter that aggravates clinicians and patients, possibly reducing the quality of patient care. This issue of Horizons explores several approaches to solving the issues surrounding clinical alarm management, including the use of secondary alarm notification systems, examining how alarms are classified, initiating cultural change, and looking for lessons from outside of the healthcare technology industry.