Bleeps, chirps and a cacophony of warning alarms assault nurses and physicians in today’s hospital units. But it doesn’t have to be that way. Several hospitals have taken steps to reduce this auditory overload in an effort to help caregivers discern between important notifications and mere noise.
“There are so many different devices that produce alarms,” according to Marjorie Funk, RN, PhD, a professor at the Yale University School of Nursing. “Alarms go off not only when a patient is in trouble, but also if a device’s batteries are running low or something else is wrong that needs attending to.”
The increasing use of alarms has contributed to the problem. The Oklahoma Heart Hospital, Christiana Care Health System and Johns Hopkins Hospital are showing that effectively managing alarms means cutting some out.
Teaming up with IT
“One of the problems with a past monitoring system was that nurses would get false alarms for every little crimped cable or moving finger,” says Steve Miller, the CIO of Oklahoma Heart Hospital in Oklahoma City. “They couldn’t tell the difference between a life-threatening alarm and a nuisance alarm.”
When clinicians and the biomedical engineering team at Oklahoma Heart came to the IT department with the issue, Miller shopped around for an appropriate tool to improve alarm management. He settled on an unobtrusive information exchange client that could read data from patient monitors and transmit that information wirelessly to nurses’ mobile devices.
Oklahoma Heart customized alarm parameters so that only the most crucial would reach nurses. The information exchange client is able to read every data field in a patient monitor, interpret the data according to the customized alarm parameters and transmit notifications of serious events along with patient information and room to nurses. Using the system, the hospital has reduced false alarms by setting time delays for certain events. For instance, an alarm caused by an SpO2 sensor will not reach a nurse until it has sounded for 30 seconds, which eliminates alarms caused by crimped cables or moving patients.
Now, nurses know that they need to respond when they receive an alarm. “Before we implemented this, nurses might not have been too responsive to alarms because they knew that maybe 80 percent of them were nuisances,” Miller says. The initiative has strong support from the chief nursing officer, who has encouraged her staff to respond to alarms transmitted through the new monitoring system.
There are also multiple redundancies installed in the system to ensure alarms receive attention. If a nurse does not respond to a notification by pressing the acknowledge button on her device, it is sent to another nurse after a set amount of time. Additionally, test messages are sent to the mobile devices twice a day to ensure they are receiving notifications.
Technology for technology’s sake is worthless; technology to improve clinical workflow is the goal. While Miller isn’t sure if the customized alarm parameters or the mobile monitoring system are improving patient outcomes, he believes they improve care by letting nurses know what is going on with and giving them more time with their patients. “We think clinical outcomes are better because happy nurses provide better care and that’s what we want: happy nurses and happy patients.”
Unique solutions for unique needs
The Christiana Care Health System in Wilmington, Del., embarked on an alarm redesign in the late 1990s. Christiana standardized alarms across all units, turning off many unnecessary alarms and setting the same defaults for all patients. Standardizing alarms at Christiana made sense because it allowed nurses to move between units and still know how the alarms should be set, according to Maureen Seckel, RN, MSN, a clinical nurse specialist.
Turning off unnecessary devices reduced the number of alarms at Christiana, according to Seckel, but a more recent initiative has tweaked the hospital’s alarm management strategy even further. While Oklahoma Heart went with an intuitive mobile monitoring system to avoid the space and financial requirements of central monitoring, nurses at Christiana monitor clinical alarms from a post across the street from the main facility.
A central monitoring room now receives alarms from all units at Christiana except for those originating in intensive care. Alarm silence has been achieved. “There are no alarm sounds on nursing units anymore,” says Anita K. Witzke, MSN,