Meeting the challenge: how hospitals complied with the new clinical alarms requirement.

Abstract

by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) took effect. As of that date, all accredited health care facilities were to have finished implementing 6 new National Patient Safety Goals. The goals addressed specific patient safety issues and were each accompanied by recommendations for action. One goal in particular significantly affected medical equipment managers—Goal 6, “Improve the Effectiveness of Clinical Alarm Systems.” The requirement is designed to ensure that nurses and other caregivers can hear critical alarms during device warnings or patient emergencies. From the time the goals were announced in July 2002, the goal pertaining to clinical alarms had health care organizations across the country scrambling to understand and implement the new requirements by the deadline. The story of how hospitals have responded reveals a major effort on the part of most hospitals to comply with this goal. Their difficulty in doing so depended largely on the extent to which they had already considered the alarms issue within their organizations. Many hospitals faced a tremendous amount of work and some significant technical obstacles to come into compliance with the new regulation. Emanuel Furst, CCE, PhD, manager of clinical engineering at University Medical Center in Tucson, Arizona, says, “This is a big deal, far more complex than it initially appears on the surface. The issue is to evaluate not only the maintenance aspect of clinical alarms but also the physical plant and user practices.” The goal is serving an important function, most people agree. Hospital administrators and equipment managers acknowledge that safety issues related to alarms do exist in the hospital environment. The goal originated with a JCAHO Sentinel Event Alert summarizing the results of a root cause analysis of 23 ventilator-related deaths in the United States. Of the 23 cases, 65 percent were related to the malfunction or misuse of an alarm or an inadequate alarm. The findings underlined the problem of human error and identified the need for rigorous staff training and ventilator maintenance. Matthew F. Baretich, a clinical engineering consultant who has advised a number of clients on how to comply with the requirements, reports that hospitals are still looking for the right response to the new requirements. “People are still struggling to make sure that they do what the Joint Commission wants, without wasting resources on activities that don’t improve patient safety,” he says. COVER STORY