Hospital Alarm Research Articles

Redesigning Hospital Alarms for Patient Safety

Because hospital alarms alert clinicians to deviations from a defined normal state, these auditory and visual signals are designed to improve patient safety. Contemporary alarms are diverse, ranging from devices that monitor heart rate to those that sound when patients try to leave their beds. Indeed, it is difficult to imagine modern health care without these electronic sentinels of safety. Despite their benefits, alarms may also increase the possibility of harm. In a sentinel event alert, the Joint Commission called medical alarms a “frequent and persistent” patient safety problem and designated them 2014 National Patient Safety Goal No. 6 following reports of several alarm-associated deaths.1 Since 2010, the nonprofit ECRI Institute has also rated alarm problems among the top 10 health technology hazards, recently calling them “the number one medical hazard of 2014.”2 Notably, because alarm-associated adverse events are voluntarily reported, the true magnitude of this problem might exceed published estimates. Why may this technology have resulted in adverse outcomes?

Alarm Fatigue

The phenomenon known as alarm fatigue is the direct result of excessive alarms in hospitals. This article highlights the effects of alarm fatigue and reviews current clinical recommendations and guidelines to raise nurse awareness and provide tools to combat the problem.

Cardiopulmonary Monitors and Clinically Significant Events in Critically Ill Children

Cardiopulmonary monitors (CPMs) generate false alarm rates ranging from 85%-99% with few of these alarms actually representing serious clinical events. The overabundance of clinically insignificant alarms in hospitals desensitizes the clinician to true-positive alarms and poses significant safety issues. In this IRB-approved externally funded study, we sought to assess the clinical conditions associated with true and false-positive CPM alarms and attempted to define optimal alarm parameters that would reduce false-positive alarm rates (as they relate to clinically significant events) and thus improve overall CPM performance in critically ill children. Prior to the study, clinically significant events (CSEs) were defined and validated. Over a seven-month period in 2009, critically ill children underwent evaluation of CSEs while connected to a CPM. Comparative CPM and CSE data were analyzed with an aim to estimate sensitivity, specificity, and positive and negative predictive values for CSEs. CPM and CSE data were evaluated in 98 critically ill children. Overall, 2,245 high priority alarms were recorded with 68 CSEs noted in 45 observational days. During the course of the study, the team developed a firm understanding of CPM functionality, including the pitfalls associated with aggregation and analysis of CPM alarm data. The inability to capture all levels of CPM alarms represented a significant study challenge. Selective CPM data can be easily queried with standard reporting, however the default settings with this reporting exclude critical information necessary in compiling a coherent study denominator database. Although the association between CPM alarms and CSEs could not be comprehensively evaluated, preliminary analysis reflected poor CPM alarm specificity. This study provided the necessary considerations for the proper design of a future study that improves the positive predictive value of CPM alarms. In addition, this investigation has resulted in improved awareness of CPM alarm parameter settings and associated false-positive alarms. This information has been incorporated into nursing educational programs.

Resultados del primer año de funcionamiento del plan de resucitación cardiopulmonar del Hospital Juan Ramón Jiménez (Huelva)

Objective To present the results of the first year of the functioning of a Cardiopulmonary Resuscitation (CPR) Hospital Plan and to describe the characteristics of the patients with cardiopulmonary arrest (CPA) in hospital units with no monitoring facilities (HU). Design An observational, prospective study in a cohort of patients who presented CPA during a one-year period. Setting HU of a general hospital and as province reference. Patients and methods Patients admitted to an HU from May 2007 to May 2008 with CPA and treated according to a specific hospital CPA Program, organized in order to: (a) decentralize the CPR through the training of the nurse as the first responder capable of performing immediate CPR and early defibrillation (DF) (less than 4 min), (b) a specific phone number as hospital alarm of CPR and (c) maintenance of the CPR maneuvers by an early intervention Resuscitation Team (RT) (less than 8 min). Main variables of interest Characteristics of patients, CPA episode and results according to the «Utstein style». Results A total of 73 patients were included with activation of the CPA alarm, 8 of which were false alarms, with an average age of 70 years and 60% men. A total of 65% occurred in the medical area in patients with heart or respiratory failure, sepsis or septic shock. Initial heart rhythm of the patients attended was asystolic in 74% of the patients, ventricular fibrillation in 18% and electromechanical dissociation in 8%. The first attending person was the nurse in 79% of cases, CPR was always initiated in less than 1 min, DF in less than 2 min (92%) and RT in less than 8 min (96%). Fifty-five percent survived and 35% of the reanimated patients were discharged live from the hospital, 78% with good neurological outcomes. Conclusions The CPR “Juan Ramón Jiménez” Hospital Program is an applicable and effective initiative in our setting.

A National Online Survey on the Effectiveness of Clinical Alarms

To develop a national online survey to be administered by the American College of Clinical Engineers Healthcare Technology Foundation to hospitals and healthcare workers to determine the problems associated with alarms in hospitals. An online survey was developed by a 16-member task force representing professionals from clinical engineering, nursing, and technology to evaluate the reasons health-care workers do not respond to clinical alarms. A total of 1327 persons responded to the survey; most (94%) worked in acute care hospitals. About half of the respondents were registered nurses (51%), and one-third of respondents (31%) worked in a critical care unit. Most respondents (>90%) agreed or strongly agreed with the statements covering the purpose of clinical alarms and the need for prioritized and easily differentiated audible and visual alarms. Likewise, many respondents identified nuisance alarms as problematic; most agreed or strongly agreed that the alarms occur frequently (81%), disrupt patient care (77%), and can reduce trust in alarms and cause caregivers to disable them (78%). Effective clinical alarm management relies on (1) equipment designs that promote appropriate use, (2) clinicians who take an active role in learning how to use equipment safely over its full range of capabilities, and (3) hospitals that recognize the complexities of managing clinical alarms and devote the necessary resources to develop effective management schemes.

Perceived urgency and the anaesthetist: responses to common operating room monitor alarms

Increasing numbers and varieties of electronic monitors are used in hospital operating rooms. Many of these are equipped with auditory alarms which are loud, insistent, or irritating, and thus are frequently disabled by the anaesthetist. This study was planned to evaluate two components of auditory alarm design which may influence the usefulness of the alarm: the perceived urgency of the auditory signal and its correlation with the urgency of the corresponding clinical situation. We also assessed the ability of practising anaesthetists to identify the monitor or condition responsible for the alarm. Sixty-four anaesthetists attending a national conference assessed ten common operating room alarm sounds for perceived urgency. Results were compared with the urgency of the corresponding clinical situation as determined by 12 senior anaesthetists. Discrepancies between the clinical and perceived urgencies of several monitor alarms were found, and there was no correlation between the two measures. The subjects were also tested for their ability to identify the alarm sounds correctly. The overall correct identification rate was 33%, and only two monitors were correctly identified by more than 50% of the subjects. The results of this study have implications for design and use of auditory alarms in hospitals and suggest the need for further research.

Combined Pressure Control and Signal Apparatus for Safer Emergency Management of Bleeding Esophagogastric Varices

Adequate tamponade for bleeding esophagogastric varices in portal hypertension poses many problems during the initial emergency care. Many methods have been described for obtaining efficient tamponade with the use of the nasogastric tubes, but few of them have been entirely satisfactory.l-lO A new apparatus for dependable and accurate control of balloon tamponade has been recently developed by the authors. The apparatus consists of two essential elements operating synchronously. This apparatus has been designed to function with any of the nasogastric tubes that have been designed by Sengstaken, Blakemore, Nachlas, Linton, and Patton.a, 6,7 A headgear unit serves to control the direct traction force on the gastric balloon (measured in grams). A cylinder reservoir unit serves to control the intraesophageal balloon pressure (measured in centimeters of water). Both units have special microswitches, which set off the standard hospital alarms should a decrease in either gastric traction force or esophageal balloon pressure occur. The tamponade controls are depicted in figures 1 to 3. The mechanisms of gastric traction with the use of the headgear unit is demonstrated in figure 1. The fulcrum (fj) is in the center of the lever arm. Thus the grams of traction force that are shown on the scale reflect the amount of pull exerted on the nasogastric tube. The scale is calibrated to 1500 gm. The direction of pull of the nasogastric tube is forward and downward to prevent any pressure necrosis of any of the nasal cartilages or epithelium at the lower portion of the nose. Sponge rubber cushions the