AAMI 2013: Alarm fatigue takes center stage
by Nancy Ryerson
, Staff Writer | June 04, 2013
The star of this year's AAMI conference wasn't a respected speaker or seasoned professional, it was the beeping alarms that are the bane of every nurse's existence. There were six sessions on alarm management alone during the three-day conference, more single-topic coverage than frequent AAMI attendees had ever seen before.
"Alarm fatigue" sets in when nurses hear so many beeps, many of them false alerts, throughout the day that they start to become desensitized to them. Of course, that becomes a major, sometimes fatal, problem when the alarm in question was an important one.
ECRI Institute cited alarm hazards as its top technology concern for 2013. The Joint Commission has also announced that alarm management needs to be a top priority.
At a Joint Commission update presentation at the conference, George Mills, director of the department of engineering, said a final alarm management draft will roll out in July or August for implementation in 2015. In the meantime, he said hospitals should identify the most important alarms to manage and then address any issues related to them.
"What are you going to do when you get home on Monday?" he asked attendees. "Build that inventory," he said.
Vendor solutions included GE's Ascom Secondary Alarm Notification Solution, which works to eliminate tragic events from missed alarms by creating a fallback system using mobile monitoring. A text message alert is sent to a nurse with a color-coded message denoting its urgency. If the first nurse doesn't look at the message after a few minutes, it's automatically sent to another nurse.
Sotera showed its Visi mobile monitor, a device that attaches to a patient's wrist and provides real-time vital signs to the nurse. Sensors also attach to the patient's chest to detect movement and report to the nurse whether the patient is lying down or sitting up.
"If the patient has been lying down for too long, we can send an alert about that," Gunnar Trommer, vice president of marketing and business development at Sotera Wireless, tells DOTmed News. Monitoring movement can also reduce false alarms by canceling the "noise" created when patients move.
Masimo's alarm management product, the Radical-7 bedside Pulse CO-Oximeter, also addresses the problem of false alarms from patient movement.
"It also prevents false alarms because of slow profusion, which is common in older patients," said Jeff Caffee, Masimo account manager.
Each vendor's goal was to capture the important information without overwhelming the nurse. For example, several vendors noted that some systems beep to show that everything is fine, a distraction that frustrates nurses.
"You have to find the balance between sensitivity and specificity," said Trommer.
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