by Sean Power
February 26, 2014
A survey of attendees conducted at the annual meeting of the Society for Technology in Anesthesia collected data about opinions toward alarm management.
Specifically, the questionnaire asked respondents to agree or disagree with the following statements using a Likert scale:
- Alarm management is a significant danger to patient safety.
- Alarm management is a significant challenge to workflow.
- My institution/organization has identified alarm management as a key challenge.
- My institution/organization has implemented a plan or protocols specific to alarm management.
- Developing an effective alarm management plan is a high priority for my institution/organization in 2014/2015.
Respondents were also asked to describe their primary employer, broken into three buckets:
- Hospitals/health care facility
- Teaching/research
- Manufacturer.
The charts below represent their responses.
Overall, the findings seem to suggest that hospitals and health care facilities are simply unsure how to manage alarms better, but that they recognize that alarm management is a problem.
This conclusion is consistent with the national survey on patient controlled analgesia (PCA) safety, which found that 95 percent of hospitals are concerned about alarm fatigue, and—at least as far as PCA goes—is an obstacle for one-third of hospitals from implementing safety measures.
What insights in these results stand out to you? Share your thoughts in the comments below.
The following findings stood out to us.
1. Most respondents from hospitals or health care facilities think alarm management is a significant danger to patient safety. Yet, none feel that developing an effective alarm management plan is a high priority for their institution in 2014 or 2015.
Almost nine out of ten respondents (87.5%) think that alarm management poses a danger to patient safety and presents a significant challenge to workflow.
Unfortunately, most of these respondents (75%) feel that alarm management is not a high priority for their institution in 2014/2015.
This finding is particularly concerning because it comes on the heels of The Joint Commission’s (TJC) 2014 National Patient Safety Goal (NPSG), which focuses on clinical alarm safety and was announced in January 2014.
The survey, therefore, suggests that almost everyone agrees that alarm safety should be a priority—given that it poses such a significant danger to patient safety and such a challenge to workflow—but that not all hospitals and health care facilities are taking action.
Michael Wong, JD, founder and executive director of the Physician-Patient Alliance for Health and Safety (PPAHS), offered one possible explanation:
“The difficulty, I think, is that hospitals just don’t know what to do to manage alarms better.”
2. Very few respondents from hospitals and health care facilities feel that their institution has implemented a plan or protocols specific to alarm management.
Only one respondent out of eight (12.5%) from hospitals and health care facilities agreed that their institution has taken action to improve alarm safety. Further, five out of eight respondents (62.5%) felt strongly that their institution has not implemented a plan or protocols.
If the challenge, as has been suggested, is that hospitals and health care facilities are unsure how to tackle alarm fatigue, then it may be helpful to promote existing resources that clinicians can use to improve alarm management. Below we have assembled some resources:
- TJC’s NPSG announcement contains starting points for improving alarm management.
- The ECRI Institute offers a number of resources for improving alarm safety that might be useful.
- The Association for the Advancement of Medical Instrumentation (AAMI) has assembled an Alarm Best Practices Group tasked with reviewing and recommending best practices for alarm management. AAMI also offers an Alarms Best Practices Library that may prove helpful, as well.
- TJC’s Sentinel Event Alert 50 on medical device alarm safety in hospitals offers further recommendations on how to improve alarm safety.
- A technological wish list prepared with the help of Maria Cvach, DNP, RN, CCRN (Assistant Director of Nursing, Clinical Standards, The Johns Hopkins Hospital) and Mr. Wong provides some technologies that may be of help today and those that should be developed and used in the future.
Overall, only 25 percent of the institutions to which respondents belong have implemented a plan or protocol, and only 25 percent identify it as an organizational focus for 2014 or 2015.
3. The survey might suggest that health care professionals are simply unclear of what the plan of action should be.
The most important—and least surprising—finding from the questionnaire is that most people agree that alarm management is a problem and that they are not addressing it.
Anecdotal evidence lends further support to the notion that clinicians, nurses, and administrators simply do not know how to do so. For example, in a recent National Patient Safety Foundation listserv thread, one subscriber asked the group if there were alarm management policies available to tailor and implement. Several people echoed the request while no policy or template came forth. One subscriber of the listserv, perhaps somewhat rhetorically, even questioned whether a policy was needed at all or if clinicians could simply follow best practices without a policy.
In the context of these types of conversations, the survey’s respondents seem to indicate, as Mr. Wong suggests, a lack of clarity on the best plan of action as well as a deep desire to improve patient safety. Better research, resources, and education might be effective remedies for the confusion.
Of course, the survey was not scientific, uses a small sample size, and is subject to selection bias given that it took place at a conference for anesthesiologists, so these findings should only be considered in context of other research on the issue.
Institutions are making progress
Early adopters such as Boston Medical Center have already taken action to decrease “nuisance alarms” by as much as 60 percent. These early success stories suggest that it is possible for hospitals to improve alarm safety. These frontrunners might need to lead the way for others.
What has been your institution’s experience with implementing changes to meet the requirements of TJC’s NPSG?