Alarm fatigue, which can occur when physicians and nurses become desensitized to clinical alarms, could be reduced by improving the training of clinicians and customizing the default settings on alarms used to monitor patients, leading opioid safety experts said in a recent webinar.
Hosted by the Premier Safety Institute as part of its Advisor Live series, the March 4 webinar included:
- Gina Pugliese (moderator) RN, MS, Vice President, Premier Safety Institute, Premier, Inc.
- Bhavani S. Kodali, MD, Associate Professor, Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School;
- Harold Oglesby, RRT, Manager, The Center for Pulmonary Health, Candler Hospital, St. Joseph’s/Candler Health System (SJC); and
- Joan Speigel, MD, Assistant Professor, Anesthesiology, Harvard Medical School and Beth Israel Deaconess Medical Center.
- Michael Wong, JD, Executive Director, Physician-Patient Alliance for Health and Safety (PPAHS);
These experts discussed ways to lower incidences of alarm fatigue – described as a “frequent and persistent problem” among hospitals throughout the U.S. in a Sentinel Event Alert issued by the Joint Commission and listed in the ECRI Institute’s “Top 10 Health Technology Hazards Report for 2014.”
“As anesthesiologists, we’re saturated with devices and machinery in the operating room, and our minds are trained to hear certain alarms and not others,” Dr. Speigel said. “So you have the problem of over-reaction to certain alarms and under-reaction to others.” She added that for hospitals to overcome this problem, “Certainly, it requires a lot of training.”
Mr. Oglesby agreed, pointing out the clinician training continues to play a critical role in improving patient safety at SJC, which has been “event-free” since it began using capnography to monitor patients receiving patient-controlled analgesia (PCA) more than nine years ago.
“I can tell you from personal experience that our devices, and the way our facilities our designed, is we are based in our campuses with pods,” he said. “We don’t only monitor capnography on the PCAs but it has expanded because of the success of monitoring patients on PCA. We also monitor patients that are on high dose opioids, say, for instance, Dilaudid. If they’re on a dose that’s higher than two milligrams within every three hours or so, they have to have end tidal CO2 monitoring on them. We also monitor end tidal CO2 on patients that are receiving Propofol for moderate sedation. There are a lot of patients that are being monitored and if you’re in a pod and the alarm goes off, the alarm is loud and it is annoying. The alarm itself is part of the reason we have stimulations of our patients. If it stimulates the patient, it also stimulates the staff.”
A critical point about alarm fatigue is that “no standard alarm is good for two patients,” Dr. Kodali said, adding that hospitals that rely on default alarm settings are creating an environment for alarm fatigue to occur.
“If you just continue to use the same parameters for every patient, then it results in alarm fatigue,” he said. “ That point comes with experience. Once you know this patient’s end tidal is always around 50, you come up with a different parameter for him.”
For a copy of the transcript of the discussion, please click here.