No easy solutions for alarm fatigue

Article at Boston.com by Liz Kowalczyk on 14 February 2011

77 year old Madeline Warner died at UMass Memorial Medical Center in Worcester USA died after nurses failed to respond to an alarm that sounded for about 75 minutes, signalling that her heart monitor’s battery needed to be replaced, state investigators found.

The article explains the problems in hospitals with large numbers of alarms that personnel are required to respond to. The whole industry is finding it difficult to come up with a solution. Options include:

1. Improving monitor technology, to sharply decrease the number of false alarms, which some studies have shown exceed 85 percent. New machines would simultaneously sense multiple measures of a patient’s health to more accurately gauge whether a patient is really in crisis.

2. Hiring more nurses, and assigning some to do nothing but watch monitors for alarms.

3. Strengthening voluntary industry standards or federal rules for monitor design and use, such as requirements for how loud alarms should be, or how long monitors should delay sounding an alarm to ensure an apparent problem is real and reduce false alarms.

4. Implement new guidelines for doctors on when to order cardiac monitoring for patients, and how often they must recheck their orders. When technology is readily available doctors end up ordering it for patients who might not benefit. But persuading doctors to put significantly fewer patients on monitors will be a huge challenge, because monitors can be an important tool for alerting staff to problems.

The hospital has already made changes to reduce the likelihood of alarms being missed. Low-battery warnings now appear on the pager or cellphone of the patient’s nurse. If he or she does not respond within a minute, a page goes to all nurses on the unit — as do alarms for potential life-threatening changes in patients. Also, the hospital has replaced cheap $1 leads for the wires that run from a patient’s chest to the monitor with $14 leads that rarely fall off and significantly reducing “leads-off’’ alarms.

GE Healthcare, a monitor maker, is testing similar technology for intensive care units. The company said the new software significantly reduces the number of false heart rate alarms because it uses information from a variety of physiological signals to evaluate patients, rather than just cardiac information. At one hospital, “the technology resulted in an 89 percent reduction in false asystole alarms’’ (asystole refers to a state of no cardiac activity), compared with a traditional cardiac monitor, the company said in a written statement. But this approach is probably only likely to work in intensive care.