Thursday, February 13, 2014

Silencing Many Hospital Alarms Leads To Better Health Care

SHOTS by Richard Knox 27 January 2014

Analysis at Boston Medical Center found that 7 North was experiencing 12,000 alarms ­a day, on average. This had led to "alarm fatigue," which occurs when there are so many noises on the unit that it actually desensitizes the staff," says Deborah Whalen, a clinical nurse manager at the Boston hospital. "If you have multiple, multiple alarms going off with varying frequencies, you just don't hear them." 
That can be dangerous. Patients can die when an important alarm is missed, or an electrode on a patient's chest comes unstuck, or a monitor's battery goes dead.

Boston Medical Center hasn't recorded any patient deaths because of alarm failure, but, Whalen says, "we were lucky." A Boston Globe in 2011 found more than 200 deaths nationally related to alarm problems. Last year, the Joint Commission, a national quality-control group, of 98 alarm-related instances of patient harm, including 80 deaths and 13 cases of permanent disability.

The known alarm-related problems are just the tip of an iceberg, according to , the Joint Commission's chief medical officer, because such cases are seriously underreported.

"It is pervasive in almost any accident that occurs in a hospital," McKee says. "If you look carefully, you will most likely find that there was an alarm as a contributing factor."

That's why the Joint Commission has at the top of its current list of issues that hospitals are expected to tackle. McKee says technology has gotten out of control. "We have devices that beep when they are working normally," she says. "We have devices that beep when they're not working."

Boston Medical Center is attracting national attention as a hospital that apparently has conquered alarm fatigue. Its analysis showed the vast majority of so-called "warning" alarms, indicating potential problems with such things as low heart rate, don't need an audible signal. The hospital decided it was safe to switch them off.

The hospital also upgraded some low-level "warning" alarms to a higher level, signifying "crisis" — for instance, a pause in heart rhythm. And nurses were given authority to change alarm settings to account for patients' differences.

"Once that happened," nurse Deborah Whalen says, "many, many, many alarms disappeared. And instead of 90,000 alarms a week, we dropped to 10,000 alarms a week." That's on 7 North alone.

These days you can easily hear how quiet 7 North and all of the adult medical-surgical units at Boston Medical Center have become. Instead of a steady stream of beeps, minutes can pass without an alarm. So when a "crisis" alarm sounds, the staff can easily hear and respond.
"It's a lot more manageable," says staff nurse Amanda Gerety. "It's a lot more pleasant being at work." And when she sleeps, she says with a laugh, "I don't hear alarms in my dreams anymore."

The hospital says patients like it better, too. For one thing, when they press the nurse-call button, the nurses are more likely to hear it.

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