Last year, The Joint Commission announced that alarm safety would be added to its list of National Patient Safety Goals for 2014. And for years, clinical alarm hazards have appeared at the top of ECRI Institute’s annual Top 10 list of health technology hazards. The excessive number of alarms that can activate—in particular, those that sound even when the patient is not in distress—is a key part of the problem. But it’s not the only part. That’s a critical point that ECRI Institute stresses in its new resource, The Alarm Safety Handbook: Strategies, Tools, and Guidance.
Why give alarm hazards so much attention?
For starters, they’re ubiquitous. The potential for alarm-related incidents leading to patient harm exists every minute of every day in virtually all healthcare facilities.
Second, alarm hazards put patients at risk. According to a 2009 analysis of the U.S. Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database, 566 alarm-related patient deaths were reported from 2005 through 2008. In its 2013 Sentinel Event Alert, the Joint Commission notes that industry experts believe this figure likely underrepresents the actual number of incidents.
Finally, alarm hazards are difficult to eliminate. Reducing clinical alarm hazards requires improving the manner in which alarms are managed—and that is a complex and lengthy process. In most hospitals, the number of alarms that will be active at any given time is staggering. And the optimal strategies for managing those alarms will vary from one care area to the next, and sometimes from one patient to the next.
With a concerted effort, however, healthcare facilities can make headway against this high-priority hazard. That’s the message that ECRI Institute conveys in its new resource, The Alarm Safety Handbook: Strategies, Tools, and Guidance.
Addressing clinical alarm hazards is not simply a matter of making sure that alarms are turned on or that the alarm volume is set appropriately. It requires a comprehensive alarm management program involving stakeholders from throughout the organization. The facility must dedicate long-term effort to developing and implementing the program, to assessing and refining its functionality, and to adapting the program to changing clinical practices and medical technologies.
Goals for an alarm management program will include both (1) minimizing the number of clinically insignificant or avoidable alarms so that the conditions that truly require attention can better be recognized and (2) optimizing alarm initiation, notification, and response protocols so that the patient receives the appropriate care at the time it’s needed.
ECRI Institute’s experience helping healthcare facilities achieve these goals has revealed that hospitals need to understand seven key points to find success:
1. Look beyond the technology. Recognize that alarm hazards are not just a technology problem—issues of organizational culture and processes must also be examined. Leadership must demonstrate a readiness to tackle the problem, and everyone involved must understand the full scope of the hazard.
2. Involve multiple departments. Address the problem through a coordinated, multidisciplinary effort. Lasting improvements cannot be achieved by departments acting in isolation; thus, a key early step will be to form a multidisciplinary alarm management team.
3. Understand your world of alarms. Invest the time to understand how alarms are used at your facility. A successful program will require identifying where your vulnerabilities lie and developing appropriate strategies to limit hazards. Activities that can help with this effort include:
• Observing how the many different alarms are handled in each care area. Much can be learned by walking around, observing what happens on the nursing floor, and engaging frontline staff about their concerns.
• Reviewing your reports of adverse events and near misses.
• Collecting and analyzing alarm data—for example, obtaining a measure of the number and types of alarms that activate per bed per day within a care area. The more data you can collect (and make sense of), the better you can target strategies to improve alarm management. However, even comparatively brief snapshots of data can yield useful information.
4. Don’t force “one-size-fits-all” solutions. Consider the needs of each care area individually. Although reducing clinical alarm hazards will require an organization-wide effort, the risks will vary from one care area to the next, and the solutions will need to be tailored to each area individually. That is, there is no one-size-fits-all answer. Numerous factors can play a role in whether alarms in a particular care area or for a particular device or patient will warrant attention, such as:
• Acuity of the patient
• Technologies being used in the treatment of the patient
• Technologies being used to communicate alarms
• Nurse-to-patient ratio
• Care model employed
• Architectural layout of the care area
5. Get input from staff. Involve frontline staff in identifying and implementing improvement strategies to help match the strategies to the needs of, and the workflow in, each clinical environment.
6. Evaluate, revise, refine. Assess the effect of the strategies that are implemented, and revise or refine the program as needed.
7. Promote your successes. Doing so can help staff see the value of any new approach and can keep the organization focused on this important patient safety program.
Many healthcare facilities find it helpful to contract with an independent organization to assess the culture and to bring together stakeholders from various departments to develop a coordinated, institution-wide strategy for improving the management of clinical alarms. Consulting organizations with experience in this area can direct you toward strategies that have been proven effective at other facilities.
ECRI Institute is one of several organizations that offers this kind of customized, on-site assistance. With a long history of evaluating alarm-equipped medical technologies, investigating incidents, and providing unbiased judgment, ECRI Institute is unique among the organizations that offer this kind of customized, on-site assistance. The Institute has worked with world-renowned healthcare facilities and health systems to identify their clinical alarm hazards, analyze current practices, and craft proven, practical alarm management strategies.
Additionally, The Alarm Safety Handbook: Strategies, Tools, and Guidance and its accompanying workbook provide guidance and tools to help hospitals create and refine their own alarm management programs.
This article is excerpted from ECRI Institute’s The Alarm Safety Handbook: Strategies, Tools, and Guidance. To purchase this resource and its accompanying workbook, or to learn more about ECRI Institute’s on-site alarm management safety review capabilities, visit www.ecri.org/alarmhandbook, contact firstname.lastname@example.org, or call (610) 825-6000, ext. 5889.
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