A National Online Survey on the Effectiveness of Clinical Alarms

Abstract

Purpose To develop a national online survey to be administered by the American College of Clinical Engineers Healthcare Technology Foundation to hospitals and healthcare workers to determine the problems associated with alarms in hospitals. Methods An online survey was developed by a 16-member task force representing professionals from clinical engineering, nursing, and technology to evaluate the reasons health-care workers do not respond to clinical alarms. Results A total of 1327 persons responded to the survey; most (94%) worked in acute care hospitals. About half of the respondents were registered nurses (51%), and one-third of respondents (31%) worked in a critical care unit. Most respondents (>90%) agreed or strongly agreed with the statements covering the purpose of clinical alarms and the need for prioritized and easily differentiated audible and visual alarms. Likewise, many respondents identified nuisance alarms as problematic; most agreed or strongly agreed that the alarms occur frequently (81%), disrupt patient care (77%), and can reduce trust in alarms and cause caregivers to disable them (78%). Conclusions Effective clinical alarm management relies on (1) equipment designs that promote appropriate use, (2) clinicians who take an active role in learning how to use equipment safely over its full range of capabilities, and (3) hospitals that recognize the complexities of managing clinical alarms and devote the necessary resources to develop effective management schemes.

An Evidence‐Based Approach to Reducing Cardiac Telemetry Alarm Fatigue

“…TJC's stance on alarm management and its issuance of subsequent patient safety alerts integrates step‐by‐step guidance for health care facilities to commence managing alarms in a methodical way. The first step highlighted in this alert, and supported by other research, encourages health care facilities to conduct alarm risk assessment utilizing an interdisciplinary alarm management committee (Korniewicz et al., ). Other necessary steps include creating an institutional policy addressing some of the following elements such as creating alarm setting and response protocols, only activating alarms that are actionable, and finally developing clinical competencies related to the effectiveness of clinical alarm systems.…”

“…Researchers reveal combining multiple parameters such as setting alarm delays and lowering threshold reduces the number of false‐positive alarms (Cvach, ; Konkani, Oakley, & Bauld, ). Scholars are also advocating for the design of “smart alarms” in which there is minimal loss of signal resulting in reduction of false alarms (Clark et al., ; Korniewicz et al., ). The recommended practice for all the stakeholders is the knowledge of workflow design and patient population of a microsystem prior to implementation of a device in that setting.…”

“…Other necessary steps include creating an institutional policy addressing some of the following elements such as creating alarm setting and response protocols, only activating alarms that are actionable, and finally developing clinical competencies related to the effectiveness of clinical alarm systems. Competencies related to clinical alarms includes, but are not limited to the role of alarms in signaling a significant change in a patient condition not just something generically abnormal, the role of alarm chaining where a more significant condition will override a lower level condition, and institutional policy regarding clinical alarm management (Clark et al., ; Cvach, ; Harris, Manavizadeh, McPherson, & Smith, ; Korniewicz et al., ; Vockley, ).…”

“…At the clinical level, nurses have decreased the number of nuisance alarms by: (a) being knowledgeable about the capacity of the telemetry alarm device, (b) receiving ongoing education in customizing and tailoring alarms, and (c) paying attention to best practices such as changing ECG electrodes daily (Cvach, ; Graham & Cvach, ; Vockley, ). There is a plethora of studies demonstrating a strong correlation between the frequency of false‐positive alarms and the number of alarm‐related patient incidents (Konkani et al., ; Korniewicz et al., ; Liu & Pecht, ; Welch, ).…”

“…Alarm fatigue among health care workers, especially nurses, poses a risk to patient safety. Ongoing research on adverse patient outcome continues to demonstrate a correlation between the frequency of false‐positive alarms and the number of alarm‐related incidents (Clark et al., ; Cvach, ; Graham & Cvach, ; Korniewicz, Clark, & David, ; Pergher & Silva, ). Clinical alarms, by design, are intended to promote quick patient assessment by alerting caregivers to a significant clinical event.…”