Reducing Hospital Noise: A Review of Medical Device Alarm Management

Abstract

Increasing noise in hospital environments, especially in intensive care units (ICUs) and operating rooms (ORs), has created a formidable challenge for both patients and hospital staff. A major contributing factor for the increasing noise levels in these environments is the number of false alarms generated by medical devices. This study focuses on discovering best practices for reducing the number of false clinical alarms in order to increase patient safety and provide a quiet environment for both work and healing. The researchers reviewed Pub Med, Web of Knowledge and Google Scholar sources to obtain original journal research and review articles published through January 2012. This review includes 27 critically important journal articles that address different aspects of medical device alarms management, including the audibility, identification, urgency mapping, and response time of nursing staff and different solutions to such problems. With current technology, the easiest and most direct method for reducing false alarms is to individualize alarm settings for each patient's condition. Promoting an institutional culture change that emphasizes the importance of individualization of alarms is therefore an important goal. Future research should also focus on the development of smart alarms.

Fatores que interferem na resposta dos enfermeiros na monitorização dos alarmes clínicos

“…A high number of false alarms is often observed and they contribute to desensitization, lack of reliability, and lack of response from professional caregivers (Cvach (3) , citing Lawless). Studies support the idea that the increase in the number of alarms reduces "faith" of healthcare professionals in alarms, at the same time it increases the noise level in the hospital environment (15) . The study by Gazarian (14) showed that practices of nurses regarding the management of alarms is an area with significant weaknesses.…”

“…Reducing hospital noise: a review of medical device alarm management (15) 2012 USA Systematic literature review 27 articles…”

“…The review by Konkani et al (15) mentions a study by Sengpiel in 2011, which showed that the sound of most equipment alarms ranges in the interval of 60 to 70 dB and some exceed 80 dB -the equivalent to the sound heard from 25 meters of a busy freeway.…”

“…Nurses have to distinguish and correctly identify which equipment is generating the alarm (source), with regard to each specific alarm and its urgency. All these aspects must be considered by equipment manufacturers for their standardization, thus making them more effective and universal among manufacturers (15) . The IEC 60601-1-8 standard that manufacturers must follow, regarding the sound and function of alarms, suggests simple and melodic alarm sounds that enable the distinction of eight different alarm sources (meeting the ability of humans in distinguishing from 5 to 7 categories of sound) and their classification as high-, medium-or low-priority (17) .…”

Nurses Perceptions of Pediatric Intensive Care Unit Environment and Work Experience After Transition to Single-Patient Rooms

“…33 Therefore, quality improvement initiatives to individualize alarm thresholds and minimize false alarms are crucial to optimize the balance between patient safety and a healing ICU environment, while simultaneously decreasing nurses' stress. [34][35][36][37] Similarly, the institution of nighttime quiet hours both in patient rooms and general areas can change culture and minimize sound due to staff conversations, enabling adherence to recommendations 2 of the World Health Organization that sound levels should be no more than 30 dB at night. However, current evidence suggests that most PICUs internationally do not have either noise or light optimization protocols in place for sleep promotion.…”