Strategies for Managing Smart Pump Alarm and Alert Fatigue: A Narrative Review

Abstract

Although smart infusion pumps are intended to prevent medication errors by alerting users about doses that exceed set thresholds, a large number of clinically insignificant alarms and alerts create the potential for alert and alarm fatigue. We searched the PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for peer-reviewed literature (January 1, 2004-August 31, 2017) on managing smart pump alerts, alarms, and related fatigue. Twenty-nine articles that met the inclusion criteria were reviewed and organized into themes. Smart pumps give users two types of signals: alarms that indicate mechanical issues such as occlusion, air in the line, or low battery; and clinical alerts that indicate that a programmed dose exceeds a predefined safety limit. Mechanical alarms occur with greater frequency than clinical alerts, but alarms and alerts vary widely by pump model, patient population, time of day, month, and type of drug. Several causes of clinically insignificant alerts and alarms may be actionable, and strategies proposed in the literature include development of a multidisciplinary team to oversee the quality improvement effort with involvement of end users, standardization of medication administration practices, widening of drug limit library thresholds when clinically appropriate, maintaining up-to-date drug limit libraries, and interoperability. Whereas many strategies have been proposed, and case studies have been reported, none have been rigorously evaluated. In addition, more research is needed related to managing occlusion and air-in-line alarms, especially for complicated infusions. Future work should focus on the evaluation of specific and replicable alert and alarm reduction strategies with a greater emphasis on quantitative metrics.

Integrating and Evaluating the Data Quality and Utility of Smart Pump Information in Detecting Medication Administration Errors: Evaluation Study

“…Methods that require less device programming, such as the use of barcode scanning pumps, may help reduce pump programming and patient identification errors. Although closed-loop systems have been implemented in several institutions as another method to address these concerns, there have been issues with titration of medications and specific error types remain unmitigated [ 22 - 24 ]. As such, efforts must focus on ways to utilize medication use information from smart pumps to recognize and address errors as quickly as possible.…”

The Effect of Alarm Fatigue Nursing Management Protocol on Critical Care Nurses' Experience

“…Scoring system: The scores gained per stride was summed up to acquire the total maximum (69) pro CCNs' perception. The overall score of CCNs' perception was deliberated and categorized like this: 75%and more were reflected satisfactory, less than 75% were considered unsatisfactory Tool II: "Critical Care Nurses' Alarm Fatigue Practice Checklists" This tool was developed by the researcher when studying related literature to assess CCNs' practices regarding alarm fatigue nursing management in the medical field (American Association of Critical-Care Nurses, 2013, Aysha, & Ahmed, 2019, Srinivasa, Mankoo, & Kerr, 2017, Lewis & Oster, 2019, Shah, Irizarry & O'Neill, 2018, Vitoux, Schuster & Glover, 2018. This tool casing six special items as following: accurate ECG electrodes skin preparation, adjust settings on oxygen saturation using pulse oximetry, customize alarm parameters on cardiac monitors, infusion pump troubleshooting alarm, ventilator troubleshooting alarms, and ASSET mnemonic (Solet & Barach, 2012).…”

Simulation and Patient Safety: Continuing to Provide Evidence

“…Patient safety is a concern for all health disciplines. To address patient safety concerns, a wide variety of strategies have been implemented, including smart pump alerts (Shah, Irizarry, & O'Neill, 2018), triggers in electronic medical records (Patterson, Anders, & Moffat-Bruce, 2017), and surgical checklists to mention a few (Haynes, Weiser & Berry, 2011). Although these and other similar strategies have been widely used, they have demonstrated inconsistent improvements in patient safety (deJager, McKenna, Bartlett, Gunnarsson, & Ho, 2016).…”