Alerts versus Alarms – Not Just Semantics
By Brian McAlpine
We often hear references to “alerts” in the context of clinicians experiencing overload or becoming fatigued. For example, alert fatigue is a well-known problem whereby clinicians are constantly bombarded with multiple types of alerts, each designed to get their attention.
Alerts can come from many different sources, including the EMR/EHR, lab systems, CPOE, medication administration software, imaging systems, nurse call systems, and many other sources. Almost any system in the clinical environment can generate an alert.
For the purposes of limiting the scope of this discussion, let’s limit the definition of “alerts” to the patient care environment and direct patient care. Using this working definition, I would also say that a nurse’s phone that receives alerts or can process text messages can also generate alerts (i.e. via a beep or vibrate) that let the nurse know when a new message has arrived.
Recently there has been increasing industry discussion and focus on “alarms” and the problem of alarm fatigue. The Joint Commission’s NPSG06.01.01 has raised the awareness of this problem and now hospitals must start to pay close attention to which medical devices and corresponding alarms are contributors to alarm fatigue.
Both alerts and alarms interrupt the clinician and can be a source of distraction that leads to critical errors, so what’s the difference? There is a big difference, especially when provider organizations attempt to get their arms around these problems.
This is really a problem where healthcare as an industry needs to focus and prioritize what is most critical. When you look at the key differences between alerts and alarms, you can further appreciate why the Joint Commission has taken action for the second time in the last 10 years, the first time being here with the National Patient Safety goal for managing audible alarms.
Alarms are typically derived from medical devices and often communicate an immediate life-threatening patient condition. Think a v-fib or asystole alarm from a patient monitor. Alarms are always more time sensitive and a delay of a few seconds may matter to the safety of the patient. Another key characteristic of alarms is that they are almost always intended for nurses or respiratory therapists (i.e. non-physicians). Physicians do not deal with alarm response – that is for nursing to handle. Finally, alarms are always regulated by the FDA from both the medical device side (alarm generation) and from the perspective of an alarm management middleware. The FDA regulates the alarm management middleware vendors through the 510k process. As a result, only a few vendors can offer an alarm notification capability because of strict FDA 510k regulations.
But what about alerts and vendors that integrate alerts? Shouldn’t these be regulated just like alarms? The answer lies in the definition of alerts and the key differences as compared to alarms. Alerts are usually not associated with medical devices and are not immediately life threatening, but could be very serious. A big difference is that alerts are not always immediately time sensitive — a delay of 30 seconds or even several minutes often does not matter like it does with a patient monitoring alarm. In terms of who typically receives alerts, these can be intended for any clinician, and often physicians receive alerts generated by systems such as the EMR. Another major difference is that alerts are generally not regulated by the FDA like medical device alarms are.
Because of these differences, many vendors can (and do) offer an “alerting” capability. The barriers to developing an alerting or alert notification feature are simply a lot lower when compared to developing alarm management middleware. But what does this mean in practical terms to a hospital looking at the diverse set of vendors that blend alarms and alerts all together into one confusing message about what their solution is really capable of? One key way to cut through all the hype is to follow the Joint Commission’s lead and focus on medical device alarms as a key starting point.
The Joint Commission just recently released its R3 Rationale report in response to its NPSG.06.01.01 for alarm system safety. A key statement in this report outlines clinical alarms as being more critical and a higher threat to patient safety as compared to “alerts”. In fact, the report explicitly states that the NPSG does not address “items such as nurse call systems, alerts from computerized provider order entry (CPOE), or other information technology (IT) systems.” It is obvious that the Joint Commission thinks the best starting point is with an evaluation of medical device alarms.
This is clearly only the starting point because we have to go back to the bigger problem as stated at the beginning of this post . Alerts and alarms interrupt the nurse and increase potential for errors in the care environment. You have to start somewhere, and by starting with alarms, you can get a handle on addressing a very key issue. This will lead to a foundation and framework that will enable you to more effectively address the alerting problem in the future.
What do you think? Are alarms the right place to start?
Brian McAlpine is VP of product management and marketing at Extension Healthcare.