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August 24, 2015 Readers Write No Comments

Connecting Mobile Health and Alarm Safety Strategies: A Guide for Hospitals Managing Mobile Alarms and Alerts
By Mary Jahrsdoerfer, PhD, RN

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As The Joint Commission’s National Patient Safety Goal on alarm safety inches closer to the January 1, 2016 compliance deadline, hospitals are discovering that long-term, meaningful reductions in alarm-related patient safety risks extend beyond medical device alarms. Although hospitals can satisfy TJC’s alarm safety deadline by presenting a solid strategy for reducing medical device alarms alone, there is an implicit understanding that managing patient monitors and ventilators are only part of a much larger problem related to clinical interruption fatigue.

In addition to medical devices, a comprehensive clinical communications strategy also includes managing the alerts (nurse call, EHR, labs), text messages, and mobile phones/devices that care team members use to facilitate collaboration around any of these patient events. A hospital should certainly follow guidelines that advise changing monitoring leads more often, implementing patient-specific monitoring thresholds, and configuring alarm delays, but these clinical interruptions only target a subset of the overall problem.

Clinical interruptions occur when a nurse continues to receive alarms and alerts while performing a patient-related task that could have escalated to another available caregiver with an integrated platform. The interruption may be an actionable, or even a critical event, but it’s still an interruption if the recipient is unable to respond with the sense of urgency required. Nurses have described frightening scenarios where they were engaged in administering life-saving treatment for one patient while an urgent alarm for another patient blared in the background. This situation could have been easily avoided with automatic escalation of that alarm to the next available nurse.

Preventing alarm collisions requires a holistic approach to managing clinical communications that must necessarily include the full spectrum of patient events. The challenge is integrating each system in each unit without overwhelming clinical users. Assimilation requires collecting input from affected users, measuring alarm and alert activity, and ensuring the right workflow.

The Joint Commission has provided a starting point for hospitals that are serious about reducing alarm-related patient safety risks. Middleware is the foundation upon which medical device alarm management is built — hospitals must utilize an FDA-cleared platform to deliver alarms to recipients on mobile phones. A long-term alarm safety strategy includes integrating all of a hospital’s clinical systems, which will require planning beyond TJC’s NPSG deadline.

The overall goal of TJC’s alarm safety goal is to reduce medical errors as it relates to medical device alarms, but nurses realize that the broader issue of interruption fatigue is a consequence of many workflow and communication inefficiencies. My admonishment for hospitals grappling with the alarm safety mandate, HIPAA compliance through text messaging, nurse call and EHR alert management, and smartphone and mobile phone deployment is to view them as subsets of the same communication architecture that require a common foundation to solve.

Mary Jahrsdoerfer, PhD, RN is CNO at Extension Healthcare of Fort Wayne, IN.

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