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Advisory Panel: Alarm Fatigue

January 1, 2014 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Is your organization using or considering IT solutions to the challenge of alarm fatigue?

Note that while I was thinking specifically of physiologic alarms at the bedside, I didn’t state that explicitly, so some answers reflect clinical alerts in traditional IT systems. Seven responses indicated a “no” answer with no IT solutions being considered.

We struggle to balance harm prevention and user design.  We are biased toward harm prevention.

We haven’t found a good solution yet. We’re looked at things like alarms that start out low and increase in volume if not addressed, but many/most vendors haven’t embraced that idea yet. We’re looking at routing alarms to phones, but that also has challenges. If you find a good solution, let me know.

We are currently considering a few IT solutions to address this, but no decision has been made to move forward.

We are currently investigating tools to consolidate alarm management but we have not yet developed an RFP or even a vision for the future.

We are currently investigating and likely to pilot a solution to integrate nurse call bells into nursing phones to improve the alarm fatigue of the ears. In the EHR environment, we are continually analyzing the alerts that fire for their utility, appropriateness, and actionability and working to reduce those that are more "noise" than "signal".

Alarm fatigue happens when the technology was not supportive of the end user – it should not exist if each vendor really knew the topic and client being served.

We have explored alarm management systems, but I was left with the realization that the devices can alarm on anything and it’s up to each organization to determine what’s important. I am not aware of any national standards.

We learned early on to be very judicious with alarms and try and keep them to a minimum. As we’ve merged in some additional physician groups, the governance of managing alerts will get increasingly interesting however. I’d be curious what type of IT helps with alarm fatigue (i.e. do they make alarms more sensitive/specific somehow?)

I wish !!! Turning off the drug duplicate alerts would be like manna from heaven as they are invariably uninformative and annoying. For example, renewing a drug always gives a duplicate alert even though the system obviously knows that if you click "Renew" it will automatically stop the current order and start the new one. But the current order is still active when the system compares the new order to the med list. Ergo, duplicate alerts gone wild. One of my other favorite alerts tells me that the patient is taking two non-phenothiazine antipsychotics.  If I was really concerned about duplication, I would want to know if they were taking two antipsychotics period. Whether it’s a non-phenothiazine makes no difference whatsoever.

Primarily focused on refining medication alert rules to reduce unnecessary noise.

I assume you are talking about actual alarms, vents and IVs and tube feeding pumps and such, not EMR alerts. Since noise levels can exceed OSHA standards 80 percent of the time in an ICU, we are keenly interested in the twin problems of noise from alerts and the false positive / false negative rates of the alerts. We do not have a good answer, but I would be happy to buy one that worked.

We’re still trying to reliably deliver secondary alerting. Alarm fatigue getting some notice, but no definite intervention as of yet.

Yes, considering FDB AlertSpace to achieve what should be included in their product in the first place (we’re on Epic/FDB).

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Currently there is "1 comment" on this Article:

  1. At our facility, alarms, specifically phone alarms are a huge concern in the NICU where I practice. The alarms for desaturation events and bradycardia events come to the phones we carry. The alarms are not smart enough yet to pick up that the infant may have self-resolved the brief dip, and the RN must stop what he or she is doing to hit six different buttons quickly to prevent the alarm from escalating to two other people (buddy RN and charge RN). We need a remote alarm system, as are infants are in private rooms and the RN cannot be two places at once, but the issues with pressing so many buttons so often is on the top of the list of alarm fatigue issues. Our managers are currently looking into different solutions, but have not yet found suitable replacements.

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