Monitor Alarms & Patient Safety

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Some groups believe that "alarm fatigue" is a "top patient safety concern." They define alarm fatigue as "clinicians becoming desensitized to the constant noise ... or overwhelmed by the sounds and turning alarms down or off."

The Joint Commission believes there is a problem with alarms and issued a National Patient Safety Goal which went into affect the first of January, 2014. Basically, the Joint Commission is requiring that hospitals "improve the safety of their clinical alarm systems." This is important to anesthesia because hospitals will probably enact policies anesthesia is required to follow. These new policies will go into effect by January 1, 2016 and likely include sanctions if they are not followed. Unfortunately, alarm policies usually apply most directly to locations where a professional provider isn't standing right next the the equipment like we are in the OR. Alarms are often intended to call a provider to check on whatever is being monitored. If you don't want to be ruled by alarm policies intended for the masses in the rest of the hospital now is the time to become involved in the development of policies on alarms. The Joint Commission requires that there be input on these policies from, "medical staff and clinical departments." The complete Joint Commission R3 Report on alarm safety is only about 2.5 pages long and available online.

This is important to anesthesia because hospitals will probably enact policies anesthesia is required to follow.

Fierce Healthcare has reported that there are an average of 350 alarms per ICU patient per day. Missing from this discussion is how many of those alarms were clinically important and how many were nuisance alarms. Also not considered were how the alarms were set. Were they set based upon perceived institutional liability if there wasn't an alarm, or were alarms set in ways that alerted clinicians about things they needed to know? In a Boston University study resetting the alarm limits for HR to limits defined as a "clinical crisis" reduced alarms by 89% without any harm to patients. (J Cardiovasc Nurs. 2013 Dec 19. [Epub ahead of print].) In the OR with an anesthesia provider continuously attending to each patient some would argue that alarms can and should be set even more conservatively - and alarm much more quietly.