Wednesday, April 6, 2011

5 solutions to alarm fatigue in todays hospitals

When my wife had a baby the monitors kept not registering the baby's heartbeat and nobody seemed to care.  When they changed shifts and the new nurse came in to check the connections he instantly decided on an emergency C section.  This is a MAJOR problem.  This incident was a  perfect example of alarm fatigue. Was the equipment unreliable? Did nurses not have time to constantly adjust or readjust faulty equipment? How can we fix this problem?  Let me tell you 5 ways that can help:

1. Simpler monitors that are easier for even the patient to understand
Example - Fukuda Denshi Patient Monitors measure, record and display a patient’s vital signs, including heart rate, blood pressure and respiration. Patients most often wear simple measuring tools, such as blood pressure arm cuffs and oxygen finger clips, though the new system is also compatible with more invasive direct line equipment.

Even the colorful display screens are a help to staff, who report they can read data easily from the new monitors. The touch screen interface allows staff to quickly input or retrieve patient information. Since the system is networked, staff can check on a patient’s status from any of the monitors throughout the facility, from the operating room to the medical surgical wing to the emergency room. Respiratory department director Scott Briggs, CRT, says he appreciates that he can now keep track of patients throughout the hospital even while he works with individual patients in his office.

A network of remote transmitters and receivers allows patients to travel the entire length of the hospital with mobile monitors.

2. Create a secure phone app for the doctors and nurses
Imagine an iPhone app that allows nurses and doctors to see all of the patients info at a glance from anywhere they are.  They already have systems that integrate with the iPad or iPhone.  Create a custom app made just for hospitals to give every one access to anyone vitals at the touch of a button.

3. Create mobile based systems that begin reporting even when the ambulance is in transit
The Management of Fasmicro and Microscale Embedded are proud to announce that our Mobile-Based Integrated Heart Monitoring System will be ready by June 2011. This product will enable doctors and hospitals obtain heart beat or professionally ECG signals of patients remotely.  It will also monitor blood pressure, temperature and other medical data.

4. The use of wireless monitors to prevent cable disconnects:
In a paper written by Washinton University Departments titled: Reliable Clinical Monitoring using Wireless Sensor Networks: Experiences in a Step-down Hospital Unit, it revealed that the sensing reliability could be
significantly improved through oversampling and by implementing a disconnection alarm system that incurs minimal intervention cost. A retrospective data analysis indicated that the system provided sufficient temporal resolution to support the detection of clinical deterioration in three patients who suffered from significant clinical events including transfer to Intensive Care Units. These results indicate the feasibility and promise of using wireless sensor networks for continuous patient monitoring and clinical deterioration detection in general hospital units.

Collecting vital signs in general hospital units poses unique challenges that are poorly addressed by existing commercial telemetry systems. In contrast to cardiac or epilepsy care which require high data rate EKG, EEG, or acceleration measurements, the collection of vital signs1 requires low data rates.

In spite of the numerous patient monitoring systems that have been developed, they are seldom evaluated with real users and real-world deployment. The evaluation of most systems does not focus on reliability and is usually performed in laboratories rather than in healthcare environments. However, there are a few notable exceptions. The MEDiSN and SMART projects focus on monitoring patients waiting in emergency rooms.

5.  Reduce False Alarms
I think this is the biggest of all of them.  As stated in the medical article "Monitor Alarm Fatigue: Standardizing Use of Physiological Monitors and Decreasing Nuisance Alarms" the sheer number of false alarms desensitizes the staff to any alarm. Cardiac monitor algorithms are intentionally set for high sensitivity at the expense of specificity. As a result, numerous false alarms occur.

A 2006 American College of Clinical Engineering survey of more than 1300 health care professionals showed that a large percentage of respondents believed that what are commonly called “nuisance” alarms occur frequently (81%), disrupt patient care (77%), and can reduce trust in alarms, causing clinicians to disable them (78%). In other studies, researchers have reported a high percentage (86%–99.4%) of false-positive alarms produced by physiological monitors, stating that alarms result in a change in the management of the patient less than 1% of the time.

Nurses in intensive care units stated that the primary problem with alarms is that they are continuously going off and that the largest contributor to the number of false alarms in intensive care units is the pulse oximetry alarm. “Smart alarms,” which analyze multiple parameter changes in a patient’s condition, may be a solution, but not all monitors currently in use have such features.

false medical alarm
False flatline Medical Alarm

If you want to learn more about the background of alarm fatigue click here at "A Patriotic Nurse".


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