Alarm management becomes an NPSG
First phase starts in January
Just about everyone agrees that alarm management is a big issue in healthcare. HPR covered the topic of alarm fatigue earlier this year. (See "Alarm management gets renewed focus, HPR April 2013, page 39.) The sense that it is an important and increasing problem has put the topic on The Joint Commission’s radar, which has put alarm management on its list of national patient safety goals. Beginning in January, hospitals are required to establish alarm management as an organizational priority and figure out what alarms are most in need of management for the specific accredited facility. That list must be based on input from medical staff and clinical departments; the risk to patients if an alarm is ignored or malfunctions; whether specific signals are required or simply add to noise and the creation of alarm fatigue; the potential for harm based on the facility’s history of incidents related to alarm management; and published guidelines.
Phase II of the goal, which starts two years later, requires hospitals to develop and implement policies and procedures related to alarm management that address when alarms can be disabled, when parameters for alarms can be changed, who can change those parameters or turn the alarms completely off, which clinical settings are appropriate for alarm signals, alarm monitoring and response, and making sure individual alarms are appropriately set and operate as they should.
In that second phase, hospitals will also have to demonstrate that staff and independent practitioners are educated about how to properly operate alarm systems they use and for which they are responsible.
"This is a high priority now," says Vladimir Cadet, MPH, an associate with the applied solutions group at ECRI in Plymouth Meeting, PA, who works with hospitals on alarm management reviews and policies.
He suggests starting with a multidisciplinary team of stakeholders — frontline staff, patient safety, clinical engineering, clinical staff, IT, and leadership. Ask them what they think is right and wrong with the alarm systems now in place. "That will give you a true perspective on the problem so you can develop an action plan."
Getting a cross-department team in place will also help prevent people from developing workarounds, which are often the result of one person being in charge of alarm management, he says. If a single person is the dumping ground for all the alarm fatigue complaints, that person may be tempted to just shut some of the most problematic alarms off. That is not the solution. "Getting everyone’s input is the basis for making this everyone’s responsibility."
After you create a team, Cadet says to analyze the current system, or hire an objective party to do so. Identify your patient safety vulnerabilities and measure incidents where possible (like the number of false alarms or complaints about noise in patient surveys) and find strategies to address those risks. It might be checklists, more education, or different technologies altogether. Once you create potential solutions, educate the stakeholders about the policies and procedures and start measuring changes in problematical alarm issues you identified previously.
One thing Cadet says you shouldn’t do is copy what another hospital does as if it has the template for success. The Joint Commission notes in its announcement of the new patient safety goal that there is no one path to successfully managing alarms. Cadet says what works for Dartmouth or Johns Hopkins may work great for them, but not for everyone. A 100-bed community hospital will have a different set of problems and solutions than a large academic medical center. Even within a class of hospitals, different things will work for different organizations. A 32-bed ICU where each nurse has two patients will likewise have different problems and solutions than a 12-bed ICU where every nurse cares for a single patient. Drilling down further, what works on one unit in your hospital may not be appropriate in another. Don’t create a template and try to implement the same thing everywhere.
For more information on this topic, contact Vladimir Cadet, MPH, Associate, Applied Solutions Group, ECRI, Plymouth Meeting, PA. Telephone: (610) 825-6000.