Some say hospital alarms could do more harm than good (+video)

Beeps and buzzes are commonplace in hospitals.

But some analysts say constant noise from medical equipment, hospital beds and other technology could do more harm than good: it creates problems for patients who need silence to heal and alarm fatigue for nurses and doctors.

When nurses and doctors respond to tedious and repetitive alarms, they could miss life-threatening alarms if they’re preoccupied or become immune to the sound.

“There’s too many alarms, and it’s just not reasonable to ask a nurse to respond to all this,” said Sam Larson, vice president of marketing for Bernoulli, a hospital alarm consulting company that researched alarms at Wesley Medical Center.

Hospitals across the nation and here in Wichita are trying to quiet some of the noises that run through hospital rooms, hallways and workstations.

The trend

Numerous health care organizations have highlighted hospital alarms as a top safety hazard in the medical industry.

An accreditation group called The Joint Commission, which certifies both Wesley Medical Center and Via Christi Hospitals, will require hospitals to address alarms for 2016 accreditation.

The section about alarm systems in the accreditation booklet doesn’t include specific standards about how many alarms should or shouldn’t go off in each hospital. Instead, it offers broad guidelines about alarm policies for hospitals.

It also says hospitals should evaluate and document patient safety associated with various alarms, including malfunction risks and who receives notification for each alarm.

The 2016 accreditation book describes the problem as multifaceted: some alarms are hard to hear while others are missed because staff becomes immune to the sound.

The commission says that without proper management, alarms could harm patients rather than help them.

The group issued an alert about hospital alarms two years ago and estimated between 85 percent and 99 percent of alarm signals did not indicate that the patient needed immediate medical attention.

A national independent nonprofit called ECRI Institute, formerly called the Emergency Care Research Institute, also highlighted alarms as the number one safety hazard for four straight years. Alarm hazards ranked second on the list for 2016.

Solutions

Research groups and health nonprofits have identified some ways for hospitals to manage alarms: reset medical devices, assess the risks of malfunction and reroute alarms to more specific departments.

Among the suggestions:

▪ Some medical devices alarm or beep, even when the patient doesn’t require medical attention. That could happen if the threshold for an alarm is set too low. If devices come calibrated for a healthy person, the nurse might need to widen the threshold for a sick patient.

“It may be something nice to know, and from a technical standpoint, may have some interest,” Larson, of Bernoulli, said about non-critical beeps. “But from a clinical standpoint, they aren’t going to do anything with the information.”

Nurses also can set the volume lower for alarms that don’t require immediate attention and set more crucial alarms louder to help prioritize calls.

▪ To lessen the burden on nurses, hospitals can reroute alarms to the most direct department to which it pertains.

For example, an alarm could sound if Wi-Fi disconnects for a short period of time. That alarm could route directly to the technology department, rather than to the nurse station, which would re-direct the call.

Safety

At their core, alarms were created to keep patients safe, so the idea of fewer alarms being safer might seem counterintuitive. But Larson says that’s just the case.

“You’re having more recognition of true events as opposed to things that are non-actionable events,” he said.

Larson said that one medical device might have several alarms on it, so when all are added together in a patient’s room, the noise becomes chaotic.

He said medical companies set alarms for the specific equipment they make, not the overall hospital environment.

“They (hospital staff) get overwhelmed and then they have to make a judgment call of, ‘what do I really need to respond to?’ ” Larson said.

Wesley Medical Center

Bernoulli studied Wesley Medical Center’s alarms and found that more than 10,000 alarms went off each day.

Wesley said it was not sure if it was going to use Bernoulli’s methods.

“It’s too early for us to know whether there’s going to be a long-term advantage for us to move forward with it or not,” said Joyce Soule, chief nursing officer for Wesley Medical Center.

The hospital is looking for other ways to address alarms.

Wesley has a hospital alarm committee staffed by people who work in a variety of hospital departments. The committee’s job is to draft policy recommendations about how to manage alarms.

Soule also highlighted a new nurse call system Wesley has implemented in its various medical campuses. The call system prioritizes and organizes the different signals that go off in a patient’s room, so alarms go to the right staff at the right time.

Via Christi Hospitals

Via Christi also formed an interdisciplinary committee to evaluate hospital alarms after the Joint Commission released its alarm safety alert in 2013.

Erin Erb, director of quality management and the systems patient safety officer for Via Christi, said the committee worked with direct-care staff to identify which alarms needed to sound, and which could be softened or shut off.

“No one ever wants to be the nurse or clinician that misses an alarm,” she said.

Via Christi also started a project called Silence Helps Healing that aims to reduce the overall noise in hospitals. It stretches beyond alarms and includes any hospital noise: squeaky wheels, the rumble of medical carts or beds, hallway traffic or any other sounds in hospitals.

Carolyn Koehn, director of safety and emergency management for Via Christi who oversees the project, said Via Christi changed its construction standards to make hospitals quieter. For example, it is putting carpet in hallways to absorb sound and distributing workstations around units to avoid noisy, centralized nurse stations.

She also said Via Christi tightened its policies for overhead announcements, limited unnecessary hall runs and errands during the evening and made it easier for employees to report squeaky wheels or other equipment sounds.

“If it’s quieter and an alarm goes off you pay more attention,” she said.

She said the idea for the project came from comments on patient satisfaction surveys.

“We did tend to think of this as our workplace, and that’s when we realized we had to change how we operated,” she said.

She added: “What this comes down to is really changing our culture.”

The future

Larson, from Bernoulli, said he sees predictive analytics as the future of alarm management.

“An alarm, in reality, is a historical event,” he said. “Even though you may get notified as soon as it occurs, it’s something that’s already happened and is something you didn’t want to happen.”

If a hospital compares a patient’s alarm data to historical data about similar patients, the findings could be used to prevent an event from occurring, he said.

“The best care happens when you can recognize when a patient is deteriorating before you have to rescue them,” he said.

This story was originally published December 11, 2015 at 7:27 PM with the headline "Some say hospital alarms could do more harm than good (+video) ."