Alarm Management Strategies

Alarm Management Strategies to Achieve National Patient Safety Goal Compliance

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The problem of alarm management has become so widespread that as of December 2013, The Joint Commission introduced it as a National Patient Safety Goal (NPSG). The Joint Commission now requires its accredited hospitals to improve their alarm systems, aiming to alleviate the constant barrage of bells and whistles that are often the hallmark of a hospital stay for patients and that contribute to alarm fatigue for healthcare workers. With alarms poised in first place on ECRI’s “Top 10 Health Technology Hazards” list for the fourth consecutive year, the issue of alarm management is one that is critical to patient safety for healthcare organizations.

Halfway to the Goal

 

The Joint Commission has previously addressed the issue of alarms with a Sentinel Event Alert in 2013 and most recently with a 2014 update to the NPSG, previously in effect in 2003 and 2004. The second phase of implementing this updated NPSG begins on January 1, 2016, by which time healthcare organizations must apply policies and procedures on alarm management to ensure alarm solutions are in place and are functioning. The NPSG also requires that healthcare organizations educate their staff and licensed independent practitioners on the purpose and the correct operation of their current alarm systems.

 

In 2014, organizations established alarm system safety as an organizational priority, identifying and prioritizing alarm signals that are most important to manage. With the second phase of the compliance approaching, some hospitals are faring better than others, says JoAnne Phillips, MSN, RN, CPPS, Manager of Quality and Patient Safety Penn Care at Home, who has twelve years of alarm management experience under her belt.

 

“While some hospitals are forerunners, others are struggling a little and are further behind than I thought they would be," Phillips states. 

 

Clinical alarms are in place to alert and activate staff to high-risk situations; however, they aren’t without their caveats. Technical hospital environments house an overwhelming number of alarming devices – and more doesn’t always equate to better.

 

Compromises in the process result in desensitization, alarm fatigue, decreased patient and staff satisfaction and ultimately a gap in patient safety. “Assessing risk means identifying the most important alarms to manage. If an alarm isn’t attended to or if it malfunctions, that creates risk for patients,” states Carr; improving patient safety is at the heart of The Joint Commission’s NPSGs.

 

Physiological alarms are a bulky issue for organizations to wrap their arms around; identifying current alarm systems, running diagnostics and successfully extracting data can be a daunting job, and hospitals have reported difficulties “retrieving data from alarms; sometimes it has to be a manual process,” states Maureen Carr, Project Director in the Department of Standards and Survey Methods at The Joint Commission, and data can’t drive clinical change when it’s inaccessible.

 

“Part of process improvement is being able to measure your successes and that’s hard to do when people aren’t understanding the breadth of the problem – such as where they get their data from,” says JoAnne Phillips.

The Proper Approach

 

The Joint Commission’s NPSGs provide organizations with the opportunity to design their own systems and processes that meet the intent of the NPSG, best fitting their individual needs. Organizations such as The Association for the Advancement of Medical Instrumentation (AAMI) and ECRI Institute also have used their specific expertise to develop alarm-related resources in an effort to improve patient safety and quality of care.

 

“Hospitals really need to have clinical engineering, IT, nursing and the provider partnership before they can move forward,” states JoAnne Phillips, who, in addition to her clinical roles, also has made valuable contributions to the development of training and information resources used on the Alarm Fatigue Task Force, including work on The National Association of Clinical Nurse Specialists (NACNS) Toolkit.

 

“Developing a work plan enables organizations to concretely show not only what they’ve completed, but also how it meets the elements of performance,” states Phillips. A thorough failure mode and effects analysis will detect the high-risk equipment, providing objective information for The Joint Commission, she explains.

The Joint Commission Compliance

 

Joint Commission accredited hospitals must be in full compliance with these new requirements on January 1, 2016 to maintain accreditation, or a “requirement for improvement” will be issued, says The Joint Commission’s Maureen Carr. NPSGs are applicable to Joint Commission accredited organizations only.

 

Some hospitals have been addressing these issues prior to The Joint Commission’s initiative, according to Carr. Children’s Hospital Los Angeles (CHLA) happens to be one of them. “We began looking at what we monitor, our organizational parameters and what the nurses can adjust to the patient about two years before The Joint Commission came up with the NPSG," says Nancy Blake, PhD, RN, CCRN, NEA-BC, FAAN, Director of Critical Care Services at CHLA, in Los Angeles, California.

 

Blake explains that the NPSG is bringing all of the players to the table; The Joint Commission has effectively “promoted teamwork rather than working in silos. At our hospital we’ve worked together with biomed for ten years to improve patient safety and outcomes.” With attention focused on the details, benefits will be seen in patient satisfaction and safety, and perhaps a positive reflection in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) scores, as well.

Joint Commission accredited hospitals must be in full compliance with these new requirements on January 1, 2016 to maintain accreditation, or a “requirement for improvement” will be issued, says The Joint Commission’s Maureen Carr. NPSGs are applicable to Joint Commission accredited organizations only.

 

Some hospitals have been addressing these issues prior to The Joint Commission’s initiative, according to Carr. Children’s Hospital Los Angeles (CHLA) happens to be one of them. We began looking at what we monitor, our organizational parameters and what the nurses can adjust to the patient about two years before The Joint Commission came up with the NPSG," says Nancy Blake, PhD, RN, CCRN, NEA-BC, FAAN, Director of Critical Care Services at CHLA, in Los Angeles, California.

Joint Commission accredited hospitals must be in full compliance with these new requirements on January 1, 2016 to maintain accreditation, or a “requirement for improvement” will be issued, says The Joint Commission’s Maureen Carr. NPSGs are applicable to Joint Commission accredited organizations only.

 

Some hospitals have been addressing these issues prior to The Joint Commission’s initiative, according to Carr. Children’s Hospital Los Angeles (CHLA) happens to be one of them. We began looking at what we monitor, our organizational parameters and what the nurses can adjust to the patient about two years before The Joint Commission came up with the NPSG," says Nancy Blake, PhD, RN, CCRN, NEA-BC, FAAN, Director of Critical Care Services at CHLA, in Los Angeles, California.

Bridging the Gaps

 

Alarm issues are multi-factorial, even within the same organization. It’s vitally important to “look at the patient population and human factors. The Joint Commission asks organizations to look back at incidents to see if there’s any way we could have done better - children’s facilities look at quality and we’re always striving to do better, looking to see if there’s something we can change,” Blake states.

 

According to Blake, the best decision making occurs when end users are engaged in alarm committees. “They’ll bring up those outliers that you need to have included in your policies and help develop a work flow for the current environment," Blake says.

 

Blake, in conjunction with Cincinnati, John Hopkins, Stanford and Philadelphia Children’s Hospitals will be doing research on pediatric alarms. “All of the data and research has been done on adults; we’re hoping to replicate a study to see how children’s hospitals are different,” states Blake.

The Future of Alarms

 

The future role of alarms in the hospital setting continues to evolve in innovative ways. Perhaps we should start thinking “more individually” about patients instead of everyone defaulting to the same parameters when we’re looking at reducing alarm fatigue, suggests JoAnne Phillips, pointing out that default settings are merely “starting points”.

 

Nancy Blake's work on the AAMI National Alarms Coalition and Alarm Standards Committee, includes a future focus on melding “the nurse mental model with the biomed mental model” and carrying this forward through product development and manufacturing. The U.S. Food and Drug Administration (FDA) also has a presence on AAMI, ensuring standards are current and meeting the needs of patients and providers alike; by analyzing alarm standards, the FDA could potentially decrease false or inactionable alarming issues and play a role in improving patient safety, according to Blake.

 

Alarm Management is a complex process that requires a multifaceted and on-going strategy to be successful. Achieving the Elements of Performance identified in The Joint Commission’s National Patient Safety Goal on Clinical Alarms provides a foundation that can be expanded upon through the use of both innovative and published best practices in order to reduce non-actionable alarms and enhance patient safety.