Print “PDF version”

What’s New in the Patient Safety World

September 2019

Alarm Fatigue in the Emergency Room

 

 

We’ve done many columns on alarm fatigue and alarm management (see full list below) but the focus has been in ICU’s, med/surg units, and the OR. One venue largely ignored has been the emergency room.

 

Now a new study (Fleischman 2019) has analyzed alarms in the emergency department and confirmed that, like in all other venues, many alarms are clinically irrelevant and only contribute to the problem of alarm fatigue. The study was based on 53 hours of observation by an ED physician and recorded patient characteristics, alarm type, staff response, whether the alarm was likely real or false, and whether it changed clinical management. There was a median of 18 alarms per hour of observation, and the median number of alarms per patient was 4. Amazingly, alarms changed clinical management in only 8 out of 1049 observed alarms (0.8%) and in 5 out of the 146 patients (3%). Moreover, staff did not observably respond to most alarms (63%).

 

The authors suggest that efforts at improving the clinical significance of alarms could focus on widening alarm thresholds, customizing alarms parameters for patients' clinical status, and on utilizing monitoring more selectively.

 

 

Prior Patient Safety Tips of the Week pertaining to alarm-related issues:

 

• March 5, 2007 “Disabled Alarms”
• March 26, 2007 “Alarms Should Point to the Problem”
• April 2, 2007 “More Alarm Issues”
• June 19, 2007 “Unintended Consequences of Technological Solutons”
• April 1, 2008 “Pennsylvania PSA’s FMEA on Telemetry Alarm Interventions”
• February 23, 2010 “Alarm Issues in the News Again”
• March 2, 2010 “Alarm Sensitivity: Early Detection vs. Alarm Fatigue”
• March 16, 2010 “A Patient Safety Scavenger Hunt”
• November 2010 “Alarms in the Operating Room”
• February 22, 2011 “Rethinking Alarms”
• February 2013 “Joint Commission Proposes New 2014 National Patient Safety Goal”
• May 2013 “Joint Commission Sentinel Event Alert: Alarm Safety”
• July 2, 2013 “Issues in Alarm Management”
• August 2013 “Joint Commission Formalizes 2014 NPSG on Alarm Management”
• February 4, 2014 “But What If the Battery Runs Low?”
• October 2014 “Alarm Fatigue: Reducing Unnecessary Telemetry Monitoring”
• December 15, 2015 “Vital Sign Monitoring at Night”
• February 9, 2016 “It was just a matter of time…”
• August 16, 2016 “How Is Your Alarm Management Initiative Going?”
• February 21, 2017 “Alarm Fatigue in the ED”
• April 18, 2017 “Alarm Response and Nurse Shift Duration”
• April 25, 2017 “Dialysis and Alarm Fatigue”
• October 17, 2017 “Progress on Alarm Management”
• November 21, 2017 “OSA, Oxygen, and Alarm Fatigue”
• May 1 2018  “Refrigerator Alarms”
• April 16, 2019 “AACN Practice Alert on Alarm Management”

 

 

References:

 

 

Fleischman, William et al. Emergency department monitor alarms rarely change clinical management: An observational study. The American Journal of Emergency Medicine 2019; Published online July 30, 2019

https://www.ajemjournal.com/article/S0735-6757(19)30500-5/fulltext

 

 

 

“PDF version”

 

 

 

 

http://www.patientsafetysolutions.com/

 

Home

 

Tip of the Week Archive

 

What’s New in the Patient Safety World Archive