AAMI: Alarm management survey shows little progress in last six years
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Based on a review of literature, J. Tobey Clark, director of instrumentation and technical services at the University of Vermont in Burlington, Vt., noted that alarms have been recognized as a “significant problem area for many years,” specifically referencing the 1974 ECRI Institute hazard report on the topic.
Since that time, researchers in the field have come to learn two important lessons:
- Humans cannot learn more than six alarm sounds and after that, it is difficult to discern the proper priority; and
- False alarms may be the most serious shortcoming, and may lead to the disabling of an alarm system.
“These two factors are fairly evident for anyone in today’s clinical practice,” said Clark.
The FDA MAUDE database has revealed that monitoring devices are the biggest offenders of faulty alarms (at nearly 100), followed by ventilators (30) at a distant second and IV pumps (11) coming in third.
In an attempt to pinpoint the main alarm management concerns, the 2006 National Clinical Alarms survey, which garnered 1,327 responders—more than half of which were registered nurses—found the biggest issue was false alarms and nuisance alarms because they reduce attention and response, as well as disrupt care and reduce trust in alarms.
Based on these results, there were four areas designated as having room for improvement with alarms: design, care management, environmental and clinical engineering. Clinical engineering was tasked with evaluating purchased items for useability, testing alarms in their environment and software setup/testing.
In 2011, Clark and colleagues conducted another national survey on alarms, which this time garnered 4,278 responders, 93 percent of whom were part of the clinical staff. The 2011 survey was sponsored by AAMI, the American College of Clinical Engineering, Philips Healthcare and the Healthcare Technology Foundation. Clark is president of the nonprofit foundation.
From within the provider setting, the largest number of respondents came from the intensive care unit (1,569), with the respiratory department as the unit with second highest number of responders with less than half (700). The clinical engineering department had the fourth highest number of responders at 214.
“There was a clear difference between the 2006 survey and the 2011 survey about the number of responders who were respiratory therapists,” which was 2,071 in the 2011, Clark pointed out. Also, 1,324 registered nurses responded, which is almost the same as the total response in the previous survey, he added, as well as 276 clinical managers and 124 biomedical engineers in the more recent survey.
In general, more experienced staff responded to the 2011 survey with an increase in experience level for more than 11 years—65.8 percent in 2006 and 78.8 percent in 2011.
Nuisance alarms were again defined as the biggest problem, according to Clark, with 75.5 percent either strongly agreeing or agreeing. More than 55.6 percent of those surveyed agreed or strongly agreed that alarm management would improve if they were integrated with pagers, cellphones and other wireless devices. Finally, 77.9 percent of the respondents agree or strongly agree that smart alarms (where multiple parameters, rate of change of parameters and signal quality are automatically assessed in their entirety) would be effective in reducing false alarms.
“The good news between the two surveys is that the nuisance alarms were perceived as somewhat less of a problem in 2011 than in 2006 [71 vs. 77 percent], and they are easier to set [71 vs. 76 percent],” Clark summed. “However, there was a downgrade in the clinical policies and procedures regarding alarm management in 2011 [55 percent], compared with 2006 [66 percent].”
Based on the results, Clark recommended that a high priority must be placed on the reduction of nuisance alarms. “Manufacturers, clinicians, healthcare leadership, government agencies and clinical engineering must focus on this area,” he stressed, noting their much-publicized connection to alarm fatigue and adverse events.
The anonymous survey also asked if the institution has experienced adverse patient events in the last two years related to clinical alarm problems. And, 17.9 percent responded in the affirmative. Clark added that the causative factor of adverse events may not be fully reported to the FDA. He also noted that “a large proportion of the responders were unsure [49 percent] if adverse events had occurred in the last two years and unsure if there had been new solutions to improve alarm safety at their facility. Improved and open communication is needed in healthcare related to these critical issues.”
The responders were fairly evenly split about whether their facility used monitor watchers. Clark was surprised by the high percentage using monitor watchers but recommended hospitals to consider this methodology in their alarm management strategy.
Based on these results, Clark said an overall “systems approach is needed to address the complexities of clinical alarm issues in healthcare. The effort needs to involve all stakeholders in developing solutions.”
The full survey can be access on the Healthcare Technology Foundation's website.