The nursing unit can be a very chaotic place. Numerous systems and
devices can generate alerts or alarms, all competing with the
caregiver's attention. Some of these sources of alarms include overhead
pages, the nurse call system, a myriad of medical devices in patient
rooms sounding alarms, alarms generated at the central station, and
ringing wireless phones.
Each of these different sources has their own alarm logic, with unique
indicators for different types of status of alarm, and their own policy
for alarm escalation (if they support escalation at all). Much effort
is spent just determining whether an alarm is coming from one of your
patients. If you determine the alert is for another nurses patient you
must still be vigilant in case that patient's caregiver is already to
another situation elsewhere in the unit. Add to this cacophony false
positive and nuisance alarms and you have a recipe for "alarm fatigue"
where alarms are subconsciously tuned-out, resulting in adverse events.
It's no wonder that poor alarm management impacts patient safety.
(full text $12) discusses current limitations of auditory alarms and
the impact on patient safety. Also discussed is a new draft
international standard for harmonizing audible alarms.
I have my doubts this new standard with have much impact on patient
safety unless it covers the full spectrum of noise makers. The real
solution is a nurse carried device that annunciates all alarms and
messages for the patients they're responsible for, along with
escalating alarms to backup caregivers. This approach would reduce
overhead pages to nil, and combine nurse call, HIT and medical device
alerts and alarms into a consistent logical whole.
Of course, such a system does not yet exist, but we're getting tantalizingly close.