Alarms and patient safety

alarm-safetyAlarms are a serious matter in busy hospitals and ERs punctuated 24/7 by the din from cardiac monitors, IV machines, ventilators and other devices. Some alarms are inconsequential. Some are malfunctions. Others signal impending crisis. Many are simply not heard.

The sheer number of devices with alarms – ECG machines, pulse oximetry devices, BP monitors, telemetry, infusion pumps and ventilators, to name a few. According to the Joint Commission, one single patient can set off literally several hundred alarms each day, depending on the severity of their condition and as few as 1 percent of all alarm signals even require clinical intervention. The resulting problem has been given a name by practitioners and researchers: alarm fatigue.

Both technology and behaviors appear to be at the root of the problem. For example, too many varied alarms, both minor and major, simply sound alike.

While most staff recognize the critical role alarms play, they often become desensitized to alarms and overwhelmed by all the noise. They may sometimes set alarm conditions too high, turn alarm volumes down or off, or neglect to adjust alarm default settings for specific patients or populations. In some
instances, staff may not hear an alarm because a door may be closed or they may be distracted and might hear the alarms only after a significant amount of precious minutes have lapsed. In other instances, a series of cascading “minor” alarm failures are the culprit. By the time an alarm signals a truly critical event – it might be too late.

Joint Commission addresses alarm safety

In April of 2013, the Joint Commission issued a Sentinel Event Alert advising hospitals to take measures like preparing an inventory of alarm-equipped medical devices and tailoring alarm settings and limits for individual patients. Recommendations include:

  1. Inventory all alarm-equipped medical devices and identify proper default settings and limits.
  2. Establish guidelines for alarm settings, and indicate when alarms are not “clinically necessary.”
  3. Also, establish guidelines for safely customizing alarm settings for individual patients and restoring them to default when finished.
  4. Set up an inspection, cleaning and maintenance program for alarm-equipped medical devices, and test them regularly.
  5. Orient staff on your organization’s process for safe alarm management and response in high-risk areas.
  6. Routinely change single-use sensors to avoid false or nuisance alarms.
  7. Determine whether the acoustics in patient care areas allow alarms to be easily heard.
  8. Set your priorities for replacing aging monitors with newer technology.
  9. Establish a multi-disciplinary team of clinicians and representatives from clinical engineering, information technology and risk management to address alarm safety and management.
  10. Share information about alarm-related incidents, prevention strategies and lessons learned.

In addition, a National Patient Safety Goal by the Joint Commission, effective January 1, 2014, gave hospitals two years to put new clinical alarm policies in place. Essentially, this includes any medical devices that have visual and/or auditory alarms. The goal was implemented in two phases. The first phase, effective January 1, 2014 charged hospital leaders with collecting input on alarm signal management from frontline staff and compiling best practices. The second phase, effective January 1, 2016 required hospitals to have specific policies for alarm safety in place.

Alarm safety key documents – resources

Action for Better Healthcare Blog from Premier Inc.

AAMI Foundation’s Healthcare Technology Safety Institute (HTSI)

White papers, as part of the HTSI’s “Safety Innovations” series, highlight alarm safety issues:

Agency for Healthcare Quality and Research (AHRQ)

American College of Surgeons

American Society of Anesthesiologists

ECRI Institute

ECRI has placed alarm safety on its list of Top Ten Health Technology Hazards for the past six years. To register and access a download of the 2017 report, use this link:

Institute for Safe Medication Practices

Initiatives in Safe Patient Care

National Association of Clinical Nurse Specialists

Physician-Patient Alliance for Health & Safety

Premier’s Action for Better Healthcare Blog

Alarm safety by Gina Pugliese

The Joint Commission – National Patient Safety Goal (NPSG)