In a recent 2-part series (Part I), (Part II) in the Boston Globe we read a number of chilling stories about patients who died in the hospital because an alarm set to warn nurses of their critical condition was accidentally missed, handled incorrectly, or failed to go off.
According to the article, between 2005 and mid 2010 more than 200 patients in the US died due to problems with alarms on monitors that track heart function, breathing or other vital signs. And research suggests these numbers are underreported.
Why is this happening? One possible reason is what researchers call “alarm fatigue.” With the use of monitors increasing, the rising number of beeps and lights can cause stress and fatigue for nurses. Additionally, high rates of false alarms cause nurses to become desensitized to alarms, leading them to develop a decreasing sense of urgency for addressing these alarms. In one unit at Johns Hopkins Hospital staff document 942 alarms in one day and one critical alarm every 90 seconds
Another major concern is technical problems and improper use of the alarms This includes issues such as dying batteries, disconnected cables, alarms that are not turned on or set properly, and volumes that are set too low. In some cases nurses lower the volume on alarms to give themselves and patients a break from the constant noise.
Currently there are limited federal level interventions in place to address this issue. Additionally, there are major disagreements between staff in hospitals and medical device companies that make monitors as to what the most important causes of the issue are. The article suggests some solutions that address both nursing and device specific issues. They include:
Hiring nurses and techs to do nothing but monitor alarms - In MA, Massachusetts General Hospital and South Coast Hospital have both been using this approach. Unfortunately this solution is very costly (South Coast spent $1Million) and can lead to alarm fatigue in the nurses hired to monitor the alarms.
Improving monitoring technology to decrease false alarms. - A number of companies are working on designing smarter monitors that follow multiple physical indicators at once and consider them all together before sounding an alarm. Paul Hickey at Children’s Hospital Boston is collaborating with engineers at MIT to develop this type of smart monitor. However, Dr. Hickey points out that a finished product is far off.
Strengthening standards for monitor design and use. – This approach can be used to regulate device characteristics, such as minimum volume, and the thresholds for alarms being sounded.
Stricter monitoring criteria - There is some concern that the number of patients being monitored has increased unnecessarily in recent years. Creating stricter guidelines for who gets hooked up to a monitor could help reduce alarm fatigue, however some providers are concerned this will create serious safety issues.
How can you protect yourself as a patient?
James Kelley of the ECRI Institute (a non profit institute focused on improving medical care) suggests that patients and families ask doctors and nurses to explain what monitors are being used for, what types of alarms to expect, and which signals to be most concerned about.
- Margot Schwartz