- Why reducing alarms is critical to safety and care and how the sound of an alert can contribute to alarm fatigue.
- How routing certain alerts to staff other than nurses can help reduce alarm fatigue.
- How a clinical collaboration platform can help reduce alarm fatigue and streamline patient care.
By now, everybody has heard of alarm fatigue. It’s a severe problem with the potential for real danger to nurses and patients alike. Your hospital is probably trying to address it right now, searching for alarm fatigue solutions it can implement right away. This post is the third in a series of three posts about alarm fatigue in nursing. In it, I talk about some of the alarm fatigue solutions and best practices I see hospitals putting in place today.
In my first post, I talked about how nurses struggle with alarm fatigue, and I went over some of the differences between alarms and alerts. In my second post, I delved further into the dangers of alarm fatigue and how it impacts patient safety, contributes to nurse burnout, and negatively impacts patient satisfaction levels.
Battling the reality of alarm fatigue is an ongoing effort—with direction provided by organizations such as The Joint Commission, ECRI, and healthcare associations such as the AACN. Hospitals across the country are making changes and experiencing success on a case by case basis. And the problem is being addressed on many levels, from organizational perspectives to highly technical solutions to suggestions about modulating the tone and volume of a piece of equipment’s monitoring response.
Reducing the number of false alarms.
In 2013, The Joint Commission’s National Patient Safety Goals provided a list of recommendations to help hospitals and other medical organizations reduce the number of false alarms in clinical settings. False alarms are a real problem and contribute to the overwhelming noise that patients and clinicians alike are forced to endure, day in and day out. The Commission’s recommendations included:
- Training staff on protocols
- Analyzing and measuring the causes of alarms
- Building a culture of safety
- Staying on top of product recalls
Each of these is practical, implementable, and entirely appropriate. And each of these recommendations can be applied to situations beyond the scope of the false alarm. Because while false alarms cause nurses real concern, they are only one of the aspects of alarm fatigue that we’re concerned with addressing. Throughout our nation, hospitals work diligently to take appropriate action in response to this list.
Reviewing the types of noises used in alarms and alerts.
Another approach in developing solutions for alarm fatigue is being taken by a group of researchers, specialists, and medical professionals. “Together, this group is developing tones that replace the anodyne blare of the current alarms with signals that mimic electronic dance music or a heartbeat,” states Emily S. Rueb, writing for the New York Times. According to Ms. Rueb, the group works to make alarms quieter, combining audible alarms with visual cues like interactive screens that look like paintings and developing a new standard for notifications.
Taking a hard look at individual alarm sounds and volume levels is an integral part of developing alarm fatigue solutions. It’s time someone looked at the sounds we currently use to see if there are better noises, snippets of music, whistles, or whatever. So, I see value in this initiative, and I look look forward to hearing more about the group’s progress, especially in getting agreement on new standards.
I believe there’s something else essential to addressing alarm fatigue: Implementing very thoughtful decision-making around alerts and alarms.
Let me tell you what I mean.
“Just because you can, doesn’t mean you should.”
This is one of my favorite sayings because it applies to alarm and alert fatigue in so many situations. At Halo Health, one of the things we bring to the table is our ability to sit with a clinical audience and analyze how alarms and alerts are being delivered across the organization.
Best practices for alarm fatigue solutions include bringing stakeholders together to review, understand, and inventory the alerts each system is sending. And then create a baseline of what alerts each machine is sending—and to whom. This baseline is vital because you run the risk of compounding the problem from system to system unless you identify this.
And compounding the problem only feeds into the danger of desensitization—otherwise known as alarm fatigue.
For example, we expect nurses to respond to multiple alerts for multiple patients throughout their shifts. In the first post in this series, I wrote about the types of alarms and alerts and notifications hospitals use to monitor patients. The combination of messages multiplied by the multiple patients assigned to a nurse in a twelve-hour shift can desensitize a nurse. The sheer number of interruptions in providing patient care can feel overwhelming to the nurses.
So taking a close look and being thoughtful about who gets a particular alert is vital. What notifications need to interrupt a nurse, and what messages or calls can, for example, be routed to a healthcare tech or a unit secretary? Remember, just because it doesn’t land on the nurse doesn’t mean it’s not meaningful. But diverting an alert away from a busy nurse can make a huge positive difference in mitigating alarm fatigue.
First and foremost, get everyone together, clinical owners, operational owners for alarm management, nurse call, or whatever else, and create an inventory. Develop the baselines and then make decisions with the clinical audience to standardize those across your care environment and make very few exceptions.
After that, training is essential. It’s a vital training point to tell a unit clerk, for instance, that they are impacting patient satisfaction by answering the phone and triaging a call from a patient quickly, just as much as a nurse would if she was answering the phone. That builds a sense of importance for the unit clerk and lessens a small percentage of the nurse’s distraction.
Next steps: Bring on a full clinical collaboration platform (CCP)
When you have created the inventory, reviewed how your organization is sending alarms and alerts, and have decided to standardize—the next logical step is to bring on a full clinical communication platform (CCP.) What that does is multifold. The CCP routes messages and alerts from the sending system to the right person. The right person is the one assigned to that patient. In this way, you can really leverage the role-based communication from the sending system.
It works in this way: As a nurse receives a message, she looks at it and realizes she needs to contact somebody. The patient in question continues to dissat, meaning they continue to have an increased respiratory or reincreased heart rate. With the role-based communication functionality of a CCP, she’s not calling the wrong on-call resource. She’s getting to the right person who can help solve the problem. Bypassing the confusion and lost time of looking for the right person condenses that whole time frame.
And when you reduce the timeframe by leveraging a CCP, you have better patient outcomes.
You have patients who are discharged faster, quicker bed turnover, and can get more patients through the hospital. So from the patient perspective? They’re happier because they feel like their issues are being addressed. The clinician is less stressed. They’re getting only the messages that they should be receiving and not messages for everybody and everything. The healthcare system’s happier because they’re increasing throughput.
What is a Clinical Communications Platform (CCP)
“The term clinical collaboration platform (CCP) describes a single platform that unifies fragmented healthcare communications across an enterprise or community, making communication and collaboration between clinicians fast, easy, and secure,” writes Jose Barreau, MD, and CEO of Halo Health.
As an example, the Halo Clinical Collaboration Platform streamlines time-sensitive clinical communication and workflows to increase nurse efficiency and accelerate patient care by:
- Streamlining clinical communication workflows
- Receiving only mission-critical alerts via a mobile device
- Eliminating wasted time searching for the physician who is on-call and interrupting off-duty physicians
- Accelerating critical care team coordination such as STEMI, Stroke, Sepsis, and COVID-19
- Improving admission/discharge processes to increase patient throughput
- Standardizing communication across the organization
Halo Health’s clinical communication platform centralizes critical alerts to reduce nurse fatigue. It accomplishes this through robust integrations (TAP, WCTP, SIP) with nurse call systems and physiological monitors.
With the CCP in place, you will have consolidated your clinical communications and standardized communications across the organization. With role-based communications, your nurses will be able to perform their jobs more efficiently and with less stress.
Alarm fatigue solutions exist on many levels, and new solutions are being introduced all the time. Whether your organization will implement the recommendations from The Joint Commission or will decide to conduct a thorough review of how its equipment is alarming and alerting remains to be seen.
There’s a lot of concern about the danger of alarm and alert fatigue, and today, as the COVID-19 crisis deepens, hospitals and medical institutions are under increasing pressure to streamline and simplify communications and processes.
Alarm fatigue solutions will include thinking through who needs to get which alarm or alert for each process and piece of equipment involved in patient care. The only practical way to lessen alarm fatigue levels is to implement change at the most basic levels by streamlining and simplifying how nurses communicate.
At Halo Health, we understand this. We are experts in improving clinical collaboration and communication in hospital workflows. And we have done implementations hundreds of times. We are clinically focused. We have found in the conversations from hospitals to hospitals that we understand the variation in those configurations. And we can show an organization’s stakeholders how the implementation can help solve a broad range of problems that can ripple across the entire enterprise.