Yep, it's a real thing, and it can certainly extend beyond medicine! Construction and weather-related alerts come to mind immediately. Now, back to healthcare, - If you've been in this business long enough or spent clinical time in the ED or intensive care units -- it probably safe to assume you have become desensitized to the many different alarms going off all over the place. The ventilator, the heart monitor, the pulse oximetry probe or the IV pumps. I bet you can hear them in your sleep after the shift is over.
Many electronic monitoring systems use some type of audio alert, like a beep or buzz, to notify medical personnel when a device registers an abnormal bodily function or other condition requiring prompt attention. Studies indicate that as use of electronic systems have become more prevalent in medicine, the number of audio alarms or alerts has also increased dramatically.
Clinical alarms exist to enhance patient safety when the device isn't functioning properly or when the patient is in some sort of clinical deterioration. The perfect alarm system would be 100% sensitive (never miss a clinically important event) and 100% specific (never alarm when there is no clinically important event). As you have probably experienced and as I have previously mentioned the sensitivity is great, but it comes at the expense of specificity. No such systems yet exist. So, we end up in a quandary.
As the old saying goes, " If you emphasize everything, you in essence emphasize nothing at all" After a while as a clinician you simply tune out the noise which could end up with your care teams missing some critical updates around your patients. Indifference and complacency kills. The high-tech machines can be very sensitive and much like the classic Aesop fable, the Boy Who Cried Wolf, silencing or turning off alarms all together can have unintended consequences. Don't simply assume someone else is handling the issue. There have been many cases across the country where ignoring alarms or simply failing to respond to them have resulted in the wrongful death of a patient.
So, what can we do about it? First consider adjusting the manufacturer alarm defaults on your equipment so alarms only sound when there is real danger. That is the low hanging fruit - nobody says your agency has to accept these outright and without question. Think about how vitals different between pediatric and adult patients. Customization has its benefits. The added bonus is now you can spend more time tending to your patients' needs and not chasing alarms that don't mean much because the parameters/settings are too stringent. One health system in Boston reduced their audible alarms by nearly 90% by changing this one simple measure. Look at your LP15 or Zoll monitor - this could also be a great place to start. Another thing you may be able to do is ensure that your electrodes are in good shape and not dried out. Pre-loading the "stickers" on the leads is a small procedural change that could improve your lead contacts and therefore reduction in false waveform artifact or "lead off" alarms. You could also begin to only monitor patients where it is truly indicated - all patients may not need a heart monitor.
I realize that most transport times are likely less than 20 mins, but I also realize that some reading this may be regularly doing long interfacility transports. In rural parts of America, especially out West - several hour transports are quite commonplace. This blog is not simply geared more towards nursing, but EMS is not immune from the patient safety risk. Maybe the alarm comes at a time when you're attempting to draw up a medication, the alarm distracts you and now you give the incorrect dose or the wrong drug altogether. It's a known fact that in high stress environments our brains will fail us by taking shortcuts. Med math on the fly is never easy - all it took was one transient curve ball from the IV pump.
Researchers are still looking at ways to best handle this complex problem, this includes potentially changing the type of sound being delivered based on criteria and algorithms amongst other things. As always stay vigilant and resilient. Maybe one day soon we can usher in an era where alarms are always meaningful, and the healthcare environment is conducive to both patient recovery and the well-being of our dedicated healthcare providers and pre-hospital personnel. Let's face it - the patients don't like the alarms either.
October 21, 2024
Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP
Pass with PASS, LLC
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