Blog | Wednesday, November 16, 2011

QD: News Every Day--Alarm fatigue tops list of 10 most dangerous hospital hazards

Alarm fatigue is the most dangerous of health care technology hazards, topping even radiation exposure and medication errors from infusion pumps, according to the updated Top 10 list offered by ECRI Institute.

It's not surprising that alarm fatigue rang in at #1. There can be as many as 40 alarms an hour in some units. Staff modify alarm setting outside of safe parameters, can't tell the alarm's importance (or even which device is issuing it) or the alarm isn't relayed to the paging system, according to ECRI Institute, a nonprofit organization focusing on patient-safety and cost-effectiveness in health care. Its report (registration required) is online. The report includes recommendations and resources for each of the 10 top hazards.

Staff may turn alarms off or down to reduce alarm fatigue, as well as reduce stress on the patient and family, the report notes. And properly setting alarms is complex to begin with, so ECRI offers best practices to reduce alarm fatigue while maintaining patient safety:
--Examine the entire environment, not only how the alarms are configured but also staffing and even the physical layout of the care unit,
--Establish protocols for alarm-system settings, including default alarm settings specific to each care unit, as well as limits specific to each patient so the proper staff are notified during an alarm,
--Clearly assign responsibilities to staff, including who is responsible for recognizing the alarm, who is responsible for delivering the information to the responsible caregiver, who is directly responsible for addressing the alarm, and who is the proper back-up provider, and
--Establish policies to control alarm silencing, modification and disabling.

Hospitalist Lisa Kirkland, MD, FACP, offers eight more best practices in her column at ACP Hospitalist.

ECRI's extensive report continues to offer best practices and resources for the entire list of top 10 hospital hazards. Beyond alarm fatigue, hazards include:
2. exposure hazards from radiation therapy and CT,
3. medication administration errors using infusion pumps,
4. cross-contamination from flexible endoscopes,
5. inattention to change management for medical device connectivity,
6. enteral feeding misconnections,
7. surgical fires,
8. needlesticks and other sharps injuries,
9. anesthesia hazards due to incomplete pre-use inspection, and
10. poor usability of home-use medical devices.