Framework for Alarm Management Process Maturity

Welch, James; Rayo, Michael F.; Kanter, Benjamin; Bagian, Tandi M.; Jacobs, Katrina; Shanawani, Hassan; Jaffe, Rory; Conti, Marlyn T.; Razzano, Lynn

doi:10.2345/0899-8205-50.3.165

Cited by 19 publications

(12 citation statements)

References 9 publications

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“…Large alarm datasets, including waveform data, are increasingly accessible as software becomes available to aggregate these data 8 ; however, these datasets alone cannot be used to determine an alarm's clinical relevance. 34 We found reported proportions of clinically irrelevant alarms particularly misleading because of conceptual inconsistencies and overlap with inaccurate alarms, highlighting the difficulty of measuring the clinical relevance of alarms.…”

Section: No Of Alarms Annotatedmentioning

confidence: 99%

Measurement of Physiological Monitor Alarm Accuracy and Clinical Relevance in Intensive Care Units

Ruppel

Funk

Whittemore

2018

American Journal of Critical Care

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Background Alarm fatigue threatens patient safety by delaying or reducing clinician response to alarms, which can lead to missed critical events. Interventions to reduce alarms without jeopardizing patient safety target either inaccurate or clinically irrelevant alarms, so assessment of alarm accuracy and clinical relevance may enhance the rigor of alarm intervention studies done in clinical units. Objectives To (1) examine approaches used to measure accuracy and/or clinical relevance of physiological monitor alarms in intensive care units and (2) compare the proportions of inaccurate and clinically irrelevant alarms. Methods An integrative review was used to systematically search the literature and synthesize resulting articles. Results Twelve studies explicitly measuring alarm accuracy and/or clinical relevance on a clinical unit were identified. In the most rigorous studies, alarms were annotated retrospectively by obtaining alarm data and parameter waveforms rather than being annotated in real time. More than half of arrhythmia alarms in recent studies were inaccurate. However, contextual data were needed to determine alarms’ clinical relevance. Proportions of clinically irrelevant alarms were high, but definitions of clinically irrelevant alarms often included inaccurate alarms. Conclusions Future studies testing interventions on clinical units should include alarm accuracy and/or clinical relevance as outcome measures. Arrhythmia alarm accuracy should improve with advances in technology. Clinical interventions should focus on reducing clinically irrelevant alarms, with careful consideration of how clinical relevance is defined and measured.

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Section: No Of Alarms Annotatedmentioning

confidence: 99%

Measurement of Physiological Monitor Alarm Accuracy and Clinical Relevance in Intensive Care Units

Ruppel

Funk

Whittemore

2018

American Journal of Critical Care

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“…Two‐by‐two tables, the kind used in evaluating medical diagnostic tests, provide a framework to evaluate the ability of a smart pump to signal errors (Figure ). Under this framework, alert and alarm fatigue is a result of a large number of clinically irrelevant alerts or alarms and low positive predictive value …”

Section: Framework Used To Evaluate the Value Of And Clinician Respomentioning

confidence: 99%

“…Thus, the key to optimizing the value of smart pump alerts may lie in tuning pump parameters to balance these conflicting priorities . (Adapted from reference . )…”

Section: Framework Used To Evaluate the Value Of And Clinician Respomentioning

confidence: 99%

Strategies for Managing Smart Pump Alarm and Alert Fatigue: A Narrative Review

2018

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Although smart infusion pumps are intended to prevent medication errors by alerting users about doses that exceed set thresholds, a large number of clinically insignificant alarms and alerts create the potential for alert and alarm fatigue. We searched the PubMed, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for peer-reviewed literature (January 1, 2004-August 31, 2017) on managing smart pump alerts, alarms, and related fatigue. Twenty-nine articles that met the inclusion criteria were reviewed and organized into themes. Smart pumps give users two types of signals: alarms that indicate mechanical issues such as occlusion, air in the line, or low battery; and clinical alerts that indicate that a programmed dose exceeds a predefined safety limit. Mechanical alarms occur with greater frequency than clinical alerts, but alarms and alerts vary widely by pump model, patient population, time of day, month, and type of drug. Several causes of clinically insignificant alerts and alarms may be actionable, and strategies proposed in the literature include development of a multidisciplinary team to oversee the quality improvement effort with involvement of end users, standardization of medication administration practices, widening of drug limit library thresholds when clinically appropriate, maintaining up-to-date drug limit libraries, and interoperability. Whereas many strategies have been proposed, and case studies have been reported, none have been rigorously evaluated. In addition, more research is needed related to managing occlusion and air-in-line alarms, especially for complicated infusions. Future work should focus on the evaluation of specific and replicable alert and alarm reduction strategies with a greater emphasis on quantitative metrics.

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“…So, alarm fatigue nursing management protocol for critically ill patients is established in ICU. Hence, this study will accomplish to layout and apply alarm fatigue nursing management protocol for CCNs to manage alarm fatigue and definitely regard critically ill patient safety care (Rayo & Moffatt, 2015, Welch et al, 2016.…”

Section: Introductionmentioning

confidence: 99%