Managing alarm systems for quality and safety in the hospital setting

Abstract

ObjectiveTo provide an overview of documented studies and initiatives that demonstrate efforts to manage and improve alarm systems for quality in healthcare by human, organisational and technical factors.MethodsA literature review, a grey literature review, interviews and a review of alarm-related standards (IEC 60601-1-8, IEC 62366-1:2015 and ANSI/Advancement of Medical Instrumentation HE 75:2009/2013) were conducted. Qualitative analysis was conducted to identify common themes of improvement elements in the literature and grey literature reviews, interviews and the review of alarm-related standards.Results21 articles and 7 publications on alarm quality improvement work were included in the literature and grey literature reviews, in which 10 themes of improvement elements were identified. The 10 themes were categorised into human factors (alarm training and education, multidisciplinary teamwork, alarm safety culture), organisational factors (alarm protocols and standard procedures, alarm assessment and evaluation, alarm inventory and prioritisation, and sharing and learning) and technical factors (machine learning, alarm configuration and alarm design). 26 clinicians were interviewed. 9 of the 10 themes were identified from the interview responses. The review of the standards identified 3 of the 10 themes. The study findings are also presented in a step-by-step guide to optimise implementation of the improvement elements for healthcare organisations.ConclusionsImproving alarm safety can be achieved by incorporating human, organisational and technical factors in an integrated approach. There is still a gap between alarm-related standards and how the standards are translated into practice, especially in a clinical environment that uses multiple alarming medical devices from different manufacturers. Standardisation across devices and manufacturers and the use of machine learning in improving alarm safety should be discussed in future collaboration between alarm manufacturers, end users and regulators.

Nursing staff’s evaluation of facilitators and barriers during implementation of wireless nurse call systems in residential care facilities. A cross-sectional study

“…The NCSs generate data on the number of calls and response time, which enables the management to monitor the performance [20]. Alarm adverse events have been found to involve human, organizational and technical factors [3]. The most salient is alarm fatigue, i.e.…”

“…The importance of implementing a multifunctional NCS that addresses the users' needs and supports effective communication between patients, healthcare providers and management, is emphasized [2]. Research on NCS has predominately been hospital-based and has primarily reflected the major driving forces of technical development, namely to enhance patient safety through reduced call response time and to eliminate alarm fatigue among healthcare providers [2][3][4][5]. In the residential care sector, research on alarm fatigue and corresponding patient safety issues has been related to monitoring systems [6][7][8][9].…”

Case Study: More Patient Safety by Design – System-based Approaches for Hospitals

“…Correct configuration, adjusting alarm limits to patient status, using alarmsparing features, and well trained staff can, alongside other measures, significantly reduce the frequency of unnecessary alarms (38)(39)(40). Increasing alarm safety can be achieved by addressing and incorporating not only the technical factor of alarms but also human and organizational factors in an integrated approach, as Bach et al (2018) concluded in their study (41).…”

Nursing staff´s evaluation of facilitators and barriers during implementation of wireless nurse call systems in residential care facilities. A cross-sectional study.

“…Research on NCS has predominately been hospital-based and has primarily reflected the major driving forces of the technical development, to enhance patient safety through reduced call response time and to eliminate alarm fatigue among healthcare providers (2)(3)(4)(5).…”