When I think of alerts and alarms in a hospital, I think of the proverbial tree falling in the forest. If no one hears it, does it make a sound?
Similarly, if a patient monitor or other hospital system sends an alert and a clinician it out or misses the flag in the electronic health record, was there an alarm?
In many clinical scenarios, sending proactive alert and alarm notifications directly to care team members on their mobile devices – when and where they need them most – can improve patient safety. Five scenarios stand out for me.
A variety of solutions are available for detecting signs of clinical deterioration. These range from basic modified early warning score systems, algorithms that pull data from a range of sources to pinpoint when a patient is nearing trouble in order to proactively communicate risk warnings to caregivers. An early warning system that for patient deterioration, paired with a notification solution that sends real-time alerts, can speed response time. Augusta Health has saved nearly 300 lives that could have been lost to sepsis through an automated process that uses Vocera technology for alerting.
Phoenix Children’s Hospital sends a “nudge” notification over the Vocera Platform to a nurse who hasn’t updated a patient’s pain score within 45 minutes of administering pain medication. The nurse can respond directly to the notification his or her mobile device with the pain score, which will automatically update in the EHR.
Fast response is critical for preventing patient falls. The University of Arkansas for Medical Sciences reduced falls by 11 percent and fall-related injuries by 60 percent in its first year of sending bed exit notifications to care team members on their mobile devices, resulting in $1.27 million in savings. Evans Army Community Hospital reduced falls by 81 percent by sending call light alerts directly to nurses.
Combining fall risk scores with nurse call requests enables alerts to be sent at different priority levels. For example, if a patient is a fall risk and needs to use the bathroom, that alert can be delivered with a higher priority than other nurse call requests.
Seconds matter when intervening in a potential patient abduction or elopement. A real-time location system (RTLS) can send alerts to nearby team members with details about the patient and their location, enabling quicker response. Because RTLS alerts sometimes trigger accidentally, there are also options for canceling them from mobile devices. Sentara Princess Anne Hospital reduced alarm interruptions by 54% in its neonatal intensive care unit by integrating the Vocera Platform with its RTLS.
According to The Joint Commission, 85 to 99 percent of alarms don’t require clinical intervention. Filtering out the noise so only actionable alarms are delivered can significantly reduce the risks associated with alarm fatigue. The 64-bed telemetry unit at Staten Island University Hospital reduced the number of alarms sent to nurses on their smartphones from 13,000 to 1,000 per day after implementing an alarm management system configured to deliver only actionable alarms with clinical context.
When used judiciously, proactive alerts and alarms can significantly enhance patient safety. It’s a best practice for an alarm committee to assess alert and alarm utilization broadly and guide decisions about alarm management. A great resource for more information is AAMI’s Clinical Alarm Management Compendium. It’s designed to help healthcare organizations meet The Joint Commission’s National Patient Safety Goal on clinical alarms.
The Vocera Platform can help manage clinical alarms and alerts for better patient safety; learn more.
The Joint Commission. “Medical device alarm safety in hospitals.” Sentinel Event Alert Issue 50, April 8, 2013.