An Overview of the Alarm Environment in an Intensive Care Unit
In today’s acute and critical care environments care professionals and patients must deal with a variety of technologies, many of which have been designed to emit alarms. It is well documented that alarm fatigue and the levels of noise due to those alarms are a problem in today’s healthcare environment.
If you have never been to an intensive care unit, let me provide you with a detailed view of what that looks like…
Physiological Monitors – These monitors display patient physiological data such as vitals and waveforms. Care providers use these devices to track and monitor the progress of their patients. These devices emit 95% of all alarms.
Patient Support Devices – These include devices such as ventilators and drug pumps. They are assigned based on the acuity and the specific needs of the patients. In most hospitals today, they are generally not networked and integrated into centralized monitoring systems.
Nurse Call Systems – These systems allow communication between the patient and nurses, as well as emergency buttons to signal a code event. You will often find these systems directly in the hospital room on the wall.
If you want to know what it sounds like, check out this interactive graphic from the Boston Globe:
The Unit Layout:
Multi-patient Rooms – Traditionally hospitals favored multi-patient rooms, where nursing staff could easily see all their patients and hear all of their alarms.
Private Rooms – From around the 1950’s to the 1970’s there was a large shift in the US to move to private rooms. These private rooms have made care providers more dependent on secondary notification devices to alerting them to their patient’s alarms.
Types of Notification:
Audible & Visual (Primary Notification) – Generally there is an audible alarm at the bedside device with some type of visual indicator such as a light outside the patient room or bed.
Messaging (Secondary Notification) – This can include devices that the care team carries such as pagers, communication badges, phones, and smart phones. Many units have central monitoring stations for nursing staff and can also have dedicated monitor watchers in a special room.
According to alarm management best practices, an alarm should be tied to an operator action. In other words, if you are sending an alarm there is an expectation that there is a reason it exists and some action should be taken. However, when there are too many alarms for a care provider to address, then the alarm system is no longer tied to an operator action. For example, a primary care assistant is assigned 10 beds and receives 720 alarms in a 12-hour shift, averaging 1 alarm per minute on his or her pager. This means that for the assistant not only is their pager constantly buzzing, but there is no way the assistant can act on the information they are provided. This is exacerbated when the majority of beds in new construction are private rooms, which require the assistant to rely on the pager for alarm communication. This is the type of situation care providers are facing today and why alarm fatigue is a critical issue that institutions like Joint Commission, ECRI and AAMI are tackling.