As I sat typing my note, I heard an alarm go off. I glanced around, looking for its
source. It was an IV machine, somewhere
in a patient room, announcing to all that could hear that it had finished its
infusion. There was no nurse in
sight. We are discouraged from turning
off the IVs without their permission, so the alarm continued, and continued,
and continued. Shortly thereafter an ECG
alarm went off, signaling an abnormal rhythm.
I glanced in the room and saw a respiratory therapist had been adjusting
the patient’s electrical leads. Behind
me, somewhere down the hall, a third alarm went off signaling God knows what.
If you are not used to being in the hospital, it can be a
noisy place. Alarms ring out in the
halls. Carts are wheeled around to bring
food, supplies, and often life-sustaining medication. The chatting between coworkers ensures that
at all hours there is a constant din.
And this, of all places, is where we send people to rest. Hospitals are not designed with the patient
in mind. But they could be.
Let’s reimagine some of the above scenarios in a patient centered
manner. First, there must be a decision
about what requires an alarm. The term
alarm fatigue, which has recently gained popularity in describing this
conundrum, describes situations in which the ubiquity of alarms detracts from
their usefulness. Anyone who grew up
with small siblings understands you can eventually grow accustomed to the most
annoying of noises. Indeed, patient
deaths have been ascribed to healthcare works ignoring alarms (Kowalczyk, 2011).
Second, there needs to be a discussion about how alarms (or
alerts) should be delivered. For
example, does an alarm need to signify the completion of an infusion? What if a text page went to a nurse’s mobile
device (many hospitals now use nursing communication systems that can send and
receive text pages and calls)? The alert
could then be placed in the queue from which it can only be removed by
addressing it manually at the actual infusion pump. This allows non-emergent alarms to cease
being alarms. By making them less
invasive alerts, actual audible alarms become more meaningful.
At the other end of this spectrum, are there alarms that
should be set off without need for human intervention? Typically, a hospital staff member has to
send out certain codes, which increases the amount of time to dispatch the
appropriate response. Some responses are
delayed dramatically by the above mentioned alarm fatigue. What if an alert about falling oxygen
saturations combined with heart and respiratory rate changes automatically
signaled a code blue across the hospital’s PA system? This takes out the guesswork and increases
the sensitivity of the code system. It
would likely create more false positives, however I find that more comforting
than false negatives from ignored alarms.
These ideas are not the resolution; they are an attempt at a
conversation. I am astounded that solutions
to these well-documented problems have not permeated the healthcare field. The cessation of needless noises in the
hospitals – the beeps and boops of non-urgent alarms – would go a long way in
making it a more peaceful place where patients can get rest, which can improve
healing (Gumustekin, Seven, Karabulut, et al., 2004). Wasn’t that the whole point of a hospital to
begin with, a place of rest and healing?
Hold that thought – somewhere I hear an alarm going off, and I intend to
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