alarm!!!

so for those who don’t know, a few months ago Greg Ellis, voice actor of Cullen from DA, posted on his twitter a link to some recordings he did for his fans of “Cullen alarm clocks/ringtones.”

If you want to listen or download:

more from Greg Ellis »

A Patient-Centered Hospital - Part II: Bells are Ringing

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 stop it.    

Citations/Further Reading

Chopra V, Mcmahon LF. Redesigning hospital alarms for patient safety: alarmed and potentially dangerous. JAMA. 2014;311(12):1199-200.

Cvach M. Monitor alarm fatigue: an integrative review. Biomed Instrum Technol. 2012;46(4):268-77.

Gumustekin K, Seven B, Karabulut N, et al.  Effects of Sleep Deprivation, Nicotine, and Selenium on Wound Healing in Rats. International Journal of Neuroscience.  2004, Vol. 114, No. 11 , Pages 1433-1442 (doi:10.1080/00207450490509168)

Kowalczyk, L. (2011, September 21). ‘Alarm fatigue’ a factor in 2nd death. The Boston Globe. Retrieved from http://www.boston.com/lifestyle/health/articles/2011/09/21/umass_hospital_has_second_death_involving_alarm_fatigue/

Krachman SL, Criner JG, D’Alonzo GE. Sleep in the Intensive Care Unit. Chest. 1995;107(6):1713-1720. doi:10.1378/chest.107.6.1713

Varpio L, Kuziemsky C, Macdonald C, King WJ. The helpful or hindering effects of in-hospital patient monitor alarms on nurses: a qualitative analysis. Comput Inform Nurs. 2012;30(4):210-7.

Since today is pan visibility day, here’s some friendly reminders!

  • pan people are not bi.
  • you dont have to be pan to date a trans person
  • we dont fuck kitchenware
  • nor other non-human things
  • pansexuality is not “”bi erasure””
  • pansexuality is not homophobic (believe me, i have been told this)
  • pansexuals are not inherently greedy or desperate
  • pan people are attracted to all genders, but we can still have preferences
  • we’re not bi
  • pansexuals arent just ‘looking for attention’ or looking to be ‘’cooler” than bisexuals
  • WE ARE NOT BI

thank