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Alarm Management Update

CHPSO has been actively engaged with the AAMI Foundation (Association for the Advancement of Medical Instrumentation) to assist hospitals in better managing their alarms. Recently, these efforts have borne fruit.

The first is the Clinical Alarm Management Compendium. The compendium contains a wealth of material, including tables of various hospitals’ default settings for certain parameters, links to in-depth resources, and a detailed walk-through of ten ideas for safe alarm management.

The second is the Framework for Alarm Management Process Maturity, coauthored by CHPSO. Using the Capability Maturity Model (CMM) as an example of practices consistent with moving towards higher reliability, this paper identifies the considerations and sequencing of steps designed to produce sustainable improvement. To provide a small sample of the content, the following are some important takeaways from this paper regarding measurement:

  • Sustainable improvement is nearly impossible unless care processes are managed, and care processes cannot be managed without a practical and sustainable source of data on the intended outcome of the process and on whether the process is being followed. In complex adaptive environments, continuous, not episodic, efforts are needed to control processes.
  • There are many potential types of measurements that can be used for process and outcomes in alarm management. Easy-to-obtain proxy measures may not completely represent processes or outcomes, so may not be useful for external benchmarking, but may be very useful for internal management.
  • Whenever possible, measures should come from the normal course of care, rather than from special collection efforts. This implies that equipment purchase decisions should include consideration of how usable and useful the data stream is from each candidate device.
  • Pilot tests should be carried out with the goal of obtaining both sustainable improvement and sustainable measures.
  • There are many types of measures and many cognitive aspects of human-alarm interactions to pick from when developing a candidate measure.

Recently, the AAMI Foundation (including CHPSO) met to develop a roadmap for the next two years. The plans include (see www.aami.org/newsviews/newsdetail.aspx?ItemNumber=3751 for further details):

  • Developing a mentorship program in which hospitals with more mature alarm management practices can advise other hospitals.
  • Adding ventilator alarms to the group’s scope of work. Ventilator alarms are much more complex than other alarms, particularly in the variety of different alarms that can be set. Work is underway to standardize the vocabulary manufacturers use for their systems (ISO 19223, voting just finished on the draft version), to make it easier to transfer knowledge gains from one system to another.
  • Creating guidelines, tools, seminars, papers, and other resources to help hospitals develop alarm defaults for particular profiles of patients and develop rules/algorithms for improving alarm notification from the primary device or through middleware to reduce clinician alarm fatigue.
  • Helping hospitals implement American College of Cardiology and American Heart Association guidelines to prevent unnecessary telemetry monitoring.
  • Addressing alarm sounds to be used in future iterations of the IEC 60601-1-8 design standard. The current standard alarm sounds are difficult to differentiate from one another and difficult to localize. We believe that many organizations are not using the standard sounds.
  • Developing basic guidelines to help clinicians better understand the parameters and defaults for physiological monitors and ventilators and why, when, and how to customize default parameters for particular patients.
  • Building a national database that will house basic default settings and those created for subsets of patients based on characteristics such as age or disease type. Once completed, this system will allow contributing organizations to benchmark their data and see how other hospitals have set their parameters.

Please contact Rory Jaffe if you have any questions.

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