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Alarm management: 5 safety measures

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Patient safety can be severely jeopardized due to improper clinical and alert alarm management, says Byron Burlingame, MS, RN, CNOR, perioperative nursing specialist in AORN's Center for Nursing Practice. "A hospital is a noisy place," he says. "Since there may be many alarms going off at once, critical ones can easily be missed, and that should be a significant concern for perioperative professionals."

A clinical alarm is patient specific and used for the purpose of alerting staff members to a patient emergency. Clinical alarms include cardiac monitors, ventilators and anesthesia machines. An alert alarm is connected to a system and alerts personnel to failures that would affect multiple patients. Alert alarms include medical gas systems, blood bank refrigerators, fire alarms and code blue alarms. Alarms can be auditory, visual, or a combination of both.

Many patients have experienced injuries and near-misses because alarms failed to function, were turned off or inaudible, Burlingame says. The issue is a growing concern for The Joint Commission, which has proposed a National Patient Safety Goal on management of alarms (Note: The Joint Commission is seeking comment on the proposed NPSG through Feb. 26. To review the proposal and submit comments, click here).

Included in AORN's Perioperative Standards and Recommended Practices is a recommended practice that addresses alarm management. It speaks to the need for precautions to be taken to mitigate hazards associated with perioperative personnel failing to hear or act on alarms or if there are non-functioning clinical and alert alarms.

Burlingame identifies the five core interventions of this recommended practice and explains why each of these safety measures is important to proper alarm management.

1. Clinical and alert alarms should be tested on initial setup. "It is essential to identify whether you're actually setting up a working alarm," Burlingame says. "Never assume a device works."

2. Clinical and alert alarms should be tested according to organizational policy and procedures. "The only way to ensure your alarms work is to test them routinely," he says. "Make sure not to deviate from your organization's alarm testing policy and procedures or you run a greater risk of missing a test."

3. An inventory of clinical and alert alarms should be conducted periodically as a collaborative effort between clinical engineering and perioperative personnel. "By involving a mix of clinical engineering and perioperative personnel, you obtain more comprehensive information than just including one group or another," Burlingame says.

An inventory assessment will help maintain accurate alarm inventory, ensure tracking of alarms tests and identify equipment with alarms. "Such information may also assist with setting the most appropriate alarm limits," he adds.

The alarm inventory should include all devices with alarms, including blood bank refrigerators, medication refrigerators, security systems, patient monitoring devices, carbon dioxide insufflators and anesthesia equipment.

4. Clinical and alert alarms should be sufficiently loud to allow them to be heard above competing noise, and competing noise should be reduced so that alarms can be heard. As noted earlier, the presence of competing noise can make it difficult to differentiate between and hear the alarms. "AORN recommends the incorporation of noise-reduction interventions into any action plans developed to decrease distractions," Burlingame says.

5. Changes in alarm default parameters (e.g., volume, high or low limits) should be communicated verbally and visually during changes of personnel, including using a clearly distinguishable visual cue, such as posting a sign, to indicate the change in the default. "It is critical that any changes made to default alarm settings are effectively shared with oncoming personnel," he says. "This will prepare them to respond appropriately to the new settings."

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