To read: ~ 5 minutes
If your hospital doesn’t have an alarm management committee, it has an alarm fatigue problem.
That’s what Shane Wilson, Productization Specialist at Connexall, has seen over his 8 years with the company, and throughout his extensive career in alarm management and workflow optimization.
Many hospitals insist on a kind of “DIY” approach to alarm management. They set up their systems without expert implementation guidance and forego a dedicated alarm management committee. “They believe they can do it themselves, and then three days later: staff are revolting.”
Without the oversight an alarm management committee can provide, these hospitals fall into a similar paradox:
- The IT teams installing the alarm management system often opt to send “every alarm to everyone” out of an abundance of caution
- Nurses and clinical staff, bombarded by alarms in patient rooms, on floor monitors, and on their individual devices choose to ignore everything they consider non-urgent
- Patients’ are put at risk when critical alarms get lost in the noise.
In these cases, a hospital’s best intentions become the source of their problem, rather than the solution.
Effective alarm management requires a dedicated multidisciplinary committee, led by clinical stakeholders who truly understand both the burden of out-of-control alarms and the specific needs and workflows of clinical staff.
In this piece, Wilson shares his 4-step approach to coordinating your people to build a culture of safety and efficiency around your alarm system.
Building a Committee to Bridge the Organizational Divide
An effective alarm committee needs to account for both technical and clinical priorities. “The clinician should have the last word in every circumstance that touches clinical workflow or patient safety,” emphasizes Wilson. “The tech folks are there to provide the tools, not make the final call.”
The Connexall approach to alarm management committees
Wilson and the Connexall Clinical team (creators of Clinical Elevate) favor a clinician-first approach that avoids two ineffective extremes: purely technical approaches that lead to alarm overload, and those that lean too heavily on clinicians and underutilize the available tech features and functionalities.
Instead, Wilson recommends utilizing your teams’ clinical expertise to guide implementation, with support from those with more advanced technical capabilities.
“An effective alarm committee needs IT support,” says Wilson, “but that support should be focused on continuous data-driven optimization rather than one-time configuration efforts.”
From Questions to Answers: the Impact of Alarm Committees on Alarm Fatigue
When Connexall implements the Clinical Elevate program at client hospitals—over the course of a 12-month engagement—they’ve found a clear common thread:
Every hospital with an effective alarm management system also has an alarm management committee that reflects the needs and goals of their specific healthcare organization. Those committees have several things in common, and there are concrete steps any organization can take to get there.
Step 1: Form a Clinically-Led Multidisciplinary Committee
Nurses are the “front line” when it comes to alarm management (and the resulting fatigue) and their input, trust, and buy-in are critical to the long-term success of any alarm management system.
Including a Nursing Lead as a part of your committee’s leadership is a great way to ensure your nursing staff is well-represented, and will help establish early trust in your system.
Your committee should also include:
- Equal representation for both IT and clinical teams — though clinicians should always have the final say over any technology that will impact clinical workflows
- Representatives from all affected departments and units, to encourage discussion of the diversity of needs and limitations that exist in any hospital.
- Clear roles, responsibilities, and goals so all the members of the committee are aligned on the decision-making processes and are empowered to work towards their planned outcomes.
- A strong communication and education plan to ensure alignment for all stakeholders.
This clinically-led, multidisciplinary alarm management committee will set the tone for alarm management throughout your hospital, so prioritize broad representation.
Step 2: Implement Data Collection and Analysis Systems
Once you establish an alarm management committee, utilizing data is the fastest route to creating systems and best practices that serve the specific needs of your clinical staff.
Some of the ways you can collect and analyze data to empower your alarm committee are:
- Developing systems to track alarm volumes, types, and response times
- Deploying daily reports that units can review to identify ongoing patterns or issues in alarm response, or lack thereof
- Creating visualization tools that make alarm data accessible to the entire committee
- Using data to identify the small percentage of patients who are generating most of the alarms.
By equipping your alarm management committee with insights surrounding alarm protocols and workflows in your organization—even the ones that aren’t working—they’ll be better equipped to tackle alarm fatigue, right from the source.
Step 3: Review and Optimize Primary Alarm Sources
One of the huge benefits of implementing the recommendations about alarm management from the committee is that hospitals can actively manage patient monitors. They can:
- Adjust default settings on monitoring equipment based on patient population
- Develop unit-specific protocols for modifying alarm parameters
- Implement patient-specific adjustments for high-alarm patients
Focus on High-Alarm Patients
“At most hospitals,” says Wilson, “10% of patients generate 80% of the alerts.” In those cases, you need to quantify what “normal” looks like. For example: if the monitor has a range for heart rate between X and Y, but the patient’s typical range is much higher than that, they will set off alarms—even though there may be nothing clinically amiss with that patient.
Personalize Monitoring Parameters
In those cases, your alarm management committee can give recommendations about oversight permissions to the hospital. According to their policies, the hospital can then give oversight to the clinicians themselves, allowing them to change ranges right inside the monitor. They can adjust the range to reflect the patient’s “normal,” rather than the monitor’s.
Empowering staff to make changes that reflect a patient’s reality (rather than pre-set alarm parameters) can mean the difference between a patient room ringing with alarms—and compromising nurse sanity—and one that’s blissfully quiet.
Step 4: Design Intentional Secondary Notification Workflows
When Wilson is advising hospital alarm committees, he encourages them to be very intentional about sending Connexall’s secondary alarms. “You have to understand the value of each alarm,” he says, “and there should be clear expectations about what kind of action should be taken in response.”
Secondary alarms serve a specific purpose
Nurses are still responsible for all the primary alarms in the native systems. So it’s important that secondary alarms don’t simply replicate that native system. To create an optimal secondary alarm notification program within your hospital, you’ll want to :
- Create a clear distinction between primary and secondary alarms. Don’t resend every native alarm just so “everyone gets everything.” Be intentional and make sure there’s a clear action attached to every alert. (Not sure which alarms deserve your attention? Our clinical team can help.)
- Develop a “pull” rather than a “push” approach to alarm notifications. Start with just a handful of critical alarms, and let clinicians request any additional alerts they’d like to receive.
- Implement appropriate delays and filtering mechanisms. Even a fifteen second delay could prevent a false alarm from being sent—freeing up your clinicians to respond to the urgent alerts that deserve their full attention.
- Design different workflows for different alarm types. Alarms for lead’s off or low battery can get sent directly to a technical team, and avoid the clinical flow entirely.
When you’re intentional about secondary notifications, alarm fatigue drops. Nurses’ phones don’t ring with every unnecessary alert, so when they do get the call: they actually answer.
An End to Alarm Fatigue: Alarm Management Committees in Action
Organizations that implement proper alarm management committees can achieve dramatic reductions in alarm volume, while maintaining—even improving—patient safety. In the best case, says Wilson, “Clinical staff are getting fewer alarms, but they’re more meaningful.” Alarm management aims to ensure that hospital staff get the right alarm at the right time, driving better outcomes between caregivers and patients.
In the case of Connexall client Novant Health, implementing these practices resulted in a 43% reduction in alarms. When nurses know that alarms are meaningful, and require action, they begin to trust the system rather than searching for ways to work around it.
Over Wilson’s many years working with client hospitals, he’s seen the impact of a well-functioning alarm committee:
- Response times shrink significantly for truly important notifications
- Systems and workflows continuously evolve as the committee analyzes new usage data
- Noise and interruptions within each floor and department diminish, as staff satisfaction increases
Alarm fatigue isn’t inevitable—it’s a solvable problem that starts with bringing the right voices to the table and letting clinical expertise lead the way.
