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During my recent visit to ECRI to hear more about their watch list for safety innovations in healthcare, the topic of alarm fatigue was brought up. In fact, it’s an item that comes up quite often at ECRI in terms of their hazards lists [#1 concern on the list for the past four years (check out the 2015 and 2014 lists)]. It was also one of the “featured” topics during the media day event.

Rob Maliff, director of the Applied Solutions Group at ECRI spoke to the members of the press on the topic of alarm fatigue. He cited the findings of a Joint Commission database that included 80 deaths that were tied to alarm fatigue.

“They could do more,” he stated during the event with regard to OEMs addressing this problem. But he’s also fully aware that it’s a complex issue and one that’s not so easily fixed.

ECRI colleague Rikin Shah agreed. Shah is a senior associate in the Applied Solutions group. He said, “Medical device manufacturers need to start developing smarter alarms, and start creating alarms so that the algorithms start thinking like clinicians would, though there are some restrictions that the vendors have in how they manufacture their products. We need to start looking toward trends that start combining multiple parameters — start looking at some other industries to find common grounds, such as airlines.”

Maliff did speak to one potential solution that could at least help to alleviate some of the current problem. Middleware is software that helps connect systems that do not “speak the same language.” In the healthcare environment, this means that a heart monitor could “communicate” with a nurses’ smartphone or critical data from a patient’s electronic record could be easily retrieved on a doctor’s tablet. It’s not a perfect solution, but it is better than not having anything connected at all.

With regard to alarm fatigue, middleware helps to ensure the most important alerts get the necessary attention. However, it is a solution that needs to be implemented across an entire hospital landscape to be successful. That means rolling it out across staff and technology and also maintaining it when new technologies need to be brought “online.”

“Middleware doesn’t necessary help mitigate the problem of alarm fatigue, but what it does help with is how to better manage the different alarms and alerts taking place from many of the systems,” said Shah. “Alarm fatigue needs to be addressed by proper alarm management methods. ECRI believes that by looking at the practice, infrastructure, culture, and technology and seeing their synergistic relationship, an organization can have a better understanding of alarm fatigue and how to manage their alarms better. However technologies like middleware are now smarter than ever by allowing users to create advanced rules in their systems so that the end users are more aware of how critical an alarm being emitted is. They are bringing the alarms right to the clinicians and they help reassign an alarm if the primary nurse is busy or not picking up an alarm. But once again, it is another tool in a system. It is one component of the alarm management strategy and it’s not the silver bullet.

Obviously, a much better solution would be to have standards in place that facilitated efficient communication across all devices. With all devices “speaking the same language,” healthcare efficiency would increase significantly. Nursing tasks such as data collection could be virtually eliminated, as all data would simply flow into the respective patients’ records seamlessly and without the opportunity for “user error” that can happen in the manual processing of this task.

Further, alarm fatigue would be greatly reduced in a connected healthcare environment since an alarm “priority” could be established. Obviously, the alarms that represent the most serious issue would get highest notification status and be “broadcast” to all available personnel. The alarms that represent a low priority issue, such as a displaced sensor, could go into a queue of issues that need to be addressed but don’t represent a critical concern.

In learning more about the problem of alarm fatigue, middleware, and communication standards, I’m convinced that it’s likely the only “silver bullet” for this problem is a standardized communication protocol where all devices “speak” to each other. Short of that, we’ll simply continue to put technology “band-aids” on the problem without truly fixing it.

What do you think? Is there another solution to alarm fatigue? Are standards unlikely to ever come about? Share your thoughts in the comments section below.

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This article first appeared at Medical Design Technology

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