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Five ways effective use of alerts helps improve patient safety

Jennifer Knapp, Director, Strategic Partnerships and Solutions Vocera Communications
Written by: Jennifer Knapp

A hospital’s team of respiratory therapists had trouble keeping up with STAT orders. Sometimes the orders were buried within patient records in the EHR. Often the therapists couldn’t access the EHR for hours while engaged with a patient or on a transport. Occasionally they missed orders altogether.

The hospital realized that leaving order detection to chance could put patients at risk. It set up the EHR to automatically send alerts for STAT orders directly to the team on their mobile phones. Now they’re notified immediately if an order is waiting, which helps speed patient care.

This is a simple yet illustrative example of why proactive alerts are so important to patient safety.

According to The Joint Commission, 69 percent of accidental deaths and injuries in hospitals are caused by communication breakdowns1. We have more data than ever, but it resides in disparate systems and care teams do not have time to sift through all the information to determine what is actionable.

In many clinical scenarios, sending proactive alerts and alarms directly to care team members on their mobile devices – when and where they need them most – can improve patient safety. Five scenarios stand out for me.

1. Early Warnings of Deterioration Speed Sepsis Risk Response

A variety of solutions are available for detecting signs of clinical deterioration. These range from basic modified early warning score systems, to algorithms that pull data from a range of sources to pinpoint when a patient is nearing trouble in order to proactively communicate risk warnings to caregivers. An early warning system that surveils for patient deterioration, paired with a notification solution that sends real-time alerts, can speed response time.

2. Pain Assessment Reminders Help Prevent Drug Overuse

Opioid overuse threatens patient safety because liberal dosing and administration can result in respiratory depression and respiratory arrest. It’s important for caregivers to receive timely reminders to assess pain levels and administer medications appropriately. When medication is administered, the electronic medication administration record can start a timer and deliver a reminder to the nurse’s mobile device. Closing the loop enables therapeutic pain management and earlier detection of adverse events, and supports The Joint Commission’s pain management standards.

3. Bed Exit Alarms Help Prevent Falls

Fast response is critical for preventing patient falls. The University of Arkansas for Medical Sciences reduced falls by 11 percent and fall-related injuries by 60 percent in its first year of sending bed exit notifications to care team members on their mobile devices, resulting in $1.27 million in savings. Evans Army Community Hospital reduced falls by 88 percent by sending call light alerts directly to nurses.

Combining fall risk scores with nurse call requests enables alerts to be sent at different priority levels. For example, if a patient is a fall risk and needs to use the bathroom, that alert can be delivered with a higher priority than other nurse call requests.

4. RTLS Alerts Enable Fast Intervention

Seconds matter when intervening in a potential patient abduction or elopement. A real-time location system (RTLS) can send alerts to nearby team members with details about the patient and their location, enabling quicker response. Because RTLS alerts sometimes trigger accidentally, there are also options for canceling them from mobile devices.

5. Prioritizing Physiologic Monitor Alarms Helps Stem Interruption Fatigue

According to The Joint Commission, 85 to 99 percent of alarms don’t require clinical intervention1. Filtering out the noise so only actionable alarms are delivered can significantly reduce the risks associated with alarm fatigue.

At a hospital in New York City, the 64-bed telemetry unit generated 13,000 alarms per day. Each nurse received an alarm every two minutes on average. Nurses risked ignoring alarms that mattered because so few were clinically significant. After implementing an alarm management system configured to deliver only actionable alarms and to send clinical context directly to nurses’ smartphones, the alarm count dropped to 1,000 per day.

Better for Patients, Better for Clinicians

When used judiciously, proactive alerts and alarms can significantly enhance patient safety. It’s a best practice for an alarm committee to assess alert and alarm utilization broadly and guide decisions about alarm management. A great resource for more information is AAMI’s Clinical Alarm Management Compendium. It’s designed to help healthcare organizations meet The Joint Commission’s National Patient Safety Goal on clinical alarms.