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Joined: Feb 2004
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Super Hero
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On the other hand ... no doubt we've all seen the "walking wounded" trundling along the corridors (intent, most likely, on nipping outside for a quick gasper), pushing their knackered drip-stands ahead of them, with the pump merrily alarming away! Now, perhaps there's a case for remote alarming! smile


If you don't inspect ... don't expect.
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Hiya,

If alarms on patient connected equipment are a source of confusion and annoyance for operators when their looking after the patients then I dont see how secondary and remote alarm notification systems are going to be of any benefit for operators or improve patient safety.

They'll just add another layer of complexity and confusion IMO.

Patient alarms fitted to monitors are meant to draw operators attention to immediately life threatening events or longer term degradation in patients health or technical faults in equipment.

If it is used Smart alarm technology should be built into OEM devices at the bedside IMO to aid the operator and improve patient safety not use it to benefit a Dr whos on a golf course or off skiing somewhere.

Whats being pushed in this thread earlier seems to be smart alarm system intended to either replace the necessary ones that have been designed by the OEM into monitoring equipment or to allow remote diagnostics to assist treatment. Not alarm notification technology as defined by FDA.

No wonder the FDA prevents companies pushing these sort of systems without them being considered a medical device or system in their own right and tested as such.

One benefit of alarms on monitors is that their simple and predictable even if their are problems with them their sensitive (over sensitive in fact). This means its failsafe if operators do respond to true and false positives at least.

Who knows what the situation would be with a system that overrides monitoring alarms using that monitors data? Lots of testing related to specific combinations of OEM monitors and alarm notification systems would then be needed to make sure it all works. Another reason why FDA probably doesnt encourage it.

Cant see a device manufacturer allowing other companies to override their alarm systems therby carrying the can for systems like this that have been "cobbled together" from bits and pieces of software using data grabbed off their monitors.

Clinical decision support systems that alert clincians to changes in patients status so they shouldn't be sold as alarm systems even if they do work in realtime.

One of the sysmptoms of alarm fatigue is ignoring alarms. The problem with lots of false alarms is that theirs cry wolf syndrome and when it is a true positive it gets ignored along with the rest.

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Super Hero
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I take it you're not a golfer, then, Rob? wink

Bravo, Mate ... we're with you on this one! Too many alarms ... why? Answer, too much (unnecessary) "monitoring"! Get the nurses off their butts and stepping up to the bedside, where they belong! smile

Last edited by Geoff Hannis; 28/03/08 1:32 PM. Reason: ...

If you don't inspect ... don't expect.
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Hiya,

Id say to many alarms coming from the same signal source leading to lots of uneccessary alarms.

Maybe theirs only a need for alarms on parameters that lead to death or injury within a couple of minutes.

Some of the blame for problems with alarms lies with the operators not setting them up correctly as defaults and then not setting them up properly in clinical use to suit the patients condition.

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Super Hero
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Back to training the donkey, then! We just have to keep banging on (regardless of the type of reaction that John mentioned yesterday). smile


If you don't inspect ... don't expect.
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Over on this side of the pond, alarm fatigue is more an issue in units with a nurse to patient ratio greater than 1:1 or 1:2, typically telemetry units and other high dependency units.

There's also a trend, called variable acuity or universal units, where patients are kept on their medical service, and medical devices like patient monitors and staffing ratios are increased if the patient's acuity goes up. The goal here is to avoid a transfer (which adds one day to the length of stay) while delivering appropriate care.

The number of patients requiring patient monitors, ventilators and pumps - who don't require 1:1 or 1:2 nurse to patient ratios seems to be growing. Or perhaps patients who once received more intensive nursing care are no longer getting it. Either way, the status quo is frequently creating alarm fatigue and resulting in failure to rescue.

John, I too have been on units where alarms are left to ring and ring, desensitizing staff and creating an adverse care environment. Sadly, little seems to be done here or in Europe.


Tim Gee: Connectologist & Principal at Medical Connectivity Consulting
contact | tim@medicalconnectivity.com - 503.481.2370 | Skype - connectologist
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