Monday, August 11, 2014

Clinical alarm systems are intended to alert medical personnel of possible patient health-related issues. While these alarms help ensure patient safety, they also can create alarm fatigue in clinicians.

According to The Joint Commission, a nonprofit organization that accredits more than 20,000 health care organizations and programs in the United States, medical staff can become desensitized to alarms in noisy environments resulting from numerous alarms. The Joint Commission further states that between 85 to 99 percent of alarms don’t require clinical intervention.


Todd Papke

These fatigued clinicians may turn down the alarm volume, turn off the alarm, and adjust alarm settings, possibly compromising patient safety. In response, The Joint Commission initiated the 2014 National Patient Safety Goal. This goal requires hospitals to establish policies and procedures for managing their alarm systems by Jan. 1, 2016.

Todd Papke, a Ph.D. graduate in health informatics at the University of Iowa, says personalized alerts is a possible solution for alarm fatigue. Papke’s dissertation, “Personal Audio Alerts in Medicine” concludes that personalization of alarms may improve information delivery and reduce overload on health care providers.

“Right now, when the alarms go off, there is unnecessary cognitive load on the nurses,” Papke says. “What kind of alarm is it? Is it a high priority alarm or a low priority alarm? Where is it?

“My study shows if you let someone create their own alert sounds, they will respond to them faster and remember them longer than they would if they use the current standard sounds.”

Papke created a Personalized Alert Study Application (PASA) that allows him to capture, edit, and compare sounds for effectiveness in the clinical setting. Papke used PASA to facilitate his study in which participants’ responses to personalized sounds were contrasted with their responses to sounds that meet the current standard established by the International Organization for Standardization (ISO) and International Electrotechnical Commission (IEC).

Twenty-four students in the UI’s College of Nursing created their own alarms, ranging from high priority to low priority, using a variety of sounds, including sound clips from movies, recordings of their own voices, and clips of classical music. Participants completed consecutive tests to evaluate their ability to recognize their alerts versus the standard melodic alerts. Eleven participants worked with 6 alarms at a time; thirteen participants worked with 10 alarms.

The students responded to 100 alerts per test by touching an iPad icon that corresponded to a specific physiological condition.

Study results

Papke observed that accuracy, reaction time, and retention were significantly improved with the personalized sounds. Median errors for the 6-alert study were 4 for personalized alarms compared with 27 for standard alarms. Median errors for the 10-alert study was 1 for personalized alarms versus 55 for standard alarms.

"If future technology allows us to let people personalize the information they are receiving, then we might very well allow nurses to create their own alert sounds,” says Papke, whose thesis supervisor was Prakash Nadkarni, UI research professor of internal medicine.

Papke will make PASA publicly available for those interested in studying personalized alarm viability in critical care environments. PASA is a stand-alone application that runs on Macintosh and Windows computers.