Technology advancements have made patient monitors indispensable to healthcare providers, to the point where the thought of removing patient monitors from critical care units, ORs, EDs, and other settings is laughable. But what isn’t funny is the unacceptably high percentage of false alerts triggered by patient monitors. Studies have shown that more than 85% of alarms generated by monitors are false or clinically irrelevant. 

In a sense, improvements in patient monitors caused the problem. The systems monitor so many parameters and are so sensitive that the stage is set for a high rate of false alarms. Each parameter has a different alarm threshold, triggered when a patient’s vital signs reach the predetermined level.

“The more alerts you generate and the more data you pull in, the more chances there are for false alerts. Where we 

are trying to go with monitoring is to use our strength in IT to do some back-end processing in clinically meaningful ways,” said Karen Giuliano, RN, PhD, and principal scientist with Philips Healthcare. “We need to have raw data communicate behind the scenes in a way that will support clinical decisionmaking.” 

Philips Healthcare’s IntelliVue monitors are indeed helping provide a more complete understanding of patient status based on the collection and combination of physiological data. The IntelliVue suite of products can suit any clinical setting and are highly configurable based on customer needs. 

The user interface and functionality is the same in every monitor in the IntelliVue family, providing continuous monitoring and a seamless patient picture regardless of where they are in the hospital. But even this market-leading technology is susceptible to a high percentage of false alarms. This is an issue Philips is working to correct. 

“We spend a lot of time refining our algorithms so our systems work better,” said Patricia McGaffigan, critical care director at Philips Healthcare. “That way, our monitors can present information in an intuitive manner and help clinicians make better judgments about treatment options.”

Smarter systems

In fact, intelligent alarm algorithms are a key piece of improving patient monitors and reducing false alarms. They integrate physiological data in a way that can provide an earlier picture of a patient’s condition. Combining this data and establishing more accurate clinical thresholds that trigger alarms should eventually reduce the false alarm rate. 

Another company using intelligent algorithms to improve patient safety and monitor accuracy is OBS Medical. Its Visensia product analyzes and interprets the combined patterns of separate vital signs. It can monitor heart rate, respiratory rate, blood pressure, temperature, and oxygen saturation, combining that information into the Visensia Index, which ranges from zero to five. A reading near zero indicates a stable patient. If the index hits three, an alert is triggered.

“Caregivers reacting to an alert provide intervention with the patient and assess what is going on to keep the patient from severely deteriorating,” said Wayne Nethercutt, COO at OBS Medical. “When you fuse vital signs with a smart algorithm, the system can sense deterioration in the patient’s condition earlier. Early warnings help clinicians avoid some of the critically unstable events that require the activation of a rapid response team.”

Visensia Bedside can be installed in patient rooms, connected to multi-parameter patient monitors, and provide real-time patient information. It can interface with bedside monitors, monitoring central stations and servers, telemetry systems, and EMRs. Visual and audio alerts are sent if the patient hits level three, and they can be sent directly to pagers and phones. Visensia Center is installed centrally, interfacing with one or multiple vital sign sources and providing real-time information on up to 48 patients, while Visensia VitalCharting allows for paperless charting of patient vital signs. 

“The system is designed to catch potential issues earlier by combining several parameters. We have a central monitor of all of our patients, and the Visensia Index is on each one, providing a global idea of the acuity of our patients,” added Lisbeth Votruba, clinical nurse specialist at Saint Mary’s Health Care. “That helps determine the patients in need of immediate attention and prioritizes alarms, adding the intuition of an experienced nurse and validating caregiver concerns and decisions on the cases where higher levels of care are needed.” 

Fighting alarm fatigue

Overall, the fact that systems are so sensitive and track so much information is good. Modern systems are, for the most part, easy to set up, easy to use, and quickly disseminate information to the appropriate caregivers. At Children’s National Medical Center in Washington, DC, the organization uses IntelliVue monitors, which are user friendly, have touch-screen capability, and send alarms that are audible at the bedside and forwarded to caregivers through wireless communication devices when they are away from the bed.

Similarly, at Saint Mary’s Health Care in Grand Rapids, which uses both Philips and GE Healthcare monitors as well as OBS Medical’s Visensia technology, the issue is not how much patient data is being monitored or how alerts are sent. The biggest issues are alarm fatigue and accuracy.

By taking advantage of networking opportunities and partnerships with manufacturers, providers can influence the direction patient monitoring technology takes. One such effort is under way at Children’s National Medical Center. In conjunction with Philips, the medical center is conducting a study looking specifically at alarms generated in its pediatric intensive care unit. 

 

Through data collection and analysis, the study hopes to come up with parameters to be used in algorithms that would increase sensitivity and specificity of the information clinicians get at bedside, increasing the positive predictive value of the information monitors provide. The three-phase study is in its first phase, having just completed data collection and begun analysis.

“My goal from a nursing systems perspective is to make sure we have equipment and technology available that enhances rather than impedes the critical nature of decisions clinicians have to make minute by minute,” said Linda Talley, MS/RN, VP for nursing systems and neonatal services at Children’s National Medical Center. “Clinicians need information they can extract from technology that is meaningful, concrete, reduces the possibility for error, and narrows the safety gap to one where information is used to drive clinical decisionmaking.” 

 

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