AST Guideline - Best Practices in Alarm Management in the Operating Room

2 that do have critical consequences. This has led to the ECRI listing alarm hazards in its list of top ten health technology hazards multiple years including being the number one hazard in 2015. 10 The majority of research conducted in the operating room has been focused on anesthesia providers since they are responsible for managing most of the devices that have alarms. However, even this research has been limited. Therefore, the following are broad-based guidelines. But it must be emphasized that the CST serves as another “pair of eyes” in the OR and can best serve the patient through her/his knowledge of alarms. Evidence-based Research and Key Terms The research of articles, letters, nonrandomized trials, and randomized prospective studies is conducted using the Cochrane Database of Systematic Reviews and MEDLINE®, the U.S. National Library of Medicine® database of indexed citations and abstracts to medical and healthcare journal articles. The key terms used for the research of the guidelines include: actionable level; alarm fatigue; artifacts; buzzing; electrosurgical alarm; false alarms; medical device alarms; nuisance alarms; smart alarms. Key terms used in the guidelines are italicized and included in the glossary. Guideline I The surgery department should develop a systematic, coordinated approach to the safe management of alarms that involves the surgical team, information technology experts, healthcare technology management technicians (biomedical technicians), risk management and HDO administration. 1. TJC recommends the following broad actions that also reflect the recommendations of the Association for the Advancement of Medical Instrumentation (AAMI) and ECRI. 1, 2 These can be translated into actions that the surgery department should implement. A. Ensure that there is a process for safe alarm management and response with measurable results. 1) The leadership goals for establishing an alarm safety management program in the surgery department should be based upon the following goals: 2 a) Enhance patient care and patient safety b) Decrease nuisance alarms and alarm fatigue c) Ensure staff accountability and responsiveness to alarm signals and ensure they know their responsibility d) Improve productivity and work flow e) Increase patient and staff satisfaction f) Optimize technology g) Align with TJC National Patient Safety Goal on alarm management h) Make the HDO an environment of healing, where there is a decrease in the noise B. An inventory of alarm-equipped medical devices should be completed identifying the default alarm settings and the limits appropriate for each care area. 1) It is recommended to complete a failure mode and effects analysis (FMEA) on alarms. FMEA is an approach for identifying the possible failures that can occur with an alarm and the actions to take to eliminate