Alarm fatigue is a major issue facing clinicians and device manufacturers. Although efforts are underway to establish protocols to address the over abundance of nuisance alarms leading to alarm fatigue, more can be done from the device development side. Insight’s experience on more than 380 medical device projects has led us to understand that following standards and regulatory guidelines alone do not create successful alarm system. Systems should be crafted to create positive clinical experiences and patient outcomes. Insight advocates designing alarms systems with these principles in mind:
Take the Settings Out of Settings
When we design system UI’s, we always say “they should have good defaults” since users are not likely to change them. This principle holds true for all types of technology, including medical devices. If alarms settings are treated like any other setting, they will undoubtedly be left at their defaults. Insight’s belief is that the adjustment and review of alarm attributes, like thresholds, delays, signal volume, and priority level, should be positioned within the primary workflows and routines. This could be handle by having the user configure settings when first setting up the device or by routinely prompting them to review and ensure settings align with the patient’s condition. This reframing should be done with care to avoid creating a new type of burden on the user, one that conflicts their ideal workflow (e.g. “I am always being alerted to check my patient’s alarm settings.”)
Flexibility for Patient and Protocol
Alarms system must not be rigid. Several studies have shown that when clinicians are allowed to configure alarm thresholds, change the priority designations of alarm condition, or build in delays to alarm signaling nuisance alarms are reduced greatly. Clinicians will grow more confident in an alarm system when they can use their expertise to align alarms with individual patient’s conditions as well as their personal workflows. Control over alarm settings creates a feeling of ownership for an clinicians, minimizing situations where alarms would be disregarded. It is likely that future systems will be able to analyze patient data and adjust settings based on the changing patient condition. These smart systems are an exciting possibility but clinicians need to be kept engaged so they remain confident the alarms are assisting them in improving patient outcomes.
Drive User Expectations
One of the recognized factors creating alarm fatigue is the clinical staff’s (as well as the patient’s) lack of understanding around what is making an alarm system activate. The “cry wolf” effect occurs because the expectations for how and when an alarm system will signal do no align with those of clinicians. More can be done to help the users familiarize themselves with the operation of the alarm system. A UI can allow users to test alarms to see and hear how the device will act. The system could offer further details describing the perceived causes and suggested response. During alarm conditions a system can provide context and related information so clinicians can make informed decision about the severity of the alarm. Hands-on interactive training and informative details will set up the right expectation around alarm signals.
Keeping these principles in mind will help devices keep users engage so they can be invested in the care management. While advanced technologies are creating new possibilities in the healthcare space, it is not enough to just migrate to these advancements. User goals and successful patient outcomes must remain the central focus of alarm system design.