Mobile App Reduces Alarm Fatigue

A mobile app that integrates clinicians' phone with infusion pump alerts is reducing alarm fatigue among staff at a small Wyoming hospital.

Alarm fatigue is a common condition among clinical staff in hospitals. Symptoms of the affliction may include sensory overload, desensitization, and missed alarms.

Now mobile apps that can pre-empt alarms and improve workflow are being tested as possible remedies.

An 88-bed hospital in tiny Sheridan, WY, (population 17,828) is a beta site for one such app.

Sheridan Memorial Hospital has integrated its infusion pump technology with Cerner's CareAware Connect app residing on clinicians' mobile phones. As a result, nurses, physicians, and pharmacists at the hospital can now track the progress of infusions using the same interface they use to securely communicate with each other.

Five years ago, everything at Sheridan was paper-based. But with the recent opening of the hospital's ICU, the ability to connect CareAware Connect to the hospital's infusion systems supplied by Pfizer subsidiary Hospira was an opportunity to move this small hospital toward greater interoperability and technological workflow integration.

Problem: Alarm Fatigue
Alarm fatigue was a concern at Sheridan, as it is at many hospitals. Nurses who could see just how soon those alarms would begin to sound are now able to attend to infusions whose supplies need restocking, or which have run their course.

"We've been on this journey for the last five years, layer upon layer, adding the different clinical components and integration opportunities along the way," says Charlotte Mather, the hospital's chief nursing officer.

"This now allows better teamwork. The alarm is sent electronically to the phone or to the [nursing station] hub, and you get a real good idea about what it is you're needing for that patient before you're making a trip into that patient's room."

The messages on the app are specific: A bag of fluid is depleted; an infusion tube has a kink in it. The app also presents a subset of the kind of data one would find in an EHR, such as an allergy list, as well as telemetry data such as vital signs, all aimed at assisting nurses with knowing more about the patients in the ICU or other hospital beds.

"The big thing with the infusion management is the unit-based dashboard that's in the clinical units as well as in the pharmacy itself," Mather says. Nurses see alarms and know when they need to return to the patient's room; pharmacists know when to start preparing replacement bags of critical fluids.

"It's like air traffic control. So you see a visual picture of all of the infusions that are running either in that unit, or in the pharmacy, in the whole hospital.

A 'Great Visual Tool'
"You have a real good idea from your team perspective in communicating between both departments what is going on, what infusion do I need to pay attention to, especially if I'm the charge nurse, or I'm the nurse manager, I'm the pharmacist. It helps you coordinate care."

From a physician's standpoint, she says, "when they're rounding on a unit, they can just get a real quick look too, or if they're in the intensive care unit, where a lot of those real critical drips and intensity of medications are being used, they can look and see real quick in one visual picture about what infusions are running at what rate and how much has gone in."

Mather calls it "a great visual tool to give you a picture about that medication piece for that patient."

Among the lessons learned, Mather says: "It was really important to test every single medication and then on the actual alerts. I tested all kinds of different ways. You just have to test over and over to make sure you are getting the correct alert at the correct time. So I guess the big thing is just test all the time, or test everything."