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How Monitors and Alarms Should Work

October 28, 2010

We seem to have become numb to the beeps. 

When I’ve stayed in an ICU room as a patient or with a relative, I’ve noticed how it seems that the only thing accomplished by our current monitors is to wake up the patient.  The alarms start beeping, the patient is rudely awakened, but the nurse doesn’t come to the bedside.  It’s true that, in many cases, the alarms shut off on their own if the problem disappears.  But why should it go off in the room at all?  We don’t have one-to-one nursing anymore, so the nurse is more commonly out of the room than in it.  Thus, the only individual consistently hearing the alarms is the patient.

I guess I’ve got a personal beef with this issue, because it seemed like a stupid reason for a sleepless night.  I had just undergone back surgery for a herniated disc.  Because I was over 50, I was placed in a monitored stepdown unit on the hospital’s beta-blocker protocol to prevent my heart from getting stressed.  When I fell asleep, my heart rate would drop below 60 beats per minute, and the alarm would sound off.  I’d immediately wake up, which caused my heart rate to speed up, and the alarm would stop.   I’d fall back asleep, and the process would happen all over again.  I think I woke up needlessly about 4 or 5 times from the alarms firing off, but the nurse never responded.  (You also have to wonder if those sudden increases in the heart rate are considered a good thing.)  Finally, I hit the call button.  The nurse came in, and I explained what was happening.  I asked her if she could turn the alarm’s trigger to 50 beats per minute, and I promised her I wouldn’t code.  She did, and I was able to sleep through the rest of the night.

I’d like to see a paradigm shift in medicine where beeping alarms are obsolete.  Instead, an alarm should state the precise problem.  The technology for computerized devices to speak has existed for decades.  “The heart rate is 140 beats per minute” would be an important message, and one that would produce a more immediate response than a beep that sounds like all the other beeps.  The monitor should announce its message in the room while simultaneously sending the nurse (and possibly the physician) a page or text message with the information.  Or, even better, if the monitor knows that only the patient is in the room, it wouldn’t sound off there at all, but only send a page with the message to the responding clinicians.

That way we could get our sleep while others scurry around to fix the problem.

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