EHR alarm fatigue and poor EHR data integrity issues top ECRI’s annual list of health IT hazards and patient safety risks.
- A lack of health data integrity, the impact of overwhelming EHR alerts and safety management systems, and medical device failures are among the top healthcare technology hazards in 2015, says a new report from the ECRI Institute. The annual list of warnings for healthcare providers flags EHR alarm fatigue as the biggest potential problem for providers for the fourth year in a row. Coupled with the repeated appearance of poor data integrity, the list indicates an ongoing need for better clinical data management and improved analytics systems that produce smarter, less frequent, and more immediately important warnings for busy clinicians.
“Caregivers rely on medical device alarms to inform them about changes in the patient’s status or circumstances that could adversely affect the patient’s care. When this warning system fails or is ineffective, patients can be harmed—as evidenced by numerous reports of alarm-related deaths and serious injuries,” the report explains. While alarm fatigue from too many flashing lights, pop-up boxes, or noises is a significant problem for patient safety, the report adds that fatigue isn’t the only issue that decreases the usefulness of EHR alerts. Missed alarms or unrecognized alarm conditions add to the dangers, and often stem from inadequate initial configuration of EHR systems.
Second on the 2015 list of hazards is a lack of data integrity, including missing data or incorrect data in EHRs and other health IT systems. Providers are unable to make the best possible decisions for their patients when they are missing critical information – including data that can produce misfiring alarms or cause an EHR to skip an important alert all together. As clinical analytics systems become increasingly important for predicting patient outcomes, such as identifying sepsis in its early stages or prompting clinicians to move a deteriorating patient to the ICU, organizations must continue to place a sharp focus on ensuring that data input remains complete and consistent.
In order to ensure that EHRs can function at their best when producing alerts, storing patient data, and performing analytics processes to aid providers with clinical decision support or early warnings, providers are encouraged to take a periodic look at their settings and configurations. ECRI recommends that healthcare organizations establish policies to address these issues and review the policies for clinical relevance and completeness.
For EHR alerts, such policies should include guidelines on who is authorized to make changes to alarm settings, what types of education are needed for staff members and at what interval, and the processes for determining when and how to reset defaults, make changes to settings for specific patients, and how to ensure that each device is properly configured.
Data integrity is a wide-ranging issue that impacts much more than EHR alarm systems, but providers that are having trouble with EHR alerts should look to the completeness and accuracy of their EHR input as part of their solutions. Before implementing new systems or significant changes to EHR alert mechanisms, providers should assess the data input workflow to highlight any deficiencies, shortcuts, or improper procedures. Education and training should be provided to all staff members who have access to EHR inputs, and organizations should establish blame-free policies that encourage staff members to report potential incidents, including near-misses, that may have an impact on the safety of patients.