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Redesigning Hospital Alarms for Patient Safety Alarmed and Potentially Dangerous

Vineet Chopra, MD, MSc1,2; Laurence F. McMahon Jr, MD, MPH2,3
[+] Author Affiliations
1The Patient Safety Enhancement Program, Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, Michigan
2Department of Internal Medicine, University of Michigan Health System, Ann Arbor
3Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
JAMA. 2014;311(12):1199-1200. doi:10.1001/jama.2014.710.
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Because hospital alarms alert clinicians to deviations from a defined normal state, these auditory and visual signals are designed to improve patient safety. Contemporary alarms are diverse, ranging from devices that monitor heart rate to those that sound when patients try to leave their beds. Indeed, it is difficult to imagine modern health care without these electronic sentinels of safety.

Despite their benefits, alarms may also increase the possibility of harm. In a sentinel event alert, the Joint Commission called medical alarms a “frequent and persistent” patient safety problem and designated them 2014 National Patient Safety Goal No. 6 following reports of several alarm-associated deaths.1 Since 2010, the nonprofit ECRI Institute has also rated alarm problems among the top 10 health technology hazards, recently calling them “the number one medical hazard of 2014.”2 Notably, because alarm-associated adverse events are voluntarily reported, the true magnitude of this problem might exceed published estimates. Why may this technology have resulted in adverse outcomes?

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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