AlarmsF. Amos Bailey, MD Dec 14, 2017
The “Internet of Things” describes the increasing trend to connect everything through the web. You can now remotely turn on your lights, adjust the temperature or even let a delivery or service provider into your home. In addition, you will be alerted when there is a “problem”. The Internet of Things is also interested in our bodies, recording the number of steps we take, stairs we climb, heartrate, and for me when and if I meditate or exercise. It seems to take joy in sending me cheerful reminders if I don’t.
My introduction to this hyper-monitored environment was when I first entered the ICU as a medical student. My senses were overwhelmed with the sounds of machines, voices and alarms. They often are false alarms or not really emergencies.
In today’s practice
We make time for our patient/family meeting and silence our phones and beepers, gather round and just when we are at the most critical point in the conversation guaranteed the IV will to beep! Recently, researchers have been studying Alarm Fatigue in the ICU. This is the dangerous tendency to ignore alarms when they are mostly false; to walk, not run, in response. The focus has been on the staff but I am thinking of the patient and family. I have seen many patients exasperated by the alarms they have no control over. When their families are present they look up to the monitor and not down to the patient. Particularly at end-of-life this seems tragic and misplaced.
Turning off the alarms
Marty had very bad heart disease. He and Renee had married in their 40’s and made a life together. A few years later Marty had the first of many heart attacks. This was ironic in that Renee was an accomplished CCU nurse at one of my training hospitals in the 1980’s. Marty had an irritable heart and on many occasions his alarms were for something serious, V-tach. Renee scrounged together a telemetry machine and a defibrillator and transformed their bedroom into a CCU. Over the next 6 months she kept Marty alive. Still his heart disease worsened. Now he was back in the CCU and late one night he was coding again. Renee, broke away from her nursing friends and ran to the door with a single command. “STOP.” Then collapsed in tears and grief in the arms of her friends. The telemetry machine was making the alarm you get when there is asystole and we had stopped. Suddenly the familiar beep of a sinus rhythm came back on the monitor but no blood pressure, no pulse. A false alarm that life had returned. The lead physician reached up and turned the monitor off.
How can we balance the ability to monitor and respond to an alarm with caring presence?