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RTN1307_B1_Alarms (NPSG.06.01.01)


Recommended Readings, Tips & Pearls

PR: Anchor The Joint Commission Announces 2014 National Patient Safety Goal[®] [REF: EOC, MD, RN, SFT] Perspectives, July 2013, Vol 33, #7, Pg 1

Three months ago TJC published a Sentinel Event Alert (SEA) on Medical Device Alarm Safety in Hospitals (Issue 50, April 8, 2003).  At the time, we did not think it particularly relevant to psychiatric hospitals and did not review it.  After all, it is the rare psych hospital that has beside telemetry, central station monitors, infusion pumps or ventilators.  Now we find the one new NPSG for 2014, NPSG.06.01.01 focuses on improving the safety of clinical alarm systems.  TJC says the standard applies to any hospital that utilizes clinical alarm systems.  For psychiatric hospitals, not many such systems come to mind and so we would like to use this review as a survey.  If you currently use/have any patient care related instruments or devices that employ a ‘Clinical Alarm’, please click on the comments link above this article to describe your device and response to this new requirement.  
Tip: Leaders should task those responsible for medical equipment to develop an inventory of alarm-equipped devices and involve Medical Staff to determine if any are utilized for high-risk/critical clinical conditions.  If none are found, document the effort in minutes.  If some exist, proceed to comply with the rest of NPSG.06.01.01 requirements.
Key Def: SIG says TJC is working on a formal definition for ‘Clinical Alarms’ but for now the working definition is “those alarms that are attached to the patient or any other alarm deemed critical by the organization”.  To help with your initial definition of critical, we suggest this definition: A critical clinical alarm is any audible or visual indication from a system or device, that when activated, may result in the injury or death of a patient unless immediate clinical intervention results [from Ensuring the Effectivenss of Clinical Alarm Systems  -includes a Clinical Alarm Risk Assessment tool].

See also: Comments attached to this article for more details

 

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3 responses to “RTN1307_B1_Alarms (NPSG.06.01.01)”

  1. FYI: Clinical Alarms Sound Off: The Joint Commission tackles alarm noise and safety control with new 2014 National Patient Safety Goal [FYI:EOC, RN, SFT]
    • This is a slightly more condensed (2-page version) of the above article (The Joint Commission Announces 2014 National Patient Safety Goal  [REF:EOC, RN, SFT] Perspectives, July 2013, Vol 33, #7, Pg 1). It again describes the 2 phases of implementation and provides suggested compliance strategies.

  2. FYI: 11/25/13
    Original Question:
    How will NPSG.06.01.01 be applied to psychiatric hospitals that do not have bedside telemetry, central station monitors, infusion pumps or ventilators? Will such hospitals still be required to establish alarm system safety as a hospital priority?

    SIG Response:
    Thank you for your inquiry. The standard is related to clinical alarm. If your organization has any sort of clinical alarms the standard would apply. You may want to query the organization to ensure there are no clinical alarms.

  3. New R3 Report Addresses NPSG.06.01.01 – Perspectives, February 2013 ● Volume 34 ● Number 2, Page 1

    The Joint Commission Develops R3Report for Clinical Alarm National Patient Safety Goal – The Source, February 2013 ● Volume 12 ● Number 2, Page 11

    “The goal addresses clinical alarms that can compromise
    patient safety if they are not properly managed. This includes
    alarms from equipment such as cardiac monitors, IV
    machines, ventilators, and so forth that have visual and/or
    auditory components. In general, this does not include items
    such as nurse call systems, alerts from computerized provider
    order entry, or other information technology systems.”

    FYI: R3 Report Issue 5 – Alarm system safety (12/11/13) – Review this report for more official details (i.e., requirements, rationale, and references/bibliography) on NPSG.06.01.01 (Clinical Alarms) from TJC

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