I Can’t Hear You!

I’m not always a great dad.  Sometimes I miss the mark or come up short.  Maybe more Homer Simpson than Heathcliff Huxtable.  It’s not my fault.  Not always.  I have three kids.  At any given time Kid 1 is calling Kid 2 names, Kid 2 is in Kid 3’s room, Kid 3 is touching Kid 1’s stuff, Kid 1 and 2 won’t let Kid 3 play, and Kid 1 and 3 are trying to deny Kid 2 her inalienable right under the 19^th Amendment to the United States Constitution…the right to vote for what everyone is going to watch on TV.  The he said, she said, what are you gonna do about it cacophony is like a Phil Spector-inspired soundtrack to my Thursday afternoons.  And not in a good way.

So last week when my daughter started screaming for me to come downstairs, I didn’t hear her.  I mean, I heard her, but I wasn’t listening.  I was making dinner, looking over homework, planning lunches, probably watching an old episode of the Patty Duke Show on MeTV, worrying about work, worrying about bills, wondering how Patty Duke could play both Patty and Cathy Lane decades before CGI, pretty much focusing on the hundred other things you gotta focus on because you’re a grown up and have responsibilities.  I wasn’t focusing on my daughter.  Until after awhile when her screaming changed.  Some part of me heard an urgency in her calls for help that was different.  And alarming.  And so I went to see what was going on, albeit begrudgingly.  At this point my daughter was in tears.  There was blood on her shirt and her pants.  She cradled a blood-soaked handkerchief that was held her pet guinea pig.  It seems she accidentally tore her guinea pig’s nail when she picked him up, and now it was bleeding.  Bleeding to death, in her eyes, by her hand, and she called for help and I didn’t come.

But it wasn’t my fault, not really.  It was alert fatigue.  There’s always a lot of noise at home.  Sometimes my noise, mostly theirs.  But lots of noise.  The number of alarms per kid per day can reach several hundred depending on the mix of kids, translating to thousands of alarm signals from every kid and tens of thousands of alarm signals throughout the house every day. It is estimated that between 85 and 99 percent of alarm signals do not require my intervention.  And these are exactly the facts I gave my daughter, referencing the Sentinel Event Alert published by the Joint Commission last year (Issue 50, April 8, 2013).  She was not convinced.  The Wall of Sound in my house, the constant background of screams and yells and fights and alarms and alerts, meant nothing standing before the sentinel event of an 11 year old girl covered in blood, holding her injured pet.

After we attended to the guinea pig, I tried to explain to her that sort of thing wouldn’t happen if the kids could just get along better, stop fighting, be a little more resilient and self reliant.  But if the solution was that obvious and that easy, there probably wouldn’t have been the problem to begin with, and I’m sure she found my solutions to be just as perfunctory as JCAHO’s recommendations

·      Have a process for safe alarm management and response

·      Inventory alarm-equipped medical devices

·      Have guidelines for alarm settings

·      Have guidelines for tailoring alarm settings and limits for individual patients

·      Inspect, check, and maintain alarm-equipped devices

http://www.jointcommission.org/assets/1/6/medical_device_alarm_safety_infographic.pdf

If it was that easy, there wouldn’t be alert fatigue.  Whatever the sound, whatever the threshold for triggering an alarm, eventually we’ll get used to it and it will only be so much background chatter.  That’s why they call it “fatigue.”  You know what doesn’t get fatigued?  Cognitive support.  All these monitors, all this data, all these parameters present patterns that signal potential dangers.  Decreased breathing could mean a comfortable patient, decreased oxygen saturation is probably a pulse ox probe that fell off, decreased patient movement is likely a sleeping patient.  But the pattern of these parameters, in a post-op patient on a morphine PCA?  That’s worthy of an alert.  That can be tracked and analyzed in the background, automatically, by a medical knowledge engine that works.

And we can do that.  That’s what we do.