In January 2010 a California hospital was fined for the death of a man whose cardiac alarm had been set to an inaudible level; when his heart stopped, the emergency room nurses were unaware of it and failed to intervene (California Department of Public Health, 2009). That same month a man died in a Massachusetts hospital after his heart rate declined over a 20-minute period; nurses did not hear his cardiac alarm, investigators found, and a second alarm had been turned off (McKinney, 2010).

Nurses attend to a variety of alarms and alerts during a shift, and there is often no system in place for prioritizing urgency. Confusion and “alarm fatigue” can result, with potentially lethal consequences: the ECRI Institute lists alarm hazards as the second most serious of the top 10 technology hazards in health care for 2010 (ECRI Institute, 2010). The problem has been shown to pose a danger to patient safety (Graham and Cvach, 2010), as have problems with clinical alarms in general (ACCE Healthcare Technology Foundation, 2006). Unfortunately, nurses are rarely involved in decisions about new technologies in health care, although the patient’s bedside has been identified as the area most in need of technological innovation (Bolton et al., 2008).

At a combined telemetry and medical–surgical unit at Cedars-Sinai Health System in Los Angeles, nurses are taking the lead in testing ways to aggregate and prioritize the alarms to which they must respond, most recently via text messages sent to nurses’ and nursing assistants’ BlackBerry devices. This system has replaced pagers and many bedside alarms, with promising results.

Timely, Accurate Messaging. In a unit where routine alerts might range in importance from an out-of-reach water pitcher to cardiac arrest, getting “the right message to the right person at the right time” is critical, said Joanne Pileggi, MSN, RN, the unit’s nurse manager. Working with Emergin, a communications software company, the unit’s nurses and nursing assistants categorized the alarms they receive—from cardiac monitors, patients’ call buttons, bed alarms, code blues, and the laboratory — according to their urgency, classifying them as red (most critical), blue (moderately critical), or yellow (least critical).

For example, if a patient’s cardiac monitor detects a dangerous arrhythmia, that information is sent to the unit’s “command center,” where a cardiac nurse sends out a red alert via text message to that patient’s nurse and the charge nurse. A beep or vibration from the nurse’s BlackBerry® phone indicates that a new text message has arrived. The nurse can glance at the device, see that the alert is red, and reply immediately, eliminating several problems with overhead paging systems: the need for repeated pages, the inability of the nurse to respond, excessive noise on the unit, and delays in response.

The 30-bed unit employs nine registered nurses (RNs) on the day shift and nine on the night shift and has been testing a variety of devices for more than two years. Staff were involved from the beginning, Ms. Pileggi said, and everyone, including aides, received training from Emergin.

An Investment in Safety. Use of the BlackBerry devices has cut the number of overhead pages on the unit by more than half. Nurses report less alarm fatigue and faster response times to alarms, and they receive critical laboratory values 10 minutes sooner under the new system than under the old one. They also save time by not handling alarms that do not require a nurse’s attention.

Darren Dworkin, chief information officer for Cedars-Sinai, said the initial costs of purchasing the devices and training the staff have paid off in more efficient and safer care. “Enabling nurses to spend more time at the bedside is a goal we want to achieve,” he said, “and so if the technology achieves that, then we are achieving our return on investment.” The unit has not conducted a cost–benefit analysis.

Few manufacturers are designing technologies with nurses in mind, and limitations of the available technology have meant that not all ideas for improving processes can be tested. For example, the unit could not incorporate IV pump alarms into the most recent test. Still, bedside nurses and patients are quite pleased. The nurses are looking forward to a test of iPhones, which will display cardiac rhythms on screen. Said Ms. Pileggi, “We’re anticipating patients’ needs, so there hasn’t been the need for patients to call as often.”