1. Alarm hazards.
Beeping, buzzing, and ringing from ventilators, pumps, dialysis machines and other patient monitoring devices has created a much reported alarm fatigue. Providers are only human, and when too many alarms go off, caregivers "may turn down the volume of alarms to an inaudible level, or they may improperly adjust alarm limits outside the safe and appropriate range."
The report describes an initiative at Johns Hopkins in which a study of all the different alarms resulted in a modification of alarm thresholds to reduce the "non-actionable, clinically insignificant alarms," by 43%. Alarm hazards has been in ECRI's top 10 hazards list's first or second place for the last three years.
2. Medication administration errors using infusion pumps.
Infusion devices contribute more adverse incident reports to the U.S. Food and Drug Administration than any other medical technology, with often severe consequences. Between 2005 and 2009, the FDA received reports about 710 infusion-pump error deaths.
One solution is the integration of infusion pump performance with electronic ordering, administration and documentation systems, which could avoid 75% of certain events.
3. Unnecessary exposures and radiation burns from diagnostic radiology procedures.
ECRI has expanded this category from radiation therapy and CT scan overexposure hazards, which ranked high for the last two years, include to diagnostic radiology procedures.
"We are recommending that healthcare facilities look more broadly at the many factors that can contribute to unnecessary radiation exposures—or, in extreme cases, cause radiation burns—with any diagnostic imaging modality," the report says.
Providers should ask if the images are really necessary, and if so, whether the doses needed to get the image as low as reasonably achievable, the report suggests.