Alarm Fatigue
It’s the beginning of a registered nurse’s twelve-hour
shift, she holds her coffee in hand and receives bedside report on her
pediatric patients. As the off going nurse is providing details of the
patient’s day, the telemetry pager has paged a tachycardia alert for one of
their patients three times in just a few minutes. The dayshift nurse silences
the pager and without skipping a beat, she explains that the alarm has been
going off non-stop and it had driven her completely crazy for a few hours. The
on-coming nurse responds, “how does the patient look, is the monitor reading accurately?”
The off-going nurses sighs, “he’s fine, totally fine.” But is he fine?
The Problem:
o Alarm fatigue is a
concerning problem in nursing when nursing staff is too overloaded with various
alarms, beeps, and dings that they become desensitized and fail to respond to
essential clinical alarms. Failure to acknowledge alarms has a direct negative
impact on patient safety (Weeks et al., 2021).
o Utilization of clinical alarm
safety was implemented to increase patient safety and improve patient outcomes;
however, it appears that alarm fatigue is actually creating an increased risk
for patient harm (Short & Chung, 2019).
o The Joint Commission (TJC)
established National Patient Safety Goals (NPSGs) in the early 2000’s (The
Joint Commission, 2021). One of the initial NPSG’s was to address the use of
clinical alarms, assessing usability and audibility of alarms. The original Clinical
Alarm Safety goal was retired in 2005 with the belief that alarms were being
adequately used and had no link to negative patient outcomes (The Joint
Commission, 2021).
o TJC (2021) had to
reprioritize alarm safety after its Sentinel Event report identified 98 reports
of patient alarm events, resulting in 80 patient deaths between 2009-2012.
o The United States Food and
Drug Administration (FDA) had reported 566 patient safety alarm related deaths
over the course of five years beginning in January 2005 (The Joint Commission,
2021).
o An Alarm Summit held in 2011
revealed that clinical alarm safety needed to be improved upon. TJC reported
that of the 1,600 organizations that completed a clinical alarm safety
assessment 1,440 felt that immediate action needed to be taken to overcome the
challenges facing clinical alarm safety risks (The Joint Commission, 2021).
o In 2014 the Joint Commission
issued new NPSG’s instructing hospitals to implement a plan indicating the
policies and procedures the organization would use of alarm system safety (Short
& Chung, 2019).
o Short and Chung (2019)
explained that the most common form of monitoring in hospitals is cardiac
monitoring via continuous electrocardiography leads. The leads monitor heart
rate, cardiac rhythm, and respiratory rate that is transmitted to a central
monitoring station.
o Alarm parameters can be
customized to the patient and any deviations from the parameters will produce
an audible alarm to a pager that the nurse carries. The challenges facing this
solution is that nurses report the pagers do not work, are not replaced when
broken, and often feel the alarms are not accurately reading the patients vital
signs.
o The never-ending beeping
ends up creating frustration and fatigue for the nurse. The pager then, ends up
being left at the nurse’s station and is ignored.
As healthcare technology improves,
hospitals must assess current approaches to problems and evaluate if newer
technology could be used as a solution to bring positive impact to patient care
and safety. Three key interventions can help alleviate alarm fatigue.
1. Properly prepare patient skin for electrodes,
change electrodes daily and maintain equipment in safe working order.
2. Minimize inconsequential alarms: modifying the
alarm threshold for cardiac and respiratory alarms. Setting alarm limits to
critical criteria customized to individual patients can allow accuracy with
alarming and increase responsiveness by the nurse. Alarm protocols can identify
who can make the decisions regarding parameters. The Joint Commission (2021) identified
important questions and procedures to consider when alarm protocols are
designed:
·
When alarm signals can be disabled?
·
When alarm parameters can be changed?
·
Who in the organization has the authority to set and/or
change alarm parameters?
·
Who in the organization has the authority to set alarm
parameters to off?
·
Who will be monitoring and responding to alarm signals?
·
Who will be checking individual alarm signals for accurate
settings, proper operation, and detectability?
3. Implementation of a multidimensional smartphone app.
The healthcare app would use data collected by a telemetry system, processed by
software, and sent to a smartphone app that would allow the nurse to see data
triggering alarm, as well as real time information from the patient’s monitor
to include vital signs, and analysis of cardiac rhythm. The nurse can
acknowledge the alert and proceed to the patient’s bedside to respond. With the
app, the nurse can forward the data to the correct physician or alert
resuscitation teams (code blue teams) if warranted (Short & Chung, 2019).
In addition to smartphone apps, additional measures of motion detection can be
utilized by incorporating sensors in patient’s rooms. For example, if app
triggers an alarm for bradycardia, a motion detector sensor in the patient room
will conduct an automatic scan of the patient to assess activity level. The motion
detector sensor transmits data to the app that indicates a green, yellow, or
red alert based on level of patient activity. A red alert would be indicative
of no movement, thus warranting an emergent response. Combination use of
smartphone apps and motion detector sensing would allow the software to triage
the alarms and allow the nurse the ability to prioritize the alarm response
needed and reduce the delay in treatment for life threatening alarm
notifications.
Benefit
to Nursing
o The average nurse
experiences just under 200 dings, beeps, or chimes from alarm notifications in
one twelve-hour shift (Gorisek et al., 2021).
o Gorisek et al. (2021)
explained that up to 90% of alarms are false notifications and may not require
intervention. The remaining portion of triggered alarms are often emergent and
require a critical response.
o Using software or technology
that can triage alarms and prioritize the need for a nurse’s attention may
reduce the quantity of alarms nurses receive each shift.
o With fewer false alarms and
distractions they may bring the nurse can increase awareness and responsiveness
to clinical alarms that do warrant immediate attention.
o Decreasing false alarms is
also believed to decrease stress and improve workflow for nurses (Gorisek et
al., 2021).
o Reduction of unnecessary
alarms also allows the nurse to focus on delivering high quality, safe, and
competent care (Weeks et al., 2021).
Benefit
to Patients
o The number one benefit to
the patient is improved patient safety. Timely responsiveness to critical
alarms by nurses improves patient outcomes, decreases adverse events, and can
be lifesaving (Pelter & Drew, 2015).
o Aside from the major
benefits, decreasing false alarms reduces noise irritation and overall
disruption of rest for patients and family.
Conclusion
Effectively monitoring patients is
an important component in delivering safe care. Nurses never intended to ignore
or becoming desensitized to critical alarms. Nurses became inundated by the
many alarms that occur in the hospital setting. After responding numerous times
to false alarms, the mindset shifted that any beeping heard was ultimately a
fake alarm. The harm comes into play when a critical alarm occurs that leads to
cardiac arrest and response time is delayed. Implementing better practices of
maintaining equipment, using alarm protocols, and integrating technology
through smartphone apps could resolve the crisis of alarm fatigue in nursing.
References
Gorisek, R.,
Mayer, C., Hicks, W. B., & Barnes, J. (2021). An Evidence-Based Initiative
to Reduce Alarm Fatigue in a Burn Intensive Care Unit. Critical Care
Nurse, 41(4), 29–37. https://doi-org.ju.idm.oclc.org/10.4037/ccn2021166
Pelter, M. M.,
& Drew, B. J. (2015, December 1). Harm from alarm fatigue.
PSNet. https://psnet.ahrq.gov/web-mm/harm-alarm-fatigue
Short, K. & Chung, Y. (2019). Solving alarm
fatigue with smartphone technology. Nursing, 49 (1), 52-57. doi:
10.1097/01.NURSE.0000549728.37810.d9
The Joint Commission. (2021). Alarm System Safety.
Leading the Way to Zero. https://www.jointcommission.org/-/media/tjc/documents/standards/r3-reports/r3_report_issue_5_12_2_13_final.pdf
Weeks, K., Timalonis, J. & Donovan,
L. (2021). Does alarm fatigue start in nursing school?. Nursing, 51 (5), 59-63. doi:
10.1097/01.NURSE.0000743284.73649.7a.
