The Dangers of Alarm Fatigue
Each shift, nurses are inundated with alarms.
Posted Jan 12, 2018
The hospital is flush with alarms. One study done at The John Hopkins Hospital identified 59,000 alarm conditions during a 12-day period—or a staggering 350 alarms per patient per day. With all these alarms, it's no wonder that nurses and other healthcare professionals suffer from alarm fatigue.
In hospitals, alarms are meant to enhance safety. They alert clinicians to when a patient is decompensating or when a device isn’t functioning properly. The perfect alarm would go off only when a clinically important event happens, and would never emit a false alarm. However, no alarm system is perfect. Research shows that up to 85 percent of hospital alarms are false.
Interspersed among all these false alarms are important ones, too. If a critical alarm goes unnoticed or ignored, the repercussions could be deadly. One notorious case involves a patient whose telemetry battery died before he went into cardiac arrest. The telemetry unit quietly beeped for 75 minutes before shutting down. Unfortunately, the man was found dead and cardiac resuscitation was never performed.
Due to the din of incessant alarms, nurses understandably become overwhelmed and annoyed. “Alarm fatigue occurs when nurses become overwhelmed by the sheer number of alarm signals, which can result in alarm desensitization and, in turn, can lead to missed alarms or a delayed response to alarms,” wrote Sendelbach and Funk in a 2013 article titled “Alarm Fatigue: A Patient Safety Concern.”
For the past several years, alarm fatigue has been a pressing concern for health-care organizations. Back in 2004, the Healthcare Technology Foundation, a non-profit that supports the development and application of safer and more effective healthcare technologies, began a clinical alarms improvement program. Moreover, the Joint Commission, which accredits hospitals, has also issued alarms and guidance.
Even though alarm fatigue has been addressed in the literature, it’s been difficult to figure out ways to reduce false and non-actionable alarms. Moreover, the number of hospital beeps and bloops increases with each passing year in the form of monitors, ventilators, pumps, pulse oximeters, compression devices, and beds.
Here are some suggestions that experts have made to reduce alarm fatigue:
- Improving protocols for alarm system management
- Improving the physical layout of the hospital unit
- Integrating alarms with critical patient information and the electronic health record (EHR)
- Delivering alarms signals along with contextual data (such as a message displayed on a smartphone)
- Changing ECG electrodes daily to reduce nuisance alarms
- Changing single-use sensors more frequently to reduce nuisance alarms
- Customizing ECG alarm settings (life-threatening versus advisory)
- Customizing delay and threshold settings on oxygen saturation monitors
- Ongoing education efforts
- Designing devices that are more intuitive in their functionality
- Obtaining constructive input from nurses and other hospital staff
- Interdisciplinary hospital-wide teams that address alarm fatigue
- Selective monitoring of patients with specific clinical indications
- Improving staffing levels and workflow patterns
Finally, merely increasing staff to respond to alarms is probably not the best approach to combating alarm fatigue because even with more people, it’s impossible for a nurse or other health-care professional to respond to every alarm and do work. Instead, improved staffing levels have to be addressed along with the underlying causes of alarm fatigue.
Hanlon, P. Patient Monitoring and Alarm Fatigue. RT: For Decision Makers in Respiratory Care. May/June 2017:18-20.
Sendelbach S, Funk M. Alarm Fatigue: A Patient Safety Concern. AACN Advanced Critical Care. 2013;24:378-386.