More technology is used in health care today than at any other time in history. It has made nurses’ jobs easier and helps keep patients alive longer. But it has also led to some unintended consequences.
Nurses who are caring for patients can become desensitized to the beeps and buzzes of medical devices — often made in error. This, in turn, has caused health care organizations to be concerned over the link between alarm fatigue and patient safety. And with good reason.
Not responding to alarms can lead to critical patient safety issues, including medical mistakes and even death. The Joint Commission, a major health care accreditation body, indicates that between January 2009 and June 2012, there were 80 recorded deaths related to alarm fatigue
Earning an advanced degree, such as a Master of Science in Nursing (MSN), and becoming familiar with the dynamics of alarm fatigue, is essential for nurse leaders who want to be part of developing solutions to the issue.
What Is Alarm Fatigue?
Alarm fatigue is the exhaustion, frustration, and anxiety that can result from an abundance of hospital alarms. Because there are so many alarms with different meanings, they can overwhelm the medical staff. The constant barrage of noises can lead to sensory numbness, and sometimes important alarms can slip through the cracks as a consequence.
The issue can involve both alarm frequency and accuracy. Although alarms alert nurses and other medical professionals to crucial information about patients’ health and equipment function, the frequent occurrence of false alarms that do not in fact indicate a clinically significant event can lead people to ignore them. This kind of alarm fatigue compromises patient safety.
Alarms in Error and Alarms Ignored
Medical device alarms are meant to indicate a serious issue with the patient or with the device itself. But a majority of the time, alarms go off in error.
In a clinical setting, where hundreds and even thousands of alarms sound every day, the number of false alarms can quickly add up. For nurses busy administering care, false alarms become nuisances because they don’t know which to respond to and which to ignore.
“For most of my career as a nurse, I wished there was a way to help determine if an alarm was real or not,” Jessica Lake, BSN, BS, RN, writes on the HIT Consultant website. “Unfortunately, one of the biggest problems facing nurses today is that the onslaught of medical technology designed to help us care for our patients is drowning us in false alerts.”
When alarm fatigue takes hold, health care workers become desensitized to the noise. This issue is especially troubling in cases of low- and mid-level notices, such as low-battery alarms, that do not indicate a care emergency.
Combating Alarm Fatigue
The Joint Commission recognizes alarm fatigue as an occupational issue as well as a patient safety issue. As of 2020, the Commission included alarm alert and notification overload to be one of the top ten health technology hazards in the industry. Consensus throughout the health care sector shows that efforts must be taken to combat this growing hazard. Following are some industry-recommended strategies that can help achieve this.
1. Establish Alarm System Safety as a Hospital Priority
The first step to reducing harm from the alarm system is to prioritize its efficiency in the hospital.
- Ensure all of the hospital’s medical staff are aware of alarm system updates and changes.
- Allow for communication between employees about what they believe might improve the alarm system.
- Communicate with patients the expectations surrounding the alarm system, such as what might cause it to go off, and how long it will take for staff to arrive.
2. Identify the Most Important Alarm Signals
The importance of any specific alarm signal is determined by input from a variety of sources.
- Medical staff and clinical departments
- The risk to patients if the alarm signal isn’t attended to, or if it malfunctions
- Whether certain signals unnecessarily contribute to alarm noise and alarm fatigue
- Published best practices and guidelines
3. Establish Policies and Procedures for Managing Important Alarms
When alarms go off, it’s important to know exactly how they should be managed or addressed. There are several aspects that must be questioned regarding alarm procedures to prevent alarm fatigue and patient safety.
- What are the clinically appropriate settings for alarm signals
- When alarm signals can be disabled
- When alarm parameters can be changed
- Who in the organization has the authority to set alarm parameters
- Who in the organization has the authority to change alarm parameters
- Who in the organization has the authority to set alarm parameters to “off”
- How to monitor and respond to alarm signals
- How to inspect individual alarm signals for accurate settings, proper operation, and detectability
It’s also important to educate staff and licensed independent practitioners about what alarm fatigue is, and the purpose and proper operation of alarm systems for which they are responsible.
Hospitals themselves may be able to diagnose the cause of nuisance alarms that do more harm than good. In 2019, Seattle Children’s Hospital established a protocol for their team of respiratory therapists. It developed high and low limits for device alarm settings, as well as allowed professionals to make adjustments to the devices if necessary to reduce ongoing errant alarms.
What Nurses Can Do to Address Alarm Fatigue
While alarm fatigue and patient safety is an industry-wide issue and not a nursing issue alone, nurses are on the front lines of both the problem and the solution. Advanced practice registered nurses (APRNs) and others in leadership positions can help their organizations implement The Joint Commission’s recommendations, while also creating a culture of responsibility around alarms and patient care.
The American Nurses Association (ANA) recommends implementing The Joint Commission’s recommendations, as well as:
- Verifying that all staff members who use alarmed devices are properly trained in safe alarm management
- Frequently changing single-use sensors, such as pulse oximetry sensors and ECG electrodes
- Reducing alarms caused by patient-contact artifacts by making sure the patient’s skin has been properly prepared before applying electrodes.
In addition, the ANA recommends using “two-way communication devices that allow caregivers to request help if they can’t respond to an alarm,” and to reduce alarms altogether to ensure appropriate monitoring.
Specifically, the ANA says that “protocols can be developed to determine which types of patients are monitored by which devices, to make sure alarms are actionable. Once a decision is made to monitor a patient, alarm parameters should be individualized based on the patient’s condition and baseline data.”
Alarm fatigue and patient safety is an issue for everyone — not just nurses — but APRNs can play a central role in implementing solutions that can lead to better outcomes industrywide.
A Nursing Program Designed for You
Ohio University’s online MSN program prepares registered nurses (RNs) and other Bachelor of Science in Nursing (BSN) graduates for a variety of advanced nursing careers, including to assume the role of an APRN.
The program concentrations enable nurses to specialize their education in their areas of interest. Concentrations include: Family Nurse Practitioner, Nurse Educator, Adult-Gerontologic Acute Care Nurse Practitioner, and Psychiatric Mental Health Nurse Practitioner.
For more information about the Ohio University online MSN program, visit the program webpage today for the full curriculum and other details.
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HIT Consultant, “Alert Fatigue: A Smarter Approach to Clinical Alarm Management: HIT Consultant
Johns Hopkins Medicine, “Using Data to Drive Alarm Improvements”
The Joint Commission, R3 Report
The Joint Commission, “Top 10 Health Technology Hazards for 2020”
Nursing Center, “Nursing Fatigue Takes Toll on Patient Care”
Psychology Today, “The Dangers of Alarm Fatigue”
RT Magazine, “Strategies to Reduce Alarm Fatigue”