More technology is used in healthcare 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’ desensitization to the beeps and buzzes of the medical devices — often made in error — have healthcare organizations concerned over the link between alarm fatigue and patient safety. And with good reason.
“Unfortunately, due to the high number of false alarms, alarms that are meant to alert clinicians of problems with patients are sometimes being ignored,” Kathleen Gaines, BSN, RN, BA, CBC, writes in Nurse.org.
Not responding to alarms can lead to critical patient safety issues, including medical mistakes and even death. In fact, Gaines reports, alarm fatigue led to 80 deaths and 13 severe injuries in the United States between January 2012 and June 2019.
Earning an advanced degree from an online MSN program and becoming familiar with nurse practitioner terms related to alarm fatigue is essential for nurse leaders who want to be part of developing solutions for the issue.
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 fact, Gaines writes, “research indicates that 72% to 99% of all alarms are false.”
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, healthcare 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 an emergency — just a critical need.
In a widely publicized case in 2010, “an elderly man suffered a fatal heart attack while the crisis alarm on his cardiac monitor was turned off and staff did not respond to numerous lower-level alarms warning of a low heart rate,” according to the Boston Globe.
“Ten nurses on duty that morning could not recall hearing the beeps, which sounded at the central nurses’ station, or seeing scrolling messages on three hallway signs that would have warned them as the patient’s heart rate fell over the course of 20 minutes and finally stopped.”
Combating Alarm Fatigue
The Joint Commission, a major healthcare accreditation body, recognizes alarm fatigue as an occupational issue as well as a patient safety issue. In 2017, the commission included alarm reduction in its National Hospital Patient Safety goals and recommended that hospitals:
- Establish alarm system safety as a hospital priority
- Identify the most important alarm signals to manage based on:Input from the medical staff and clinical departments
- Risk to patients if the alarm signal is not attended to or if it malfunctions
- Whether specific alarm signals are needed or unnecessarily contribute to alarm noise and alarm fatigue
- Potential for patient harm based on internal incident history
- Published best practices and guidelines
3. Establish policies and procedures for managing important alarms that, at a minimum, address:
- 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”
- Monitoring and responding to alarm signals
- Checking individual alarm signals for accurate settings, proper operation, and detectability
4. Educate staff and licensed independent practitioners about the purpose and proper operation of alarm systems for which they are responsible.
Meanwhile, the medical device industry and human factors experts are looking toward standardization and the creation of “smart” alarms that are “easier to hear, understand, and locate,” Judy Edworthy, a professor of applied psychology at Plymouth University in the United Kingdom, tells the Canadian Medical Association Journal (CMAJ).
Hospitals implementing alarm fatigue solutions can follow the lead of Johns Hopkins Hospital in Baltimore, which has been an industry leader on this issue since beginning its own alarm reduction practices in 2006. As a result, Johns Hopkins has seen a significant reduction in total alarm incidents and received the Emergency Care Research Institute (ECRI) 7th Health Devices Achievement Award in 2012 for its alarm reduction practices.
What Nurses Can Do to Address Alarm Fatigue
While alarm fatigue 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 artifact 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 is an issue for everyone — not just nurses — but APRNs can be on the front lines of implementing solutions that lead to increased patient safety and better outcomes industry-wide.
About the Ohio University Online Master of Science in Nursing Program
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 APRNs.
For more information about Ohio University’s online MSN program, visit the program webpage today.
Alarm Fatigue is Way Too Real (and Scary) for Nurses: Nurse.org
Alert Fatigue: A Smarter Approach to Clinical Alarm Management: HIT Consultant
Alarm Fatigue a Top Safety Hazard: CMAJ
Patient Alarms Often Unheard, Unheeded: The Boston Globe
National Patient Safety Goals Effective January 2017: The Joint Commission
Do You Hear What I Hear? Combating Alarm Fatigue
A Comprehensive Study of Alarm Fatigue – Johns Hopkins Hospital’s Award-Winning Alarm Management Initiative: ECRI Institute
Using Data to Drive Alarm Improvements: Johns Hopkins Medicine