AHA: Tired? It might be alarm fatigue
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“In terms of alarm fatigue, part of it is bad luck, but part of it is bad luck that you can control,” she offered.
“In the old days, we had alarms but we hoped that these alarms were set for action,” she said. Now, with so many alarms trying to get attention from the staff, it is difficult to tell which patient needs assistance.
“There are nearly constant alarms for call bells, IV pumps, feeding pumps, cardiac monitors, dosimeters, respirators and chair and bed alarms. All of that noise is getting in the way.
“How did we get here?” she asked. “Device manufacturers built machines with sensitive, loud alarms to protect themselves from liability.”
From 2005 to 2006, 566 alarm-related deaths were reported in the U.S. by the FDA. In 2010, this number increased to 800. “These alarms aren't helping us anymore; they are just getting in the way.”
White referenced the Three Mile Island nuclear reactor crisis, saying that there were so many loud alarms that staff couldn’t diagnose the problem, which later resulted in a meltdown. “This could be our operating room,” she said.
“Many hospital control rooms are not well organized,” White added. “They are complex, poorly organized and don’t readily provide important information.”
While the purpose of clinical alarms is to communicate changes that require action, with so many, it has become difficult for staff to pinpoint which alarm is on. “There are too many false positives and too many alarms,” she said.
In 2002, the Joint Commission sent out an urgent alert to hospitals after it received notice that 23 adverse events (death or coma) occurred from ventilator malfunctions. “In 65 percent of these cases there were no responses to alarms or the alarms were set incorrectly,” White noted.
The Joint Commission stepped in with the first National Patient Safety Goals to improve the effectiveness of clinical alarms. These guidelines spell out that device systems must now undergo maintenance and testing and have alarm settings that are sufficiently audible to be heard over background noise.
White said that with the multiple alarm-producing set-up in hospitals, there are somewhere between 150 to 400 alarms going off per patient per day in a typical intensive care unit. “It’s staggering to think about.”
She noted that most of these alarms have “inconsistent use,” because most of the time when they go off, no action is necessary.
While she added that the customization of alarms may be one fix, what happens when a staff member does a rotation on another floor?
White referenced a 2006 study that looked at alarms in EKG monitoring (Am J Emerg Med 2006; 24[1]:62-67), which enrolled 72 low-risk patients with chest pain. Over the duration of the study, 1,762 alarm events were reported and only 11 of those were “real.” Only three of these cases resulted in a change of management. “This means that 99.4 percent were false alerts,” White said.
In 2012, alarm fatigue was deemed the top health technology hazard by ECRI Institute. Dose exposure and medication administration errors were right behind.
If alarm fatigue is getting you down, White said there may be solutions that can offer some hope. She offered the following strategies to help mitigate alarm fatigue:
- Make sure you have the right alarm settings: Customize alarm settings for each of your patients. You can also build in escalation of alarms. She noted that you may want to briefly silence the vent while you are suctioning or silence the monitor while you are providing patient care;
- Reduce nuisance alarms: Maximize the signal. White said that good skin prep, changing the electrodes daily and replacing the batteries daily can help; and
- Reduce the noise: Give fewer patients alarming devices, reduce overhead paging and decrease system alerts.
She said that the most effective strategy is to be proactive. “Confirm that alarms are on, that they are clinically appropriate and that they can be heard in the environment of intended use.”