Hospitals need to minimize the risk associated with the ubiquitous patient safety issue of alarm fatigue, which has again been singled out by the ECRI Institute as the top technology hazard for 2013.

The institute is a federal patient safety organization of the US Department of Health and Human Services.

"We all know there are a lot of devices in the ICU — everybody's on a monitor, and a lot of other devices at the bedside have alarms on them," said Marjorie Funk, PhD, RN, professor at the Yale School of Nursing in New Haven, Connecticut.

"The problem now is that a lot of patients outside the ICU are on monitors and other devices, and many of the alarms produced are false," she told Medscape Medical News.

Dr. Funk discussed the issue of alarm fatigue at the American Association of Critical-Care Nurses (AACN) 2013 National Teaching Institute and Critical Care Exposition in Boston, Massachusetts.

During her presentation, Dr. Funk listed contributors to the cacophony of alarm sounds on a hospital unit, which include infusion pumps, feeding devices, ventilators, and monitors. In addition, the battery-operated telemetry monitors frequently used outside the ICU have alarms to indicate a low battery, she noted.

 
The staff becomes overwhelmed by the sheer number of alarms and can miss or have a delayed response to alarms.
 

In fact, it's estimated that approximately 90% of alarms in various ICU settings are either false or insignificant, according to a series of studies. Over time, "the staff becomes overwhelmed by the sheer number of alarms," Dr. Funk said, "and can miss or have a delayed response to alarms that can lead to sentinel events or patient death."

One key way to reduce alarm fatigue is to eliminate unnecessary monitoring wherever possible.

As part of the PULSE trial, Dr. Funk and her team evaluated the use of electrocardiographic (ECG) monitoring in cardiac units. They found that 26% of more than 4300 patients on monitors did not meet American Heart Association practice standards for monitoring (J Am Coll Cardiol. 2013;61[10 suppl]:E1496).

"If we eliminate unnecessary monitoring, it should result in a reduction in the overall alarm burden," Dr. Funk said.

AACN Recommendations

One of the practical strategies to reduce the incidence of false or nonactionable alarms offered in the new AACN Practice Alert on Alarm Management is to ensure good signal quality. The alert recommends that the electrode area be washed with soap and water and wiped with a rough washcloth or gauze. Alcohol should not be used because it dries the skin out. In addition, ECG electrodes should be changed at least daily.

Whenever possible, disposable adhesive pulse-oximetry sensors should be used, and sensors should be replaced when they no longer properly adhere to the patient's skin. Monitor alarms should be customized to meet the needs of the patient, and nurses should set customized alarms within 1 hour of assuming care and as the patient's condition changes.

Alarm limits can be widened if it does not compromise patient safety, and default alarms can be deactivated for conditions that are not treated, such as premature ventricular contractions. Smart alarms that take several parameters into account before the alarm sounds have also been shown to reduce false critical ECG alarms, Dr. Funk explained.

"Hospitals really need to pay attention to this," she noted. It is possible that The Joint Commission will address alarm management in a National Patient Safety Goal. If that happens, "hospitals will be required to make alarm safety a priority as a condition of accreditation."

"It's important for a hospital to understand its own situation and to develop a systematic coordinated approach to alarms. Alarm safety has to become a hospital priority," Dr. Funk said.

An interprofessional approach is required to address the issue of alarm fatigue, said Sue Sendelbach, PhD, RN, director of nursing research at Abbott Northwestern Hospital Minneapolis, Minnesota, who was asked by Medscape Medical News to comment.

"In addition to clinical nurse specialists, staff nurses, hospital administrators, and physicians, biomed engineers, systems analysts, and industry need to collaborate," she said. "The issue of alarm fatigue can most effectively be addressed, and eventually eliminated, by working with the people closest to the patient and those who support the needs of the patient."

Dr. Funk and Dr. Sendelbach have disclosed no relevant financial relationships.

American Association of Critical-Care Nurses (AACN) 2013 National Teaching Institute and Critical Care Exposition. Presented May 22, 2013.

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