Time to Battle Alarm Fatigue

Better Monitoring and Management

Laura A. Stokowski, RN, MS

Disclosures

February 20, 2014

In This Article

Clinical Monitors and Alarms: A Perfect Storm

Technology is supposed to help, not hinder, patient care. Clinical monitors and devices may have become more sophisticated, but the alarm systems generated by these devices have lagged behind, so once again, in 2014, they are found at the top of the ECRI Institute's list of biomedical technology hazards.[1] The category of alarm hazards encompasses inappropriate uses of alarms (such as improper setting of alarm parameters or volumes) and disabling alarms entirely, actions that are chiefly attributable to a phenomenon known as "alarm fatigue."

If you are familiar with the fable of "The Boy Who Cried Wolf," you understand the concept of alarm fatigue. Alarms beep, chime, ring, or otherwise signal caregivers so often -- nearly always as a false or nuisance alert -- that nurses become desensitized to the sound and may fail to respond when the alarm finally portends a true, clinically significant event.[2] Alarm fatigue is a well-documented problem in critical care, but only recently has it crept into nonacute patient care areas as the use of alarm-enabled devices has grown.

Experienced nurses have seen this day coming. Think about all of the devices used in patient care -- vital sign monitors, pulse oximeters, ventilators, infusion pumps, feeding pumps, and wound evacuators. All of these devices have alarms -- or multiple alarms. Collectively, the devices in use on a single patient can produce hundreds of alarms every day.[3] On an entire unit, the number of daily alarms can easily reach into the thousands, even tens of thousands.[4]

Managing all of this noise is an overwhelming task. The nurses responsible for these alarms must ascertain their meaning, prioritize, respond, and distinguish the actionable from the nonactionable. Not only do many alarms require a trip to the bedside to assess and reassure the patient, they sidetrack busy nurses who are engaged in other tasks, raising the risk for making an error and for cross-contamination if the nurse inadvertently touches the equipment before washing his or her hands.

It is not difficult to understand why the nurses who must respond repeatedly to these alarms are sometimes driven to unsafe actions, such as turning down alarm volumes, widening alarm parameters, or even shutting some alarms off altogether. Maria Cvach, Assistant Director of Nursing at the Johns Hopkins Hospital, leader of the hospital's Alarm Committee and author of many articles on the topic of clinical alarm management, refers to this situation as "a perfect storm" because of the proliferation of alarmed devices on the clinical units, where lower staffing ratios make a quick response to alarms more difficult and accountability for alarm system management is less clear. To avoid missing true events, the alarm thresholds on these devices are set too tightly, at the expense of generating thousands of false or clinically insignificant alarms, and desensitizing the staff to alarms in the process.[5]

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