Time to Battle Alarm Fatigue

Better Monitoring and Management

Laura A. Stokowski, RN, MS

Disclosures

February 20, 2014

In This Article

The Joint Commission Revisits Alarms

In 2013, the Joint Commission issued a Sentinel Event Alert, "Medical Device Alarm Safety in Hospitals," to revisit the issue of alarm safety. This was followed by the announcement of a new 2-phase patient safety goal[4] on clinical alarm safety for hospitals and critical access hospitals. The first phase, beginning in January 2014, is a requirement for hospitals to establish alarms as an organizational priority and identify the facility's most important alarms to manage. In 2016, hospitals will be required to develop and implement specific components of alarm management policies and procedures and educate staff on alarm management.

The first phase is a time for organizations to look at their own unique patient populations, and obtain input from each clinical department and medical staff about the most important alarm signals that occur in each patient care area. Using internal incident history and published best practices and guidelines, each area must determine whether specific alarm signals are needed or unnecessarily contribute to alarm noise and alarm fatigue. As pointed out by Cvach, there is no "one-size-fits-all" approach to alarm management.[5]

As of January 1, 2016, facilities must use these data to establish policies and procedures for alarm management, including the following for each alarm-enabled device:

Clinically appropriate settings for alarm signals;

When alarm signals can be disabled;

When alarm parameters can be changed;

Who has the authority to set alarm parameters;

Who has the authority to change alarm parameters;

Who has the authority to disable alarm signals;

Monitoring and responding to alarms; and

Checking alarms for accurate settings, proper operation, and detectability.

Many intensive care units already have such policies for their cardiorespiratory monitors, but other alarmed devices might have slipped into use over the years without accompanying policies being developed about the use of their alarms.

The proliferation of alarm-generating devices outside of critical care areas has now made it mandatory for all nurses working with alarm-generating devices to receive alarm management training. New nurses must learn contextual awareness when working with monitored patients, including how to suspend alarms before moving patients and performing procedures that will precipitate alarms. These nurses must learn to customize alarm settings to the individual patient and deactivate alarms for conditions that aren't treated on that patient.

Another issue that is not often considered is workload. It is always tempting to hope that technology can somehow replace staff by increasing patient surveillance, but after years of experience with such technology, we know that this is not the case. Monitors and other devices require much human interaction to function properly, and to respond to the frequent alarms inherent in their use. It should be no surprise to find that a relationship exists between workload and how long it takes to respond to monitor alarms.[13]

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