Alarms are a constant presence in many health care settings. Whether this works for or against patient safety is a question nurses and safety officials have been asking with rising frequency. In January, a cardiac patient at Massachusetts General Hospital (MGH) died after his heart rate fell and eventually stopped over the course of about 20 minutes. According to a report released on April 2 by Centers for Medicare and Medicaid Services investigators, and noted in an article in the Boston Globe, "alarm fatigue"—which results from alarms sounding so constantly that health care providers become desensitized, either not noticing them or ignoring them altogether—was a contributing factor in the death. In this case, in spite of at least one alarm sounding repeatedly at the central nurses' station, nurses on the unit weren't aware that the patient was in distress until one went in for a routine test and found him unresponsive. Investigators noted that a separate crisis alarm at the patient's bedside had been turned off—whether accidentally or intentionally isn't known. (Read the Boston Globe's coverage of the MGH event at http://bit.ly/c2cGF6.)
Although this particular case made headlines, it wasn't the first of its kind. It's a common enough problem that the ECRI Institute listed alarm hazards as second among its top 10 technology hazards of 2010. Nor was it much of a surprise to anyone within the nursing community.
"Every new piece of technology we get adds a new alarm," says Linda Bell, clinical practice specialist at the American Association of Critical-Care Nurses. "Whenever patients move—if they roll over in bed, if they're shivering, if they cough—an alarm goes off. We've created an alarm environment as a part of routine care."
In response to the January incident, MGH officials have taken steps to address the problem, including disabling off switches on alarms, assigning nurses to central stations to monitor alarms, and increasing the number of speakers on patient units, as well as forming a committee to create best practices and standards for alarm use. Ultimately, making alarms more effective in keeping patients safe in any health care setting will require minimizing false and "nuisance" alarms—which serve only to distract from basic patient care. Just as vital, says Bell, is making the alarm sounds unique and easily distinguishable from one another. "In an ideal world, the companies producing the technology would work together to ensure that," she says.
In the meantime, there are steps nurses can take to minimize nuisance alarms and maximize the safety and effectiveness of monitors. (For more details on those steps, see http://bit.ly/bdFBJo.)
"When nurses are trained on new equipment, they should be taught to calibrate it to individual patients," says Bell. Default settings may not account for normal variations in sinus rhythms, blood pressure, and the like, but a nurse who knows the patient can often adjust the machine to best meet her or his needs and reduce false alarms. "We can't eliminate them," she explains. "If patients are moving, you're going to get alarms. The goal is to set the equipment so you eliminate as many of the nuisance alarms as possible while still getting the real thing."—Laura Wallis