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Department: PATIENT SAFETY

Fighting bed alarm fatigue in orthopedic units

Daniels, Karen RN-BC

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doi: 10.1097/01.NURSE.0000453007.17772.ec
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IN MANY ORTHOPEDIC UNITS, almost every patient is at high risk for falling. Some facilities' protocols require patients at high risk for falling to have a bed or chair alarm in use at all times. As a result, alarms warning staff that patients are moving are sounding constantly. Despite the many alarms, however, some patients fall, sustaining serious injuries.

When too many alarms are false or clinically insignificant, nurses tend to respond more slowly, a phenomenon called alarm fatigue.1 This article explains the dangers of alarm fatigue and steps that can be taken to manage it.

Alarming trends

Alarms are designed to keep patients safe by alerting nurses and other staff to changes in a patient's status.2 Examples include alarms for telemetry, I.V. pumps, and chair and bed alarms, which are intended to alert staff when a patient attempts to get up without assistance.

On any given unit, at any given time, alarms are sounding. A Johns Hopkins study of an ICU found 563 alarms sounded per patient per day.2 The growing use of monitors and other devices with alarms has led to more false alarms and more alarm fatigue.1

How dangerous is it?

Studies have shown that up to 99% of alarms sounding on a unit can be false or insignificant.3 When nurses don't respond in a timely manner to the remaining 1% of alarms—the significant ones—patients are exposed to significant dangers.

Between January 2009 and June 2012, The Joint Commission reported 98 alarm-related sentinel events, 80 of which were fatal.3 ECRI Institute, a leading patient-safety organization, considered alarm fatigue the number one technology hazard of 2013.4

Alarms sound for reasons that range from clinically insignificant to life threatening. For instance, when bed alarms sense a change in weight distribution, they're triggered to alert nurses that a patient is getting out of bed. The problem is that these alarms sound not only when the patient is attempting to get up but also when the patient is simply changing positions in bed. The alarm will continue to sound until someone turns it off. Other false alarms can occur when staff forget to turn off the alarm before transferring the patient.

Nurses tend to stop or disregard alarms they hear constantly to focus their attention on daily tasks. When nurses answer all alarms, their scheduled work falls behind.1

Another concern is that nurses may deactivate an alarm that sounds constantly.5 When an alarm is turned off, it can't alert hospital staff when a patient is unsafely transferring without help. Whether nurses delay their response to bed alarms or turn them off completely, patient safety is compromised.

Patients' falls in the hospital can significantly prolong length of stay.6 Patient falls on an orthopedic unit can be especially serious for several reasons.

  • Patients who've recently had joint replacement surgery are at risk for damaging the prosthesis.
  • Patients with a history of osteoporosis are at increased risk for fracture.
  • Patients who recently had surgery are at risk for wound dehiscence.
  • Postoperative patients using anticoagulants are at risk for serious bleeding, including subdural hematoma.

Preventing alarm fatigue encourages staff to respond appropriately to bed and chair alarms, which helps to prevent falls and avoidable complications.

Steps to prevention

One easy intervention is to increase nurses' awareness of alarm fatigue; for instance, by conducting a staff development session on the topic.1 Nurses may not realize how significantly delaying their response to the alarms can affect patient safety.

Nurses and other staff members should round on patients regularly and implement bedside handoffs. When nurses spend more time in patient rooms, patients are more likely to ask for assistance with mobility. As nurses become more aware of alarm fatigue, they need to incorporate alarm response into their primary daily activities.5

On a patient's admission to the unit, the patient and family need to be educated about the alarm's purpose and how to use the call light for assistance. This education should be documented in the medical record on admission and reviewed every shift.

Nurses need to reevaluate the need for a bed alarm every shift. If the patient no longer needs a bed alarm, then the alarm should be discontinued. Tell the patient to continue to use the call light and wait for assistance before transferring. Another way to prevent false alarms is to be sure to turn off the alarm before an assisted transfer.5

Attaching a bed alarm to the call light system improves the rate of response to an alarm. When an alarm has a visual as well as an auditory component, the staff can locate the source of the alarm and respond more quickly.5

Alarms that turn off automatically when a patient stops attempting to get out of bed help prevent alarm fatigue.5 The nurse won't need to manually turn off every alarm that sounds.

Some bed alarms offer a different tone to alert hospital staff that a patient is moving who has both a high fall risk and high injury risk. Technology is ever evolving and engineers are constantly improving specificity and sensitivity.2

Continuing the battle

Because falls are a huge safety risk in the hospital, nurses and other staff need to continue to fight alarm fatigue to protect patients from avoidable injuries and other complications.

REFERENCES

1. Harris RM, Manavizadeh J, McPherson DJ, Smith L. Do you hear bells? The increasing problem of alarm fatigue. Pa Nurse. 2011;66(1):10–13.
2. Funk M, Cvach M, Sendelbach S. Managing alarm fatigue: new approaches and best practices. AACN Critical Care Webinar Series. 2013. http://www.aacn.org/DM/Webinar/WebinarDetail.aspx?Category=WEBINAR-SERIES&ProductCode=WB0004.
3. Joint Commission. Medical device alarm safety in hospitals. Sentinel Event Alert. 2013;(50):1–3.
4. Ulrich B. Alarm fatigue: a growing problem. Nephrol Nurs J. 2013;40(4):293, 346.
5. Cvach M. Monitor alarm fatigue: an integrative review. Biomed Instrum Technol. 2012;46(4):268–277.
6. Graham BC. Examining evidence-based interventions to prevent inpatient falls. Medsurg Nurs. 2012;21(5):267–270.
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