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What's that sound? Managing alarm fatigue

George, Tracy P. MSN, APRN-BC; Martin, Vicki MSN

doi: 10.1097/01.NME.0000452689.19763.3f
Department: On the Horizon
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At Francis Marion University's Department of Nursing in Florence, S.C., Tracy P. George and Vicki Martin are both Instructors.

The authors have disclosed that they have no financial relationships related to this article.

Although healthcare monitoring devices are supposed to improve patient safety and quality of care, alarm fatigue is a serious issue in healthcare settings across the United States. Many alarms beep constantly in hospitals, and alarm fatigue occurs when nurses become numb or desensitized to the high number of alarms. This is the largest technology hazard of 2012 resulting in compromised patient outcomes and requires healthcare strategies for safer, quality patient care.

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Don't turn it off

One of the most common alarm fatigue issues in hospitals is the false alarm, which occurs 80% to 99% of the time on hospital units. Harm happens when the alarm is sounding for a reason, but it's ignored because the nurse assumes it's false.

Another issue is deactivating alarms. Nurses may turn off an alarm because the beeping is too disturbing for both patients and staff. However, this is dangerous because when there's a true emergency, no one will know.

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Creating a safe space

Alarm management is essential for providing safe, quality care for positive patient outcomes. It's so important that The Joint Commission has issued a Sentinel Event Alert on medical device alarm safety. The Joint Commission noted that of 98 alarm-related patient events reported from January 2009 to June 2012, 80 led to death, 13 led to permanent functional disability, and 5 led to prolonged care and hospital stays. What went wrong in these alarm-related events? Some of the necessary alarms were missing, others had incorrect settings, some of the alarms were on a silent setting, and some alarm signals were turned off completely.

Along with the Sentinel Event Alert, one of The Joint Commission's National Patient Safety goals for 2014 is alarm safety (see Evidence-based practice recommendations). Its alarm guidelines recommend several ways to make alarms safer, including:

  • training nurses on the safe use and response to alarms on high-risk units
  • identifying the default alarm settings and limits for alarms throughout the facility
  • providing nurses with guidelines for tailoring alarms to reduce unnecessary noise
  • maintaining alarms properly.

By 2016, The Joint Commission is calling for all organizations to have clear-cut guidelines for managing alarms, which includes:

  • clinically appropriate settings for alarm signals
  • when alarm signals can be disabled
  • when alarm parameters can be changed
  • who in the organization has the authority to set alarm parameters
  • who in the organization has the authority to change alarm parameters
  • who in the organization has the authority to set alarm parameters to “off”
  • monitoring and responding to alarm signals
  • checking individual alarm signals for accurate settings, proper operation, and detectability.
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Smart innovations

Thanks to organizations realizing the safety concerns of alarm fatigue, there are several innovative ways to reduce alarm fatigue that you may see in the near future. For instance, smart alarms look at several aspects of a patient's assessment, not just one area. Human monitor surveillance allows someone outside of the unit to review the alarms. The monitor watchers notify the nurse when alarms go off. This technique hasn't shown an increase in patient deaths or transfers to critical care units. Wireless technologies, such as pagers and cell phones, may also decrease alarm fatigue. Noise is a significant issue in hospitals, and the use of pagers or cell phones is an effective and quick method to notify nurses of alarms without increasing noise.

Figure. Evide

Figure. Evide

Some changes don't involve technologic advances, just simple changes in patient care routines. In one study, by replacing ECG electrodes daily, the alarms on a unit decreased by 46% a day, which reduced alarm fatigue and allowed nurses to respond better to critical alarms. By changing the heart rate default settings and empowering nurses to further modify default rate settings based on each patient's condition, there was a 60% decrease in alarms at Boston Medical Center, and patient satisfaction scores increased.

You can use the following mnemonic to help prevent alarm fatigue and provide quality patient outcomes:

  • Alarm sensitivity
  • Sounding notification
  • Significant need to monitor
  • Evaluate situation
  • Timely response/technology training.
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It's too loud!

Despite interventions to reduce alarm fatigue, noise is an occupational hazard in most hospitals where noise levels exceed the World Health Organization's recommendations of 35 decibels (dB) during the day and 30 dB during the night. However, advances in technology using visual or vibrating alarms may help decrease noise pollution.

For example, some alarms occur when patients change positions. To help reduce false alarms caused by movement, alarms with short delays can be implemented. During suctioning or repositioning the patient, the alarm could be delayed while the brief procedure is performed. Another way to reduce noise is to standardize alarm sounds to reflect the urgency of a situation. The sound for high-priority alarms alerts the nurse to an urgent issue. There are different sounds for medium- and low-priority alarms so that the nurse knows which alarm to attend to first.

In addition, nurses need to receive ongoing, updated training on patient alarms. There's new information and research on alarms being published frequently, and you need to know about new guidelines and innovations to be better prepared to manage alarms. It's also important to review the outcomes of these innovative approaches to alarms. Are there fewer patient deaths with these new approaches that warrant making changes? It's important that we continue to look for new ways to improve patient care and decrease the issue of alarm fatigue.

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Necessary noise

Alarms can be disturbing to patients, caregivers, and staff, but they promote improved patient safety. As nurses, we want our patients to get better faster without any complications. Your patient's life may depend on your response to his or her alarm.

Organizations and nurses must be committed to ongoing training on alarm devices because a “one size fits all” approach doesn't promote evidence-based practice. Ongoing research is necessary for improving alarm management systems and considerations must be given to the benefits and risks of patient alarms.

Do you have gaps in your alarm device knowledge base? Your patients' lives may be at stake! Remember, The Joint Commission will be monitoring alarm safety. Nurses, let's work smarter and not harder.

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consider this

Figure

Figure

Kathy is a nurse on a busy, short-staffed medical-surgical unit. This is Kathy's third consecutive 12-hour shift, and she's tired. It seems as though every patient's monitor has been going off all night long. She hears another alarm and goes into Mrs. M's room. Kathy is tempted to silence it without even looking because it's the fourth time the alarm has gone off in 3 hours. She figures that it's likely a false alarm.

However, Kathy assesses the situation and realizes that the pulse alarm has gone off because Mrs. M's pulse has dropped to 42. Kathy initiates the rapid response team and contacts Mrs. M's physician. At the end of the shift, she reflects on the situation and is thankful that she didn't silence the alarm because Mrs. M's life was in danger.

Have you ever been in Kathy's situation? This scenario reveals the potential for major errors related to alarm fatigue.

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memory jogger

Figure

Figure

Remember ASSET to prevent alarm fatigue and provide quality patient outcomes.

  • Alarm sensitivity
  • Sounding notification
  • Significant need to monitor
  • Evaluate situation
  • Timely response/technology training
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on the web

Figure

Figure

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Learn more about it

Cvach M. Monitor alarm fatigue: an integrative review. Biomed InstrumTechnol. 2012;46(4):268–277.
    Hannibal GB. Monitor alarms and alarm fatigue. AACN Adv Crit Care. 2011;22(4):418–420.
      McKinney M. Hospital's simple interventions help reduce alarm fatigue. Mod Healthc. 2014;44(5):26–27
        Mitka M. Joint Commission warns of alarm fatigue: multitude of alarms from monitoring devices problematic. JAMA. 2013;309(22):2315–2316.
          The Joint Commission. National patient safety goals. http://www.jointcommission.org/assets/1/6/HAP_NPSG_Chapter_2014.pdf.
            The Joint Commission. Sentinel event alert: medical device alarm safety in hospitals. http://www.jointcommission.org/assets/1/18/SEA_50_alarms_4_5_13_FINAL1.PDF.
              The Joint Commission. The Joint Commission announces 2014 national patient safety goal. http://www.jointcommission.org/assets/1/18/JCP0713_Announce_New_NSPG.pdf.
                Wong M. Four technology recommendations to reduce alarm fatigue. http://ppahs.org/2012/11/14/four-technology-recommendations-to-reduce-alarm-fatigue.
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