Alarm fatigue presents a real and present danger to patient safety, and it’s easy to see why. With the constant beeping from medication pumps, ventilators, vital sign machines and more, clinicians can become desensitized by the sheer volume, increasing response times and causing critical alarms to be missed. Because of this, a survey from the Physician-Patient Alliance for Health & Safety found that 19 out of 20 hospitals are concerned about the effects of alarm fatigue1.
Yet, audible alarms are a fundamental component of the life-critical technology these same hospitals rely on to provide patient care. The question is how can we resolve the alarm fatigue epidemic in order to utilize this technology effectively and avoid the patient safety pitfalls caused by poor alarm management.
In this article, we will discuss three steps hospitals can take to reduce the dangers of alarm desensitization, as well as the benefits the changes can offer to clinicians and patients. We will also delve into implementation barriers that may be experienced and how to overcome these issues in order to successfully reduce the sensory overload caused by the din of alarms, while providing assurance at all steps along the patient’s care journey.
#1 – Improve visualization of alarms
The first step to reducing alarm fatigue is to invest in remote displays and speakers that offer more ways to visualize the devices that are alarming. While traditionally there is only a display at the central nurses’ station, with the layout of wards such as the Med/Surg Unit, having displays positioned in several different areas allow clinicians to visualize alarms efficiently while reducing time away from the patient.
#2 – Create order sets
The next step in reducing alarm fatigue is to look closely at what is happening to cause each of the alarms, with the understanding that not all alarms will be critical. This is important because alarm volume, type, acuity, and how to safely make changes to those alarms are all driven by orders.
Once the cause of the individual alarms is well-understood order sets can be created that give nurses the autonomy they require to make changes and adjust alarm settings to the individual patient’s needs. As an added benefit, this can prompt direct conversations with the attending physician and residents that may not have otherwise happened, further enhancing patient care.
#3 – Determine which alarms are critical
Finally, in order to reduce alarm fatigue and its consequences, nursing and physician leadership must take a step back and determine which alarms should be responded to. Prior to this step, every alarm requires a response, which can lead to burnout and critical alarms being ignored. Instead, it must be determined which alarms were critical – such as arrhythmia – and which alarms are clinically insignificant for the specific patient population. This increases the value and clinical significance of each alarm.
Benefits that can be achieved by alarm fatigue reduction
Reducing alarm fatigue comes with numerous benefits to patients, clinicians and hospitals. When you consider that the noise level caused by constant alarms can rise to well over 90 decibels (the level generated by standing next to a lawnmower), it’s easy to see why reducing the din can have an immediate impact.
Medical teams, who have not been rounding on units because it was too loud and instead have been discussing care plans for the patients off the unit, can come back in. This can enable them to be more present and collaborative with the unit staff, improving the care they give, as well as their satisfaction. For patients, reducing the noise of alarms can mean the ability to get the healing, restful sleep they need for recovery, while significantly increasing their safety. Overall, staff may have a quicker response time and patients experience less disturbance.
Barriers to implementation and how to achieve success with change
However, despite the unarguable need to reduce alarm fatigue, there are barriers to implementing the steps we’ve described. The good news is that there are also simple steps to help overcome these barriers and succeed in creating real change.
The challenge of technology
The first barrier to implementation is the technology itself. Hospitals must recognize that monitoring devices often come with all alarms turned on and therefore invest the time to determine what actually must be alarmed on a particular unit. Fortunately as manufacturers have gotten more attuned with alarm fatigue, they have developed a better understanding of what typical alarms would be seen in particular hospital areas such as an intensive care unit versus an emergency department. Because of this, while all features are still included in the monitors, they are not necessarily activated unless you choose to.
Staff education
Staff education is another issue that can result in a barrier to implementing steps to reduce alarm fatigue. If staff members don't know what they are looking at, how will they know it’s a problem? This is where understanding an alarm’s thresholds and what the acuity level means allows clinicians to gain an understanding of the need to respond to an alarm and determine whether an alarm is “a walk versus a run.”
Any alarm you run to that is not actually run-worthy only adds noise, fatigue, and stress. That’s where things fall apart – when a nurse doesn’t respond because they no longer hear an alarm, or they say to themselves, “it’s just that again,” when it’s potentially a more critical alarm. Everyone who touches the patient needs to be educated which alarms are clinically significant, including residents.
Patient education
The final issue that must be addressed in order to overcome barriers to implementation is patient education. Patients and family don’t necessarily understand where the noises are coming from and the reason behind them. That is why in order to improve management of alarms, hospitals must outreach tools for patients, such as a pamphlet that explains the alarms that might occur and the actions that should be taken for each alarm. Nurses can also help by explaining alarms to patients, such as explaining that when an IV pump is alarming, it simply means the fluid is empty – it’s not an emergency.
Summary
- Alarms represent a vital tool to inform clinicians when something is or might be wrong that compromises patient safety.
- However, with these alarms, we have added the new hazard of alarm fatigue.
- Due to desensitization, critical alarms may be missed or ignored.
- Overcoming alarm fatigue requires three steps: improving visualization of alarms, increasing autonomy by creating order sets that address individual patient needs and enhancing the value of each alarm by determining which alarms are critical.
- Successful reduction of alarm fatigue can be achieved by improving the use of technology and increasing staff and patient education.
References
1. Wong, M. (n.d.). First National Survey of Patient-Controlled Analgesia Practices. Physician-Patient Alliance for Health & Safety. https://ppahs.files.wordpress.com/2013/10/ppahs-sasm-handout.pdf