Alarm Fatigue: Hazards and Prevention

A typical 15-bed hospital unit experiences 942 high-priority monitoring alarms each day.¹ That’s almost 63 alarms per bed each day, or 40 alarms that nurses are required to tend to each hour. With such a high volume of alarms sounding off regularly, it can be easy for staff to lose a crisis alarm in the mix of continuous beeping.

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Desensitization, missed alarms, or delayed responses to alarms are common symptoms of alarm fatigue. What’s startling is that approximately 90% of hospital alarms are said to go unanswered by staff.² It can be next to impossible for nurses to respond every 90 seconds to a sounding alarm since almost everything in a patient’s room is hooked up to a monitor. Everything from high-priority cardiac alerts, to restless movement, to interference can signal an alarm at the nurses’ station. Studies have indicated that approximately 95% of alarms are alerting staff to non-actionable events, which translates roughly to only 50 cases of alarms requiring actual nurse intervention each day on a typical 15-bed unit.³

It’s clear that the true function of alarm alerts is getting watered down by all the noise. When only 5% of alarms are alerting staff to actionable events, it can be difficult to judge which alarms require attention.

Alarm hazards, including alarm fatigue, are of such concern to healthcare officials that it topped ECRI’s Top 10 Technology Hazards for 2012. Alarm fatigue is so prevalent in hospital settings that it beat out radiation exposure, medication administration errors, and cross-contamination for the number one spot.⁴ In fact, alarm hazards actually displaced radiation errors for the top position on ECRI’s annual report. That’s saying a lot.

More than 200 hospital deaths between January 2005 and June 2010 have been attributed to alarm hazards, including alarm fatigue.¹ The Boston Globe reports that in 2009, one such instance of alarm fatigue resulted in an alarm beeping for an unspecified period of time without any nurse response. A cable had come loose in the patient’s heart monitor, which then initiated a steady low-pitched beeping noise to alert staff of its removal. The alarm was said to have never been heard by staff, and the nurses only realized the patient had stopped breathing once it was too late. The alarm was lost in the noise of the unit without proper volume control settings, which failed to draw the attention of the nursing staff.¹

There are a number of steps that hospitals can take to minimize the effects of alarm fatigue and other alarm hazards and prevent adverse effects.

What can be done to minimize alarm-related adverse effects?

1. Note which devices are connected to alarms and how they are integrated in each patient room and at the nursing station
2.  Learn how the alarm settings are configured on each device
3. Create unit-wide protocols for alarm-system settings that determine which alarms are active, what the set volume level of each alarm is, and how alarm limits should be tailored to each patient (i.e. monitoring of patient bed movement on a case-by-case basis)
4.  Establish alarm response protocols so that each alarm is acknowledged, proper staff is notified, and the alarm is addressed in order to reduce alarm fatigue
5.  Establish unit-wide policies for the silencing, modification, and disabling of alarms

With an alarm sounding every 90 seconds in a typical 15-bed unit, hospitals need to begin to think strategically about resisting alarm fatigue. Setting limits and creating alarm protocols can severely minimize nuisance alarms and reduce the constant wave of beeping that is plaguing nurses.

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Sources:

¹Kowalczyk, L. (2011). Patient alarms often unheard, unheeded. The Boston Globe. Retrieved from http://www.boston.com/lifestyle/health/articles/2011/02/13/patient_alarms_often_unheard_unheeded/

²Lunau, K. (2011). On noisy hospitals and ‘alarm fatigue:’ How all those bells interfere with sleep and healing. Macleans.ca. Retrieved from http://www2.macleans.ca/2011/10/12/on-noisy-hospitals-%E2%80%98alarm-fatigue%E2%80%99-and-how-all-those-bells-interfere-with-sleep-and-healing/

³Welch, J. (2012). Alarm Fatigue Hazards: The Sirens Are Calling. Patient Safety and Quality Healthcare, 9 (3), 26-33.

⁴ECRI Institute. (2011). Top 10 Health Technology Hazards for 2012. Retrieved from https://www.ecri.org/Products/Pages/Top-10-Hazards-Resources.aspx