Alarm fatigue in nursing is a real and serious problem.
Hospital safety organizations have listed alarm fatigue — the sensory overload and desensitization that clinicians experience when exposed to an excessive amount of alarms — as one of the top 10 technology hazards in acute care settings. Because of this, the Joint Commission made alarm management a National Patient Safety Goal starting in 2014.
Serious Consequences
Researchers have concluded that, in an effort to make alarms highly sensitive, specificity has been sacrificed. That means that alarms are constantly sounding, which causes nurses and other staff to become overwhelmed and desensitized. This “crying wolf,” in turn, leads to delayed response and missed alarms.
One well-publicized case of alarm fatigue in nursing involved a monitor alarm that sounded softly for about 75 minutes, signaling that the battery needed replacing. Because the staff did not respond, the battery eventually died. When the patient went into cardiac arrest, there was no working alarm to alert nurses of the crisis. The patient could not be resuscitated.
Another case of alarm fatigue involved a patient being treated for a head injury. He was on pulse oximetry and a cardiac monitor, and had been given an anti-anxiety drug for restlessness. An alarm indicated an increased heart rate and decreased oxygenation, but it was an hour before a nurse checked the patient and found him unresponsive. The patient died, and an investigation found the alarm had been turned off.
Alarm Fatigue Research
In order to eliminate alarm fatigue in nursing and change staff behavior, researchers in any institution must document and define the problem. Many studies have been conducted and made the following findings:
- Between 2005 and 2008, the Food and Drug Administration reported more than 560 alarm-related deaths in the United States.
- Between January 2009 and June 2012, hospitals in this country reported 80 deaths and 13 severe injuries attributed to alarm hazards.
- Between 72 percent and 99 percent of clinical alarms are false.
- One study showed that more than 85 percent of all alarms in a particular unit were false.
- One hospital reported an average of one million alarms sounding a week.
- Another hospital reported 350 alarms per patient per day.
Contributing Factors to Alarm Fatigue in Nursing
Research has indicated that these factors contribute to alarm fatigue in nursing:
- Alarm parameter thresholds are set too tight.
- Alarm settings are not adjusted to the individual patient.
- Poor electrocardiogram electrode practices result in frequent false signals.
- The staff may be unable to hear alarms or detect from where an alarm is coming.
- Staff training on monitors and alarms is inadequate.
- Response to alarms is inadequate.
- Alarms malfunction.
How to Use Evidence-based Practice to Decrease Alarm Fatigue in Nursing
Alarm fatigue is systemic and needs to be addressed at the institutional level. One of the first steps is having a nursing staff that has been properly educated in the use of evidence-based practice. One way for RNs to increase their knowledge of evidence-based practice is through an online RN to BSN program.
Secondly, a nursing staff that wishes to address alarm fatigue should start by forming an interdisciplinary committee and collecting data about alarm events. Examine previous studies to take advantage of their findings.
Once you have gathered your data and completed researching the latest evidence, decide on an alarm-management policy and process. Within the policy, decide what the setting parameters are and allow staff to adjust settings based on the needs of individual patients. In addition, decide where alarms are not needed and assure that equipment is maintained properly.
The number of devices with bedside alarms has grown exponentially in the last few decades, and alarm fatigue in nursing is a system-wide challenge that needs to be approached holistically. BSN-prepared nurses who are educated on the use of evidence-based practices can help create policies to reduce alarm fatigue and improve overall patient care.
Learn more about the UT Arlington online RN to BSN program.
Sources:
Sendelbach, Sue. “Alarm fatigue: a patient safety concern,” http://www.nursingcenter.com/JournalArticle?Article_ID=1617134
Ensslin, Peggy A. “Do you hear what I hear? Combating alarm fatigue,” http://www.americannursetoday.com/hear-hear-combating-alarm-fatigue/
McKinney, Maureen. “Hospital’s simple interventions help reduce alarm fatigue,” http://www.modernhealthcare.com/article/20140201/MAGAZINE/302019996
