According to The Joint Commission, alarm fatigue occurs when clinicians become desensitized or immune to the sound of an alarm. Fatigued clinicians may:
- Turn down alarm volume
- Turn off alarm
- Adjust alarm settings.
Any of these actions may jeopardize patient safety. A tragic example of alarm fatigue is 17-year old Mariah Edwards, who following successful removal of her tonsils, died after nurses muted the sound on the monitors that were in place to alert caregivers of deterioration of her physical condition following opioid administration.
The need to urgently address this issue has been emphasized by The Joint Commission in its Sentinel Event Alert #50, “Medical device alarm safety in hospitals”. According to The Joint Commission Sentinel Event Alert database, between January 2008 and June 2012, there were 98 alarm related events reported, of which:
- 80 resulted in death (82%)
- 13 resulted in permanent loss of function (13%)
- 5 resulted in unexpected additional care or extended care (5%)
Consequently, it is no surprise that the problem of alarm fatigue and the need for better alarm management was the most discussed topic at the recent the Association for the Advancement of Medical Instrumentation (AAMI) annual conference.
Here are three lessons learned about alarm fatigue and better alarm management:
1. To Reduce Alarms Turn to John Hopkins Research
The most referenced research for reducing false alarms and increasing the number of actionable alarms is that of Maria Cvach, RN, MSN, CCRN (assistant director of nursing and clinical standards at The Johns Hopkins Hospital) and her colleague Kelly Creighton Graham, RN, BS. “Monitor Alarm Fatigue: Standardizing Use of Physiological Monitoring and Decreasing Nuisance Alarms”.
As Ms. Cvach did not present, reproduced below are three tips for decreasing alarm fatigue from their research:
Tip #1 – Use “Smart Alarm” Technology
Using “smart alarm” technology that brings together a number of physiological parameters may recognize and reduce clinically insignificant alarms while accurately reflecting the patient’s condition and preserving clinically significant alarm vigilance.
Tip #2 – Reduce Alarm Duplication
Cvach and Graham describe an example “The alarms for high and low heart rate were the same as the bradycardia and tachycardia alarms. Although how the monitor calculates bradycardia varies somewhat from how it calculates heart rate low, and how the monitor calculates tachycardia differs from how it calculates heart rate high, the task force thought that the monitor alarm did not need to sound twice; therefore, the alarms for heart rate high and low were moved to message level and the alarms for bradycardia and tachycardia were increased to warning level.”
Tip #3 – Revise Alarm Default Settings
In their research, Cvach and Creighton Graham were able to decrease critical monitor alarms by 43 percent from baseline. As they explain, one of the changes was to “revise the default settings for the unit’s monitor alarms, including parameter limits and levels, so that alarms that occurred were actionable and clinically significant.”
2. Patient Surveillance Monitoring Improves Patient Safety
According to a study by the Department of Anesthesiology, Dartmouth Hitchcock Medical Center, Dartmouth Medical School, patient surveillance monitoring results in a reduced need for rescues and intensive care unit transfers. Their study demonstrated a drop of rescue calls from 3.4 to 1.2 per 1,000 patient discharges and a decline in transfers to the ICU from 5.6 to 2.9 per 1,000 patient days.
3. Reducing Leads Can Reduce Alarms by 22%
Making sure that monitors are functioning optimally can reduce the number of alarms that sound. For example, according to the presentation by Melanie Quinton, “Building a Strategy to Support Medical Device Integration and Alarm Management”, a pilot study conducted by Kaiser Permanante at one of their medical centers shows that “leads replacement/hygiene has decreased our alerts by 22%”.
For four technology recommendations to reduce alarm fatigue, please click here.