Alarm Fatigue, Patient Monitoring, Patient Safety

PCA Survey Indicates Response to ECRI Institute 2014 Top Ten Safety Technology Hazards and The Joint Commission’s National Patient Safety Goals for 2014

By Lynn Razzano, RN, MSN, ONCC (Clinical Nurse Consultant, Physician-Patient Alliance for Health & Safety) and Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety)

The ECRI Institute recently released its Top Ten Technology for 2014. At the top of this list – alarm hazards. Although ECRI acknowledges that patient monitors are undoubtedly beneficial, ECRI says that the frequency of alarms can be detrimental:

“Excessive numbers of alarms—particularly alarms for conditions that aren’t clinically significant or that could be prevented from occurring in the first place—can lead to alarm fatigue, and ultimately patient harm. That is:

  • Caregivers can become overwhelmed, unable to respond to all alarms or to distinguish among simultaneously sounding alarms.
  • They can become distracted, with alarms diverting their attention from other important patient care activities.
  • They can become desensitized, possibly missing an important alarm because too many previous alarms proved to be insignificant.”

In the recent survey conducted by A Promise to Amanda Foundation and the Physician-Patient Alliance for Health & Safety, The survey clearly pointed out hospitals views on alarm fatigue as a major clinical concern. Almost 200 hospitals from 40 states confirmed that the issue alarm fatigue was extremely high, with the vast majority (more than 95 percent) concerned.

The decisions clinicians make or are not making as a result of alarm fatigue are potentially detrimental to patient safety and may potentially cause inadequate delivery of care to the patient. The survey also found that almost nine out of ten hospitals (87.8 percent) believe that a reduction of false alarms would increase the use of patient monitoring devices, like an oximeter for oxygenation or capnograph for adequacy of ventilation. This point alone identifies a huge disconnect that jeopardizes patient safety and work flow processes that are essential to safe practices.

Alarm Management and the potential for alarm fatigue has become a national patient safety issue that is preventable and needs to be recognized in order to reduce patient harm and decrease cost expenditures. The results of the PCA Survey suggest two tools that hospitals believe could help manage alarms better.

The first is a single indicator. Seven out of 10 hospitals (70.7 percent) would like “a single indicator that accurately incorporates key vital signs, such as pulse rate, SpO2, respiratory rate, and etCO2.” Moreover, those concerned alarm fatigue is an unmanageable problem were more than twice as likely to want a single-indicator assessment tool (OR=2.278; 95% CI 1.073-4.838). This information helps clinicians reform their practice, re-educate their staff via in-services, develop clinical competencies and hands on communications and observations which would significantly reduce the number of alarms. The adoption and use of the single indicator assessment tool being consistently used by all could promote maximum patient safety. Moreover, from a nursing perspective, such a tool would greatly assist busy staff in quickly evaluating patients.

The second is a recommendation for making patient assessments. Almost half of the respondents (44.6 percent) would like “recommendations on how best to easily make such assessments” of patients, and more than half (52.9 percent) would like to see more clinical training. Moreover, twice as many of those concerned that alarm fatigue is an unmanageable problem would like recommendations for ease of assessment for their nursing staff (OR=2.039; 95% CI 0.992-4.190). Incorporation of such an assessment into the daily care plan could allow for identification of real-time outliers, gaps in care, and the cause of the diversion that resulted in the occurrence of nuisance alarms.

Both of these findings from the survey point to the same issue – how can busy clinicians quickly and easily identify a physiological decline in the patient.

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