As technology has advanced, so have the multiple medical device systems used to monitor patients for potential problems, contributing to the noisy hospital environment. Nurses have become overwhelmed with a multitude of beeps, buzzers and alarms. Various devices including bed alarms, infusion pumps, cardiac monitors, ventilators, vital-sign machines, sequential compression devices and many others, have audible alarms for competing for attention that desensitize nurses to the urgency of alarm response. Although healthcare monitoring devices are supposed to improve patient safety and quality of care, alarm fatigue is a serious issue in healthcare settings across the United States.
Alarm fatigue has emerged as a growing concern for patient safety and can put patients in danger if ignored. There is a need to identify the rationalization of why alarm fatigue occurs along with understanding interventions and strategies to eliminate the cause that may impact patient outcomes. The purpose of this research paper is to determine if there is a correlation between alarm fatigue and negative outcomes in patient care.
Purpose of Alarms Bedside monitoring is an important function in hospital units and is required to provide continuous oversite of patient parameters. Clinical alarms were made to provide warnings to alert clinicians when a change in a patient’s condition has occurred or when a device is not functioning how it should. Alarms are specifically designed to cause cognitive distress and capture the attention of the clinicians’ caring for multiple patients to a change warranting clinician awareness, closer assessment and supportive intervention (). Not all alarms require interventions or closer assessments and this is where problems may occur.
Actionable alarms are alarms that are sounded due to the patient being in a physiologically abnormal state which requires assessment and interaction (Bonafide et al., 2015). An actionable alarm requires further clinical interventions to correct the problem. High or low sustained vital signs are an example of an actionable alarm. Non-actionable alarms are true alarms that do not require clinical intervention or action and can be as a result of an intentional action (Bonafide et al., 2015). Examples of non-actionable alarms include motion artifacts and low-quality pulse oximetry reading when the patient moves an extremity. According to one observational study done in an intensive care unit setting, a total of 426 alarms were recorded in 40 hours of observation which is an overage of 10.6 alarms per hour (Bridi, Louro, & Silva, 2014). Majority of these alarms were considered non-actionable and false causing alarm fatigue and a decrease in response time. Alarm Fatigue Alarm fatigue is sensory overload when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms (Sendelbach & Funk, 2013). The primary source of alarm fatigue in clinicians is considered to be the repetitive sounds of non-actionable alarms. The Joint Commission indicates that the number of alarm signals per patient per day can reach over several hundred depending on the specific unit in the hospital and it is estimated that between 85-99% of alarm signals do not require clinical intervention (The Joint Commission, 2013). The desensitization to alarms occurs largely because the devices have cried wolf too often. The large number of non-actionable alarms has caused nurses to turn down the volume of audible alarm signals, adjust the alarm settings outside limits that are appropriate for the patient, ignore alarm signals, or even deactivate alarms. Alarm fatigue can also cause delayed response times when there is an actionable alarm being sounded. One study in a pediatric intensive care unit showed an incremental increase in response time as the number of nonactionable alarms increased (Bonafide et al., 2015). Due to these issues, alarm fatigue is now a huge patient safety concern and has been suggested to be the biggest contributor to alarm adverse events. Alarm Fatigue and Patient Safety Alarm fatigue is considered to be one of the leading causes of sentinel events within the healthcare system. According to a study by Sowan (2015), alarm fatigue often results in the death of patients and thus has forced the patient safety and regulatory agencies to focus on the issue. When staff members disconnect monitoring equipment, silence alarms, or become desensitized they can miss important safety signals. Alarm fatigue has been identified by the Joint Commission as a major contributing factor in 80 deaths, 13 patients with permanent loss of function and five patients who required unexpected additional care or extended stays from January 2009 to June 2012 (The Joint Commission, 2013). Common injuries or deaths related to alarms included those from falls, delays in treatment, ventilator use and medication errors that can be traced back to alarm system issues. According to ERCI (2013), a leading patient safety organization, considered alarm fatigue the number one technology hazard of 2013. Harm From Alarm Fatigue An example of clinical alarm fatigue and it contributing to patient outcomes was presented within the December, 2015 article of Patient Safety Network titled Harm from Alarm Fatigue. A case study of a 54-year-old man with hypertension, diabetes and end-stage renal disease on dialysis was admitted to the hospital with chest pain. His electrocardiogram showed no evidence of a myocardial infraction but his troponin was slightly elevated. The patient was admitted to an observation unit and was place on a telemetry monitor for further monitoring. While the patient was on the unit his telemetry monitor was constantly alarming with warnings of low voltage and asystole. The bedside nurse initially responded to these constant alarms but each time she went in the room she found the patient to be well and responsive. The study stated that the most common cause of false asystole alarms is under-counting of heart rate due to failure of the device to detected low-voltage QRS complexes in the ECG leads used for monitoring which is what the patients telemetry device warned of (Pelter & Drew, 2015). The nurse decided to silence all of the telemetry alarms instead of looking for a different telemetry monitor with higher voltage. The patient was not checked for approximately four hours and when the nurse went to perform vital signs he was found unresponsive with no pulse. A code blue was called but the patient did not survive. The study stated that the biggest harm that was resulted from this case was that the patient developed a possible fatal arrhythmia that was not noticed by the clinical staff due to the patient telemetry monitor being turned off (Pelter & Drew, 2015). This adverse event reveals a clear hazard associated with hospital alarms. Alarm Fatigue and Other Patient Outcomes An example of a sentinel event that happened due to alarm fatigue is a patient death that occurred in 2013 at Des Moines hospital after a nurse turned off all his patients monitoring alarms. One of the alarms that was set was to alert the staff of any drop in the patients’ blood oxygen levels. When the patient was found, he was unresponsive, ashen, pale and cyanotic. The patients oxygen saturation also had fallen to a critically low level. When the staff checked the patient alarms they found that the alarms had been shut off for at least three hours. The patients respiratory therapist stated that numerous interventions could have prevented his death if alarms were on to notify the staff (). The nurse stated later that he did in fact turn the patients alarm off due to the alarms always going off, even when the patients were healthy. Another example of a sentinel event that happened due to alarm fatigue occurred in a cardiac patient at Massachusetts General hospital. According to the story, the patient died after his heat rate fell and eventually stopped over the course of about 20 minutes (). The alarm for the patient was sounding frequently but due to the nurses become desensitized they did not notice it. Nurses on the unit were not aware that the patient was in distress until a nurse went in the room for a routine test and found the patient unresponsive. Negative patient outcomes will continue to happen unless interventions are put into place to help prevent alarm fatigue.
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