Helping Hospitals Fight The Battle Against Alarm Fatigue
Source: Rob Szczerba
One of the top technologies hazards in the healthcare system is the problem of alarm fatigue, in which the sheer number, variety, and frequency of machine alarms in a hospital room leads to many of them being ignored or muted. The negative results range from annoyance to patient deaths.
On the Emergency Care Research Institute (ECRI) Top 10 Health Technology Hazards for 2014, alarm hazards ranked number one. According to the American Association of Critical Care Nurses (AACN), “Although studies show it is difficult for humans to differentiate among more than 6 different alarm sounds, the average number of alarms in an ICU has increased from 6 in 1983 to more than 40 different alarms in 2011. In addition, 80% to 99% of electrocardiographic monitor alarms are false or clinically insignificant.”
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Medical alarm hazards are the top technology danger facing hospitals. (Photo credit: Wikipedia)
In a recent Forbes column, “Understanding Healthcare’s Top Technology Hazard,” we looked at some of the devastating impacts that alarm hazards had on both patients and the healthcare system. Describing the problem is easy, identifying effective and efficient solutions usually proves a bit more difficult.
For guidance, we turned to the Association for the Advancement of Medical Instrumentation (AAMI). In an article titled “Monitor Alarm Fatigue: An Integrative Review,” Maria Cvach, the assistant director of nursing at Johns Hopkins, broke down the research evidence into five major themes:
Excessive alarms and effects on staff
Nurse’s response to alarms
Alarm sounds and audibility
Technology to reduce false alarms
Alarm notification systems
From these areas of research evidence, she developed evidence-based strategies for decreasing alarm fatigue into the following three areas:
Technology
Use “smart alarms” that keep track of multiple parameters
Standardize alarm sounds for easier identification by staff
Add troubleshooting animations to monitoring equipment
Hospital
Form an interdisciplinary alarm management committee to conduct an alarm risk assessment and explore strategies to reduce the number of alarms
Set alarms at actionable limits and levels
In scheduling staff, consider that as workload increases, so does alarm response time
Provide additional means to deliver alarm signals from monitors to caregivers, such as pagers, phones, or waveform screens
Invest in initial and ongoing staff training on alarm devices
Employ overall noise reduction strategies to reduce stress on patients and staff
Caregiver
Suspend alarms for a short time period prior to direct interaction with patients
Adjust alarms to patient’s actual needs
Properly prepare the patient’s skin for interface with the device
Routinely replace electrocardiograph leads and electrodes
Document alarm parameters in the patient’s medical record
Research in the area of alarm hazards and alarm fatigue is continuing in many universities and corporations around the world. However, many of the items in this review and other comprehensive approaches are achievable today with minimal effort and cost. Hopefully, the leadership of hospitals and other healthcare facilities are listening �C above the din of all those beeping machines.
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