Combating Alarm Fatigue
How alarm fatigue affects staff and patients
If you step into any in-patient hospital or critical care center, you’ll notice one thing in common: near-constant, loud, piercing alarms. Of course, the purpose of an alarm is to get someone’s attention, immediately, when something abnormal occurs. One study records an average of 1.2 alarms heard by a nurse every 60 seconds, or as many as 359 alarms per medical procedure. Few alarms are of any clinical value, making them frustrating to hospital staff and in the worst cases, harmful to patients. Overall, frequent false alarms and noise levels do little to foster a healing, comforting environment.
The ECRI Institute listed alarm fatigue, or missed alarms, as the #7th Health Technology Hazard of 2019. An average nurse in the ICU has to deal with three dozen kinds of alarm sounds, but several studies support the fact that most people cannot differentiate between more than six different alarm sounds.
Imagine you’re a nurse who has just sterilized your hands to administer care to one patient, and you hear an alarm sound from another room. Immediately, you’re distracted from your task at hand. You must quickly identify the alarm type from where you’re standing and decide if it’s more important than the care you were about to provide. Regardless, you’re distracted from the task at hand.
To complicate matters further, many alarms are non-critical issues or irrelevant to the specific patient. In fact, recent studies estimate as many as 90% of alarms in critical care settings are either false or clinically irrelevant. This leads healthcare providers to believe that many devices are “crying wolf,” delaying practitioner response time when a real emergency occurs. This is alarm fatigue at its core: a delayed response, or no response at all, to an alarm. Sometimes, habituation results in some alarms not even being heard at all.
All of this said, it’s no surprise that alarm fatigue is a severe challenge for healthcare providers. Alarm fatigue results in increased response time or decreased response rate due to experiencing excessive alarms. When nurses do not respond quickly enough to the few alarms that need response, patient care is affected. The Joint Commission made alarm management a National Patient Safety Goal over five years ago and has prioritized it every year. There were more than 560 alarm-related deaths in the United States from 2005 to 2008, and by 2012, the number was reduced to 80 deaths over a three year period.
Strategies to reduce alarm fatigue
Any time spent responding to false alarms is time that could have been spent focusing on patient care. The primary contributing factors are outlined below, alongside two strategies to reduce alarm fatigue:
Reducing false alarms by considering the clinical context
A standardized set of alarms for every patient is one of the primary contributors to excessive, unnecessary alarms. These can be tweaked per the needs of the patient during check-in. For example, a sharp increase in blood sugar of a diabetic patient may be extremely important and time-sensitive, while the same alert in a non-diabetic patient isn’t a cause for concern. By taking the vital signs of the individual patient into consideration when setting alerts, practitioners reduce the number of false alarms from the start. One solution to this challenge is a dedicated messaging platform that allows for Electronic Health Record (EHR) integration.
By taking a few moments to set up the customized alarms relevant to the patient’s characteristics, the frequency of unnecessary or unimportant alarms decreases significantly. Additionally, when a care team knows that alerts are chosen precisely, individual practitioners respond more carefully when alarms sound.
Alarm priority systems/customization
Clinical alerting that routes alarms directly to practitioners’ devices reduce sensory overload for both patients and care providers. Patient care is improved when important alarms get a response as quickly as possible, but patient care is also improved by a restful, quiet healing environment. By funneling the important alarms directly to the physician or nurse on-call, the number of distracting, audible alarms on the floor decreases to only the most critical.
A messaging platform that integrates with the nursing call center helps triage low-priority alerts to unit coordinators. Only actionable alarms relevant to the nurse’s unit are sent directly to them. More importantly, directing all alarms to one specific device reduces the cognitive load and number of distractions a nurse experiences during a shift.
Additionally, funneling alerts to one device means that the care provider can identify the type and location of the alarm immediately: without having to memorize dozens of alert sounds, drop their current task, or rush to another end of the unit.
While it’s clear that alarm fatigue and false alarms are frustrating for care providers, many care teams aren’t sure where to start when creating a strategy to combat false alarms. The team at miSecureMessages is here to help: our platform offers the EHR integration, encryption, security measures and dedicated support needed for care teams of any size.