Alarm Fatigue – Managing Alarm Systems to Improve Patient Safety
Originally meant to alert clinicians of critical medical problems, physiological alarms can potentially adversely affect quality of care if there are too many false alarms. One study estimates that 72% to 99% of clinical alarms are false[1]. Such high levels of false alarms result in alarm fatigue, the dangerous medical phenomenon whereby clinicians and patients become desensitized to auditory alerts due to overexposure. Alarm fatigue may cause patients to turn-down or turn-off their monitoring equipment. As such, alarm desensitization commonly results in missed clinical alarms and can thereby contribute to a lack of critical care. Complexly, the causes of alarm fatigue are nearly as multifaceted as the interventions necessary to improve patient monitoring and outcome.
Patient safety and regulatory agencies have proposed comprehensive, multi-tiered strategies to tackle the issue of alarm fatigue. Broadly, their recommendations aim to decrease the incidence of false alarms and improve clear and actionable alarm-communication procedures. The Joint Commission Perspectives on Patient Safety outlined the following strategies, actively recognizing that each medical setting faces unique sets of challenges. In short, they encourage hospital management to[2]:
- Develop a multidisciplinary team to review [alarm] trends and develop protocols
- Take appropriate measures to reduce the number of “nuisance” (false-positive) alarms
- Clarify who is responsible for alarm notification and response
- Develop clear protocols for handoff communication
- Carefully analyze and measure potential alarm-related problems
- Build a culture of safety
- Adequately train staff
Unfortunately, such strategies may prove difficult to implement. In the aim of combating the important technological hazards of nuisance alarms, directives like ‘analyzing and measuring potential alarm-related problems’ are easier said than done. For instance, there exists no standardization of alarm sounds between device manufacturers and, as such, distinguishing between auditory notifications is highly challenging in settings where there is more than one monitoring system.
Accordingly, a systematized approach is needed to combat these multi-layered challenges. At John’s Hopkins Hospital, comprehensive strategies, such as improving monitoring-device skin prep, reducing clinically unnecessary monitoring, reconfiguring alarm notification parameters particular to patient populations and moving away from auditory alters to paged/texted/visually-communicated ones, managed to reduce the incidence of critical monitor alarms by 43%[3].
Originally intended to save lives, medical alarms run the risk of crying wolf if they sound off too often. Without question, alarm fatigue research demonstrates the need for improved clinician and patient education on the relevance of individual monitoring systems. Patient awareness and staff training are crucial to decreasing clinically irrelevant monitoring while improving efficacy of alarm monitoring systems[4]. There appears to be a general consensus that creating a culture of safety involves every medical stakeholder. By developing clear response protocols, optimizing technology usage, increasing clinician and hospital staff awareness, and educating patients, the use of monitoring systems may be improved; ultimately, to promote a culture of improved patient safety.
[1] Sendelbach, Sue, and Marjorie Funk. “Alarm Fatigue: A Patient Safety Concern.” Nursing Center. https://www.nursingcenter.com/journalarticle?Article_ID=1617134&Journal_ID=230572&Issue_ID=1616941.
[2] “Sound the Alarm: Managing Physiologic Monitoring Systems.” The Joint Commission Perspectives on Patient Safety11, no. 12 (December 2011): 6-11. https://www.jointcommission.org/assets/1/6/Perspectives_Alarm.pdf.
[3] “Closing the Clinical Alarm Gap.” 24×7 Magazine. http://www.24x7mag.com/2010/09/closing-the-clinical-alarm-gap/.
[4] “Reducing the Safety Hazards of Monitor Alert and Alarm Fatigue.” PSNet. https://psnet.ahrq.gov/perspectives/perspective/199/Reducing-the-Safety-Hazards-of-Monitor-Alert-and-Alarm-Fatigue.