It's an all-too-common occurrence in hospitals: Alarms sound simultaneously and for all sorts of reasons—some serious, some not. Nurses get confused by the cacophony and in some cases ignore or switch off the alarms. The results can be deadly for patients.
In late April, the Joint Commission announced an intent to work with the Food and Drug Administration to develop a systematic strategy to address so-called alarm fatigue.
"The solution is not entirely within the hospital's control," says Paul Schyve, M.D., senior vice president at the Joint Commission, noting that newer devices have even more alarms than those made five or 10 years ago. "The manufacturers who are creating better and more pieces of technology are trying to do the right thing."
Nevertheless, the situation appears to be worsening. "We know that sheer volume of alarms overwhelms staff, and they become desensitized," says Kathryn Pelczarski, director of the applied solutions group at ECRI Institute, which researches strategies to improve patient care. ECRI ranked alarm fatigue No. 2 on its list of top 10 health technology hazards for 2011, the second year in a row the issue earned that spot. Radiation administration and dosing topped the list for 2011.
Each hospital and unit has unique vulnerabilities, so solutions should be tailored realistically for those circumstances. Hospitals can designate multidisciplinary teams to review alarm events and risk data, Pelczarski says. These teams also can observe staff responses to alarms.
"They need to really drill down to those underlying causes," she says. Consulting with front-line nurses and patient care technicians reveals how actual practices may differ from policies. If frequent false alarms aren't addressed, they may inundate staff and cause them to miss clinically significant alarms.
"It's a 'cry wolf' phenomenon. The one time when it's important, people may not look," says Maria Cvach, R.N., co-author of "Monitor Alarm Fatigue: Standardizing Use of Physiological Monitors and Decreasing Nuisance Alarms" in the January 2010 American Journal of Critical Care. Customizing alarm limits for individual patients may help. For example, in the case of a marathon runner, the normal heart rate could be lower than the default.
Some hospitals are evaluating brief delays in alarm notification—about 5 to 10 seconds—for conditions that may quickly resolve. "You can adjust these delays to whatever you feel is safe for that particular parameter," says Cvach, assistant director of nursing, clinical standards, at Johns Hopkins Hospital.
That means an alarm won't sound if the change in a patient's breathing is due to a cough or sneeze, not a more imminent concern. Physician input is essential, Pelczarski says, to ensure that a delay won't jeopardize prompt response if the condition doesn't resolve on its own.
Other concepts being explored by hospitals include:
- A central surveillance room with monitor watchers that notify caregivers of clinical alarms on patient floors.
- Alarm integration systems in which alarms from various pieces of equipment are filtered through an integration system that directs
them to communication devices worn by specific staff.
Alarm standardization by manufacturers would be helpful, experts say. Alarm tones should be distinct for each type of medical device and level of urgency.
They don't sound the same. Different manufacturers make them differently," Cvach adds. "That's challenging.