Alarm fatigue — when clinicians fail to respond to alarms due to overexposure — is a serious condition that can have fatal consequences for patients. In fact, the ECRI Institute named alarms the most hazardous health technology for 2012. In October 2011, several organizations, including the Association for the Advancement of Medical Instrumentation, The Joint Commission, the ECRI Institute and the American College of Clinical Engineering, held a medical device alarms summit to address alarm fatigue and identify ways to prevent and eliminate it.
Shawn O'Connell, MS, RN, a member of the AAMI Medical Device Alarm Committee and Director of clinical value marketing at medical device manufacturer B. Braun Medical, shares the top causes of alarm fatigue and strategies to prevent it.
Causes
The sheer number of alarms clinicians must respond to is one of the main causes of alarm fatigue. Data reported at the medical device alarms conference showed there can be as many as 300 or more alarms per shift, Ms. O'Connell says. Compounding this issue is that many alarms are not clinically relevant for the patient. "There are more and more devices with more and more types of alarms, but not all of them have clinical significance," Ms. O'Connell says. "An alarm may not be telling something about a patient, but it may be about the device, or it may not require action on the part of the clinician."
Cardiac monitors are among the top alarm-producing devices, according to Ms. O'Connell. It monitors multiple parameters beyond heart rate, such as the occurrence of abnormal beats and ST-Segment elevation, which can signal an impending heart attack. In addition to sounding an alarm to warn clinicians of a physiological problem, the cardiac monitor may also sound because of electrode interference. For example, heart rate alarms can occur when a patient rolls over in bed or scratches an electrode, when electrodes are not changed frequently or if there is electrical interference from other equipment. "A restless patient is one of the most challenging because [he or she] is constantly moving, grabbing [his or her] clothes, setting of the alarms constantly," Ms. O'Connell says. "It may prompt clinicians to set very broad alarm limits or turn some alarms off."
When confronted with an overwhelming number of alarms, clinicians may not respond promptly, turn some alarms off or broaden monitoring parameters. These actions can cause physicians, nurses and staff to miss a critical change in the patient, which may lead to harm or death. In fact, the FDA reported there were 566 alarm-related deaths in the United States between 2005 and 2008.
The number of alarms does not affect only clinicians, however. Alarms' loud volume can lead to sleep deprivation of patients, which can in turn affect the patients' mental and physical state. Alarms' effect on patients is particularly challenging in the neonatal intensive care unit, where too much visual and audio stimulation can be "incredibly detrimental," Ms. O'Connell says.
Solutions
Ms. O'Connell provides six short- and long-term strategies to reduce alarm fatigue.
1. Gain leadership support. The organization's leaders need to recognize alarm fatigue as an important issue and support efforts to remedy the problem.
2. Use a team approach. Ms. O'Connell suggests gathering key clinical leaders in the organization to discuss and prioritize the top alarm-related challenges. These leaders can provide insight into which devices produce excessive alarms and which alarms may be clinically insignificant.
3. Establish alarm policies. Establishing alarm policies is a key step in mitigating the risk of alarm fatigue. Ms. O'Connell suggests starting broadly, such as requiring certain alarms always be on and alarm responses documented. "It's a big undertaking because there are so many devices that can produce alarms. You should start with ones that have the most potential to cause patient harm if not addressed: cardiac monitors, infusion pumps, respiratory monitors, [anything] that can alert you to a life-threatening change," she says.
An alarm policy should address the need for alarms in different areas of the hospital. For instance, some alarms in the ICU may not be necessary in less acute areas. The policies should also leave room for clinical judgment, Ms. O'Connell says.
4. Choose technology wisely. Organizations need to carefully consider a technology's alarm systems before purchase. "There are dozens of different alarm configurations, some may be unique so one supplier can differentiate itself from another; there might not necessarily be strong clinical evidence to support the clinical significance of the alarm," Ms. O'Connell says.
5. Work with suppliers. Healthcare organizations should work with the supplier when acquiring new equipment, according to Ms. O'Connell. "Work collaboratively with the supplier to truly understand the logic behind all the alarm."
6. Conduct additional research. Very little research on alarm fatigue exists, which makes establishing policies and standards more difficult. The paucity of research on this topic may be due to a general unawareness of its importance. Alarm fatigue garnered attention only when incidents of alarm-related death were highly publicized, Ms. O'Connell says. In addition, alarm fatigue research is not as high-profile as studies in other areas, such as infection control. Its relatively low status in the research arena may be partly responsible for the difficulty getting funding for the research and attracting researchers.
However, research is needed to identify alarms that are clinically significant, how alarms should be set and what the most effective alarm sounds are, among other issues. "There are still a lot of unanswered questions," Ms. O'Connell says. "It's hard to make concrete recommendations for change without research."
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Shawn O'Connell, MS, RN, a member of the AAMI Medical Device Alarm Committee and Director of clinical value marketing at medical device manufacturer B. Braun Medical, shares the top causes of alarm fatigue and strategies to prevent it.
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Causes
The sheer number of alarms clinicians must respond to is one of the main causes of alarm fatigue. Data reported at the medical device alarms conference showed there can be as many as 300 or more alarms per shift, Ms. O'Connell says. Compounding this issue is that many alarms are not clinically relevant for the patient. "There are more and more devices with more and more types of alarms, but not all of them have clinical significance," Ms. O'Connell says. "An alarm may not be telling something about a patient, but it may be about the device, or it may not require action on the part of the clinician."
Cardiac monitors are among the top alarm-producing devices, according to Ms. O'Connell. It monitors multiple parameters beyond heart rate, such as the occurrence of abnormal beats and ST-Segment elevation, which can signal an impending heart attack. In addition to sounding an alarm to warn clinicians of a physiological problem, the cardiac monitor may also sound because of electrode interference. For example, heart rate alarms can occur when a patient rolls over in bed or scratches an electrode, when electrodes are not changed frequently or if there is electrical interference from other equipment. "A restless patient is one of the most challenging because [he or she] is constantly moving, grabbing [his or her] clothes, setting of the alarms constantly," Ms. O'Connell says. "It may prompt clinicians to set very broad alarm limits or turn some alarms off."
When confronted with an overwhelming number of alarms, clinicians may not respond promptly, turn some alarms off or broaden monitoring parameters. These actions can cause physicians, nurses and staff to miss a critical change in the patient, which may lead to harm or death. In fact, the FDA reported there were 566 alarm-related deaths in the United States between 2005 and 2008.
The number of alarms does not affect only clinicians, however. Alarms' loud volume can lead to sleep deprivation of patients, which can in turn affect the patients' mental and physical state. Alarms' effect on patients is particularly challenging in the neonatal intensive care unit, where too much visual and audio stimulation can be "incredibly detrimental," Ms. O'Connell says.
Solutions
Ms. O'Connell provides six short- and long-term strategies to reduce alarm fatigue.
1. Gain leadership support. The organization's leaders need to recognize alarm fatigue as an important issue and support efforts to remedy the problem.
2. Use a team approach. Ms. O'Connell suggests gathering key clinical leaders in the organization to discuss and prioritize the top alarm-related challenges. These leaders can provide insight into which devices produce excessive alarms and which alarms may be clinically insignificant.
3. Establish alarm policies. Establishing alarm policies is a key step in mitigating the risk of alarm fatigue. Ms. O'Connell suggests starting broadly, such as requiring certain alarms always be on and alarm responses documented. "It's a big undertaking because there are so many devices that can produce alarms. You should start with ones that have the most potential to cause patient harm if not addressed: cardiac monitors, infusion pumps, respiratory monitors, [anything] that can alert you to a life-threatening change," she says.
An alarm policy should address the need for alarms in different areas of the hospital. For instance, some alarms in the ICU may not be necessary in less acute areas. The policies should also leave room for clinical judgment, Ms. O'Connell says.
4. Choose technology wisely. Organizations need to carefully consider a technology's alarm systems before purchase. "There are dozens of different alarm configurations, some may be unique so one supplier can differentiate itself from another; there might not necessarily be strong clinical evidence to support the clinical significance of the alarm," Ms. O'Connell says.
5. Work with suppliers. Healthcare organizations should work with the supplier when acquiring new equipment, according to Ms. O'Connell. "Work collaboratively with the supplier to truly understand the logic behind all the alarm."
6. Conduct additional research. Very little research on alarm fatigue exists, which makes establishing policies and standards more difficult. The paucity of research on this topic may be due to a general unawareness of its importance. Alarm fatigue garnered attention only when incidents of alarm-related death were highly publicized, Ms. O'Connell says. In addition, alarm fatigue research is not as high-profile as studies in other areas, such as infection control. Its relatively low status in the research arena may be partly responsible for the difficulty getting funding for the research and attracting researchers.
However, research is needed to identify alarms that are clinically significant, how alarms should be set and what the most effective alarm sounds are, among other issues. "There are still a lot of unanswered questions," Ms. O'Connell says. "It's hard to make concrete recommendations for change without research."
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