On any given day in certain hospital units, up to several hundred alarms may sound per patient, according to The Joint Commission. However, American Nurses Association (ANA) estimates that 85-99% of these signals don't require clinical intervention, and as a result, nurses can become unaffected by the sounds. This desensitization, known as alarm fatigue, can ultimately put patient safety at risk.
As alarms go off repeatedly, nurses and others working in the environment think the chaos is normal and become immune to it.
Reducing the number of alarms in ICUs has become a national priority, as safety organizations such as the Joint Commission have started requiring hospitals to prioritize alarm safety — or risk losing accreditation. In 2016, hospitals were expected to develop and implement specific components of policies and procedures to address the problem.
Knowing which alarms to eliminate is a complex issue, and researcher Halley Ruppel, MS, RN, a doctoral student in the Yale School of Nursing, explored this question in a recent article published in the American Journal of Critical Care.
Ruppel, who worked in pediatric intensive care for seven years, reviewed studies from a 30-year period that classified alarms by accuracy and clinical relevance. The studies focused on physiologic alarms such as patient monitor alarms, ventilator alarms, infusion device alarms, and continuous pulse oximetry alarms.
Her review showed measuring accuracy is somewhat straightforward, but assessing clinical relevance is more subjective because it depends on the context of the patient. But the bottom line is that both inaccurate and irrelevant alarms contribute to alarm fatigue.
To combat alarm fatigue in many cases, the alarm settings could be customized by a nurse based on a patient’s needs. An athletic patient who has a low normal resting heart rate, for example, may need a different setting than the default configurations.
Customizing monitor settings may be a logical strategy to reduce the number of clinically irrelevant alarms, but training nurses to tailor the alarm settings for each patient requires education and training.
The goal is overall clinical improvement in nurse awareness and knowledge of alarm fatigue and improvement in compliance with best practice changes to reduce alarm burden. Improving staff compliance with strategies to reduce alarm burden may benefit from preintervention one-on-one sessions to evaluate nurses’ baseline practical skills on the use of best practice alarm-reduction strategies. The intervention also might benefit from assessing nurses’ personal awareness and perception of alarm fatigue.
Reducing the number of alarms will not only decrease the risk of alarm fatigue, but also help nurses avoid the tendency to become dependent on alarms more than their own assessments at the bedside. Hospitals should aim to create an environment in which the sound of an alarm means action is required.
When you’re in the thick of a busy, noisy ICU, you might not realize the impact of multiple alarms vying for your attention, creating distractions and potentially jeopardizing patients. Education about the ramifications of nurse fatigue and the benefits of alarm-reduction strategies can help nurses get control over the situation, improve the work environment, and ensure patient safety.
Has your unit done anything to reduce alarm fatigue?