Today’s technological advancements can be ignored just as easily as they save lives. AACN officials are sharing guidance for nurses that they hope will not fall on “deaf” ears.
The impact that technology has had on the delivery of healthcare is reaching an immeasurable status. For the most part, the impact has been positive. Improved diagnostic tools are allowing for earlier treatments that are becoming more likely to involve digital technology — from a baseline utilization of telehealth platforms that allow for remote assessment and care planning to sophisticated surgical tools in the operating room that are literally saving lives in real time —the benefits of today’s technological advances can easily be seen full circle. The use of social media and email is also allowing for easier connectivity between patient and provider, advanced technology is allowing for easier diagnosis, and healthcare staff of all disciplines are able to work more efficiently and effectively thanks to information technology that performs such functions as recording patients’ medical history, verifying the correct dosing of medication and tracking vital signs with ease.1 Unfortunately, however, the increased sophistication of technology and the proliferation of its usage in various patient-care settings is also making the tendency for “alarm fatigue” to occur among clinicians that much easier. Defined by the American Association of Critical-Care Nurses (AACN) as a sensory overload that occurs when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarm sounds and an increased rate of missed alarms,2 alarm fatigue has contributed to unnecessary patient deaths due to delayed response to alarm warning sounds as a result of a sensory overload among those staff members who are frequently in the presence of sounds emitted by such devices as beds, monitors, infusion pumps and ventilators.
“It seems like every piece of equipment used in patient care makes a sound,” said Linda Bell, MSN, RN, clinical practice specialist with the AACN. “Awareness of those sounds fades over time as clinicians get used to the noise coming from the various pieces of equipment. While alarms can be life-saving, having too many alarms causes fatigue and increases the potential for missing important patient interventions.”
Commonly described as a desensitization to those alarm sounds, one of the more problematic conditions of this phenomenon is that many of the various “chimes,” “dings” and “pings” that may be audible at any one time on any unit may in fact not signal an emergency and can thus further contribute to the propensity that a clinician could unintentionally ignore the sounds.
“Some alarm sounds are warnings, but many of them simply indicate a change in a patient’s condition that doesn’t require immediate action and may not be clinically relevant,” Beel said. Recent studies have estimated that approximately 90 percent of alarms in various critical-care settings are either false or clinically irrelevant, according to AACN findings. Improved safety measures in response to the increased likelihood of fatigue has also been identified as a national patient safety goal by the Joint Commission3 and AACN officials have identified strategies to help with alarm fatigue avoidance. These strategies for patient-care settings include:
- providing proper skin preparation for and placement of ECG electrodes;
- using proper oxygen saturation probes and placement;
- checking alarm settings at the beginning of each shift, with any change in patient condition and with any change in caregiver; and
- customizing alarm parameter settings for individual patients in accordance with unit or hospital policy.
Of note, “alarm management affects the entire organization and is not an individual clinician problem,” according to Bell. That said, the AACN also is promoting guidance for administrators and management that includes:
- establishing an interprofessional team to gather data and address issues related to alarms;
- developing unit-specific default parameters and alarm-management policies;
- providing initial and ongoing education on monitoring systems and alarm management for all appropriate staff; and
- developing policies and procedures for monitoring only those patients living with clinical indications that require monitoring.
“Not every alarm that sounds is important or actionable,” Bell said. “It’s important that we figure out how to limit the number and frequency of alarms. Then, when a piece of equipment does alarm, we will know it is important and actionable. That means the alarm is really telling the clinician something significant about the patient in that moment and requires them to attend to [that patient].
The importance of curbing alarm fatigue also has legal implications for nurses and allied health professionals as evidenced by staff members of a Long Island, NY, nursing home who are currently on trial related to a patient who became disconnected from her ventilator and died in 2015. According to a recent report by the Associated Press, three employees implicated in the death may have experienced alarm fatigue and the three employees in question have pleaded not guilty to the several felony charges they are facing, including criminal negligent homicide and willful violation of health laws. While prosecutors are claiming that the staff members heard the relative alarms indicating the disconnection from the machine, defense attorneys are citing a number of false alarms that may have impacted the reported nine minutes that it took for them to respond to the incident.
However, a review of research studies that assessed alarm accuracy and/or clinical relevance in hospitalized patients published by the AACN over a 30-year period found low proportions of clinically relevant patient alarms. These findings underscore the need for more rigorous alarm intervention research as hospitals work to meet Joint Commission requirements to reduce unnecessary alarms, according to AACN officials.
“Clinical relevance can be a subjective term, and interventions should focus on reducing clinically irrelevant alarms, with careful consideration for how clinical relevance is defined and measured,” said Halley Ruppel, RN, MS, co-author of that review study. “Especially in ICUs, nurses may use alarms to help them track changes in a patient’s condition. Clinical relevance should reflect alarms that may be informative, even if not immediately actionable or corresponding to a life-threatening incident.”
- Krueger A. 6 ways technology is improving healthcare. Business Insider. 2010. Accessed online: www.businessinsider.com/6-ways-technology-is-improving-healthcare-2010-12
- Sendelbach S, Funk M. Alarm fatigue: a patient safety concern. AACN Adv Crit Care. Accessed online: www.ncbi.nlm.nih.gov/pubmed/24153215
- The joint commission announces 2014 national patient safety goal. Joint Commission Perspectives. 2013;33(7):1-4.