Spend time in any ICU, and you can’t miss the alarms. The blaring, incessant beeps that randomly erupt from machines around the bedside are startling at first, but the noise is so constant it eventually becomes part of the background.
Alarm fatigue has long been a concern in critical care units, where acutely ill patients may be surrounded by as many as 20 advanced medical devices at a time. Many of these devices, which include ventilators, infusion pumps, compression stockings and vital sign monitors, contain multiple alarms. Cardiac monitors, in particular, set off numerous alarms. Though these devices look high-tech, none of them can actually talk to each other—and they must often beep loudly over each other to get noticed. The lack of interoperability between these alarm systems creates a chaotic chorus of confusion, as Dr. Peter Pronovost, a critical care physician with The Johns Hopkins Hospital, describes in this STAT article.
One ICU unit may produce hundreds of alarms per patient and thousands of alarms per day. While alarms are necessary to alert care team members to issues that could develop into adverse events, many turn out to be false warnings. Dr. Pronovost estimates that nurses in the ICU answer a false alarm every 90 seconds on average.
The environment is “no different than it was 50 years ago,” Dr. Pronovost told STAT, noting this system of alerting nurses to potential medical events has progressed little since the inception of ICUs in the 1960s.
Work we have done with hospitals confirms the ineffectiveness of this system. Our research shows that nine times out of 10 caregivers respond to alarms that end up not being significant. That means only 10 percent of alarms are actionable.
For short-staffed nurses, the clamor of beeps, chimes, dings and other noise is more than annoying. Taking time to chase down alarms, assess their severity and reassure patients sidetracks them from other important tasks and patients who need them. The distraction can also raise the risk of medical errors and cross-contamination if they rush to touch a beeping piece of equipment or flustered patient before washing or sanitizing their hands.
Yet nurses cannot afford to ignore alarms, block them out or delay their response to them either, because they never know when a patient might be experiencing a significant medical event.
The proliferation of alarmed devices in units with staffing shortages creates a “perfect storm” that makes quick response to these alerts difficult and accountability for managing them unclear, as this Medscape article explains. Some nurses are taking actions into their own hands by turning down alarm volumes, widening alarm parameters and shutting some alarms off altogether. These fixes may alleviate alarm overload for the moment, but they also put the millions of patients who pass through these units at even greater risk for serious and fatal medical errors.
Alarm fatigue is no longer just a critical care syndrome. With the use of alarm-enabled patient monitoring devices on the rise, it is spreading to non-acute hospital units as well. It is becoming a major source of nursing stress, burnout and dissatisfaction, with one study finding that 91 percent of nurses believed the noise had a negative impact their work.
The Price for Patients
Alarms may overwhelm nurses, but they can take a heavier toll on patients, increasing their anxiety and interfering with their attempts to sleep, rest and recover. Over time, disrupted sleep, much of which patients attribute to noise, can lead to sleep deprivation as well as decreased immune function and pain tolerance, as this article in the Nursing Critical Care journal illustrates.
The maximum level of noise in hospitals at night should not exceed 40 decibels, according to the World Health Organization, yet alarms on machines and peak unit sound levels often register much higher.
Many patients, particularly those in critical care, already have a compromised ability to tolerate stress caused by noise, and exposure to more can increase blood pressure, heart rate and irritability. Noisy, brightly lit environments and sleep deprivation may also contribute to delirium in patients, a condition that causes at least a third of critical care patients to experience sudden, intense periods of confusion marked by hallucinations, delusions and paranoia. Patients who develop delirium have longer recovery periods, higher mortality rates and a greater chance of developing dementia once they leave the hospital.
While other factors such as heavy sedation, ventilation and physical immobility may also spur delirium, some hospitals are trying to minimize noisy alarms and sound disruptions in patient rooms as part of their efforts to prevent this condition, as this article in The Atlantic illustrates.
Antidotes to Alarm Fatigue
None of us can argue with the fact that alarms are a vital part of any sophisticated and safe patient care device. But how can clinicians manage alarms without being overwhelmed by them? Simply ignoring them is not the answer—no matter how many false positives they may generate.
While adjusting default settings and alarm thresholds and training nurses on how to operate alarm systems reduced the total number of hospital alarms in a study conducted by the University of Texas Health Science Center at San Antonio, these strategies were not enough to combat alarm fatigue for nurses or improve their attitudes toward alarms. Researchers found that this fatigue and staff cynicism toward alarms stemmed from other factors such as high frequency of nuisance alarms, confusion in locating alarms, unit layouts that hindered alarm response, lack of clinical policies and procedures on alarm management, and complexity of newer monitoring systems.
Nursing teams need a unified way to monitor, prioritize and escalate alarm activity throughout their units so they can respond in an appropriate and timely manner. Fortunately hospitals are beginning to harness new technology and data capture to make this happen.
Our founder David Condra authored a piece for Nashville Medical News exploring how technology and data can turn the tide of this fatigue. Condra outlined four steps that hospitals can take to address alarm fatigue, ease the burden of care on nurses and staff, and improve the quality of care, safety and experience for patients. Get his insights in the full article here.
If you want to know the cost of outdated technology to your hospital, staff and patient care, talk to one of our clinical specialists today.