Alarm Fatigue in Nursing: Consequences & how to Reduce it

Alarm fatigue in nursing is a nurse’s response to sensory overload that occurs due to exposure to excessive alarms. The sensory overload results in a desensitization to the sound of alarms. The alarm sounds may be true patient events or false alarms caused by other factors. The effect of the alarms is the same, nonetheless.

Alarms are time-sensitive notifications that communicate an immediate patient need. Some alarms signal a life-threatening situation. Alarm fatigue in nursing is a critical issue for a few reasons. First, because alarm fatigue is caused by over-sensitization to alarms, it is associated with delays in response time, which could result in negative consequences for patient outcomes. Depending on a patient’s status or individual situation, delayed care could have dire consequences, even leading to death.

Desensitization to medical device alarms due to frequent, non-urgent alerts, leading to delayed or missed responses.

Types of Equipements that Cause Alarm Fatigue in Nurses?

Any number of alarms may trigger alarm fatigue in nursing. The most common types of alarm associated with alarm fatigue include the following.

1. Medication Pumps

Medication pumps typically have two types of alarm signals. One alarm indicates mechanical issues with the device, such as a low battery, occlusion of tubing, or air in the line. The other alarm alerts nurses if a programmed medication dose exceeds the prescribed safety limit.

2.Vital Sign Monitors

Vital sign monitors are designed to assess vital signs continuously or at set intervals. The alarm is triggered when one or more vital signs drop or spike. Some machines are set so the alarm changes pitch or becomes louder and faster until a nurse manually turns the alarm off.

3.Sequential Compression Devices

Sequential compression devices are used to improve blood flow in the legs as a preventive measure to reduce the risk of patients developing DVTs. The device may alarm if the tubes need to be reconnected or become kinked. The sound of SCD alarms is quite common on post-surgical floors.

4.Ventilators

Ventilators monitor several patient and machine variables constantly. The machines monitor airway pressure, volume, flow rate, and respiratory rate. The ventilator alarm is a safety mechanism designed with a preprogrammed set of parameters to alert nurses when there is a problem.

5.Telemetry Monitors

Patients who require cardiac monitoring for an extended period may be put on a telemetry monitor. The monitor checks for abnormal heart activity that could indicate a setback or a new or serious problem. While the monitors are effective at identifying abnormalities quickly, low batteries, disconnected electrodes, or wires that rub together could also cause the machines to alarm. I know how stressed I felt when only five or six alarms sounded each hour. Nurses who work on a telemetry floor may have several patients to care for each shift, all with multiple devices and alarms sounding off, which is quite stressful.

Consequences of Alarm Fatigue:

1. Delayed response to critical alarms
2. Missed life-threatening events
3. Decreased patient safety
4. Increased nurse stress and burnout
5. Reduced productivity

Types of Alarms:

1. Critical (life-threatening): Asystole, Ventricular Tachycardia
2. Warning (potential harm): Tachycardia, Hypotension
3. Advisory (non-urgent): Low battery, Loose lead

How to Prevent Alarm Fatigue

Nurses and healthcare leaders can help prevent, avoid, and mitigate alarm fatigue in a variety of ways, such as:

• Optimizing nurse schedules so alerts don’t fall on one person
• Educating staff on protocols for monitoring systems and managing alarm settings
• Evaluating where and when alarms are clinically significant or superfluous
• Consistently gathering nurse feedback about burnout and alarm fatigue
• Customizing alarms based on each patient’s condition and healthcare needs
• Designating actionable responses for each type of alert so nurses know how to respond
• Consolidating or disabling redundant alarms
• Properly preparing patients for the placement of device hookups and monitoring protocols
• Categorizing alarms based on priority levels
• Analyzing alarm data to pinpoint and predict when issues arise
• Reducing alarm decibel levels or experimenting with different sound types
• Regularly maintaining and updating equipment, including changing or charging batteries and installing new software

Strategies to Reduce Alarm Fatigue:

1. Standardize alarm settings and parameters
2. Implement alarm management policies
3. Educate nurses on alarm management
4. Use smart alarms and analytics
5. Regularly review and adjust alarm settings
6. Implement alarm escalation protocols
7. Use visual and auditory differentiation

Decreasing Decibels

A contributing factor to alarm fatigue is the amount of noise the alarms produce. Constant beeping and alarms throughout the unit can cause nurses to miss their own alarms or change the settings to improper parameters in order to avoid the noise. The World Health Organization recommends noise levels of 35 decibels (dB) during the day and 30 dB during the night. 

Advances in technology have increased the use of visual and/or vibrating alarms to help reduce alarm noise. Hospitals can implement functions on their monitors to pause alarms for short periods when providing patient care, turning a patient, and/or suctioning. These may all trigger patient alarms but if a trained healthcare professional were at the patient’s bedside pausing alarms would help reduce the alarm noise.

Boston Medical Center switched cardiac monitor thresholds from “warning” to “crisis” and as a result reduced the noise levels from 92 dB to 70 dB. In doing so, nurses had quicker reaction times to alarms and patients were less disturbed.

Examples of Alarm Management Technologies:

1. Philips Healthcare’s Alarm Management Solution
2. Medtronic’s CareLink Network
3. Hospira’s Alarm Management System
4. Masimo’s Patient SafetyNet
5. Mindray’s Vital Signs Monitoring System

REFERENCES

1. The Joint Commission. Sentinel Event Alert Issue 50: medical device alarm safety in hospitals.  http://www.jointcommission.org/sea_issue_50/. Updated April 8, 2013.
2. Gorges MM. Improving alarm performance in the medical intensive care unit using delays and clinical context. Anesth Analg. 2009;108(5):1546-1552. 
3. Woo M, Bacon O. Alarm Fatigue. In: Hall KK, Shoemaker-Hunt S, Hoffman L, et al. Making Healthcare Safer III: A Critical Analysis of Existing and Emerging Patient Safety Practices [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020 Mar. 13. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555522/
4. Lewandowska K, Mędrzycka-Dąbrowska W, Tomaszek L, Wujtewicz M. Determining Factors of Alarm Fatigue among Nurses in Intensive Care Units-A Polish Pilot Study. J Clin Med. 2023 Apr 25;12(9):3120. doi: 10.3390/jcm12093120. PMID: 37176561; PMCID: PMC10179395.

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