Healthcare’s clinical workers face an overwhelming number of care-related alarms each day, resulting in a wearing down of their awareness because of the constant, even excessive noise pollution. Abundant alarms get ignored in the same way as the boy who cried wolf one too many times. Known as “alarm fatigue,” the abundance of such alarms can put patient health at risk and dull the responses of caregivers.
According to the US Department of Health and Human Services’ Agency for Healthcare Research and Quality, alarm fatigue occurs when “busy workers are exposed to numerous frequent safety alerts and as a result become desensitized to them. This desensitization can lead to longer response times or missing important alarms.”
Alarm fatigue is a growing problem, as well as a serious one, as the number of false alarms, specifically, grows.
Research shows that as many as 99 percent of ECG monitor alarms are false or clinically insignificant. Thus, hospitals struggle to address this problem effectively and efficiently. But there is no magic bullet. “The cause of over-exuberant alerts and alarms is multi-factorial and, therefore, difficult to address,” AHRQ said.
Reducing the effect of alarm fatigue can be addressed in many ways, including alarm settings, limits, and delays; setting alarms based on clinical population instead of an individual patient, and staff and patient education. Additionally, implementing secure healthcare communication systems can eliminate noise pollution and connect care teams instantly through mobile devices.
Before we dive into ways that TigerConnect can help reduce alarm fatigue, let’s first review some of the strategies AHRQ recommends to combat alarm fatigue.
Vendor-set alarm defaults for devices are often set to maximum, and hospital systems leaders rarely change them. Some of these default settings may not meet workflow expectations, or the default settings may not be appropriate for a given patient population. Leadership should prioritize alarm parameters and make decisions on what type of alarm is needed for each alarm state, as well as if that alarm will be transmitted to a secondary device, such as a pager or smartphone.
These decisions should be based on the workflow and patient population for each individual unit. Combining alarm default changes with added delays between the alarm and the provider notification shows the greatest reduction in false alarms, the organization says.
Some alarms are set by the overall patient population, which does reduce alarms, but this is not as effective as adding in some consideration of individual patient characteristics. Default settings are useful when patients first arrive on a unit; they can act as a safety net by detecting significant deviations from a “normal” population of patients. Once enough data has been collected, configured alarms specifically for each individual patient’s own “normal” and can be implemented at a level at which an action or intervention is required.
Staff education forms the bedrock of all change management efforts. Interventions require proper staff education and training. Educational interventions that increase clinicians’ understanding of and competencies with using the monitoring systems can decrease alarms. There is a growing movement to monitor only those patients who have clinical indications for patient monitoring. Likewise, educational interventions usually are focused on nurses, but a team-based approach combined with a formal alarm management committee structure and broad-based education can reduce critical alarms.
Focusing on care teams is only half of the problem. Patients should be taught about the need for alarms and the actions that should occur when a clinical alarm goes off. “This helps set expectations and allows patients to participate in their care. On rounds, it is good practice to discuss how alarms should be used and to inquire about the patient’s experience with alarms, including how they may be interfering with sleep or rest,” the AHRQ says. “Discussion of alarm settings and changes to those settings should allow for patient feedback and include education for patients so that they understand the rationale for the adjustments and what is likely to happen. Such education will decrease the chances that patients will feel the need to change or disable alarms themselves.”
The following six suggestions can prevent alarm fatigue by using a clinical communication and collaboration platform, like TigerConnect:
Alarm fatigue has been a fixture on the patient safety hazard list for several years, and this is not likely to change, said the ECRI Institute — an independent nonprofit organization authority on the medical practices and products that provide the safest, most cost-effective care.
“Failure to recognize and respond to an actionable clinical alarm condition in a timely manner can result in serious patient injury or death,” ECRI Institute said in 2017. “Patients face safety risks in a number of different circumstances: when an alarm-worthy condition is not properly detected by a medical device, when the condition is detected but not properly communicated to the provider, or when the provider receives an alarm or alert but chooses to dismiss, ignore, or override the warning.
“Addressing clinical alarm hazards in all their forms requires a comprehensive alarm management program that includes stakeholders from throughout the organization.”
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Tags: Care Team Collaboration