Although Alarm Fatigue Remains a Problem, Some Progress Is Happening
New research is shedding light on alarm fatigue and how to combat it. False alarms may be more problematic than the overall noise level in a unit.
- Nurses respond well to a decrease in false alarms, even if the noise level stays the same.
- Clinicians should be educated on how to set alarm parameters for specific patients.
- Good management of electrodes can reduce false alarms.
Alarm fatigue continues to plague hospitals, but recent work has revealed some tactics to help alleviate the problem.
Frontline clinicians and researchers have been investigating the problem of alarm fatigue, trying to determine the root causes, says Bette McNee, RN, NHA, clinical risk management consultant at insurance broker Graham Company in Philadelphia. They are getting closer to identifying whether alarm fatigue is caused by the number of alarms, the sounds, distractions, or other factors.
McNee identifies three encouraging studies in the effort to address alarm fatigue. In one review of worldwide literature from Poland, the researchers concluded “intensive care nurses think that alarms are burdensome and too frequent, interfering with caring for patients and causing reduced trust in alarm systems. They feel overburdened with an excessive amount of duties and a continuous wave of alarms. Having to operate modern equipment, which is becoming more and more advanced, takes time that nurses would prefer to dedicate to their patients.”1
The researchers focused on why the alarms were problematic. The key problem was the frequency of false alarms, McNee notes.
“When nurses are responding to the equivalent of car alarms, it decreases their confidence in alarms in general,” she says. “That was true resoundingly across the board in all the literature they looked at.”
Clinicians also cited the difficulty in understanding the priority of alarms. For instance, in an ICU, there are so many devices with different alarms that it can be difficult for nurses to understand what is most important and what might be relatively mundane.
“If it is a high-pitched alarm with this machine, is that a priority over the beep on this other machine? The pulse oximeter doesn’t always ring differently from a feeding tube,” she says. “They have to have emergency response in every situation, which is needlessly exhausting for a nurse.”
Staffing Also a Problem
Another issue identified was inadequate staffing. McNee notes this can be related to the overabundance of alarms. If the ICU eliminated or reduced many false alarms, staff might have enough bandwidth to respond to the true alarms.
The researchers found other potential risk management issues with alarms, including the lack of an annunciator at the nursing station so every alarm is heard and the room identified.
In another study, clinicians in a pediatric ICU measured the sound levels before implementing several tactics to reduce nuisance alarms. The pulse rate alarm, which produces a constant beeping noise, was turned off, and parameters on other alarms were changed to reduce false alarms.2
In the second phase of the study, researchers educated everyone on the unit about the equipment and how to set alarm parameters specific to a patient, the differences in what the sounds meant, and how to prioritize the alarms by sound.
“The also put the televisions on closed captions or patients used headphones, and they put signs everywhere telling everyone to hush,” McNee says. “Every five minutes, decibel meters would take measurements from different places around the unit and on several nurses. At the end of the study, they had a decrease in the number of alarms by 50%; however, the decibel measurement only had a negligible change.”
The researchers asked the nurses how they perceived the noise level in the unit. They found the nurses were quite pleased with the change no matter what the decibel meters said.
“Despite these findings, nurses perceived a quieter and more pleasant workplace. These impressions might have resulted from subjective expectations vs. actual volume levels, or they might owe to the reduction in incidence of alarms themselves, which they had viewed as nuisance sounds,” the researchers wrote.2
The experience underscores the value of eliminating nuisance alarms and educating staff on how to set alarm parameters specific to the patient, McNee says. Even without lowering the decibel level overall, nurses can be more confident that an alarm actually means the patient needs attention and not feel like they are chasing false calls all the time.
Electrode Management Helps
A third study revealed practical interventions can reduce the number of nuisance alarms, McNee says. The clinicians in a community hospital ICU introduced a new procedure that included washing the patient’s chest with soap and water, shaving the skin as necessary, and applying new electrodes at the start of a shift. The number of alarms decreased significantly.3
“So many times when the nurse is getting that alarm, it’s the electrode on a hairy chest or just an electrode that peeled off and isn’t getting a good reading anymore. Often, these electrodes are slapped on in an emergent situation,” McNee says. “When someone is wearing an electrode and they have oilier skin, they’re going to start generating false alarms. It is better to schedule at a downtime in the shift some time to remove these and replace them with fresh electrodes.”
McNee says she is encouraged by the progress in identifying ways to reduce alarm fatigue. The best practices are quantifying the false alarms, such as the electrodes that were peeling off, and also making sure the parameters on different machines can be set specific to individual patients.
“What we’re learning is that the alarm fatigue is driven more by false alarms than overall noise,” she says. “If we can do work in this space to reduce false alarms, I believe the nurses will feel overall that the environment is less stressful and that they can more effectively care for their patients.”
Risk managers should continue to study research findings for evidence-based best practices.
“It’s important that a hospital look at the evidence and research. Otherwise, you could be spending time on quality improvement initiatives that are not going to directly address the problem,” McNee says. “You want to look for that research that reveals something you can apply in your own organization as a best practice and be confident that you’re going to make a difference.”
- Lewandowska K, Weisbrot M, Cieloszyk A, et al. Impact of alarm fatigue in the work of nurses in an intensive care environment — a systematic review. Int J Environ Res Public Health 2020;17:8409.
- Cvach M, Doyle P, Young Wong S, et al. Decreasing pediatric PACU noise level and alarm fatigue: A quality improvement initiative to improve safety and satisfaction. J Perianesth Nurs 2020;35:357-364.
- Leigher D, Kemppainen P, Neyens DM. Skin preparation and electrode replacement to reduce alarm fatigue in a community hospital intensive care unit. Am J Crit Care 2020;29:390-395.
- Bette McNee, RN, NHA, Clinical Risk Management Consultant, Graham Company, Philadelphia. Email: [email protected].
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