The sheer volume of alarms in the typical hospital room causes alarm fatigue: Clinicians experience sensory overload from the excessive number of alarms and become desensitized, which can lead to longer response times or critical alarms being missed altogether.
According to The Joint Commission, alarm alert and notification overload is one of the top ten health technology hazards in healthcare. No matter the size of the hospital, chances are high that you are exposed to the sounds of alarms beeping and buzzing all day long. Modern hospitals foster a highly computerized clinical environment, resulting in nearly everything being hooked to a monitor that can make audible noises—real or false. More than 19 in 20 hospitals are concerned with alarm fatigue and the potentially detrimental effect it can have on patient safety.
A study at Johns Hopkins Hospital found that 350 alarms were produced per bed during a single day in an intensive care unit. When alarms function as intended—sounding when medical action should be taken—patient safety is enhanced. However, alarms sounding all day, every day, lead to such extreme desensitization that many alarms simply aren’t heard, they are disabled, or they aren’t triaged appropriately.
In fact, many hospitals aren’t fully utilizing the technology available when it comes to monitoring patients in order to avoid adding another beep to the mix. Almost 90 percent of hospitals would “increase their use of patient monitoring devices that incorporate capnography and/or pulse oximetry if they could reduce false alarms.”
Alarm fatigue needs to be resolved in order to increase patient safety and decrease sentinel events related to poor alarm management. Here are eight ways to help diminish the din of alarms throughout your hospital, improve patient safety, and boost clinician satisfaction:
1. Clean and monitor the equipment
There are a number of ways to reduce how often a monitor sounds the alarm, one of them being simply cleaning and replacing electrodes, or ensuring that a monitor is working as it should. Regularly changing single-use sensors and establishing routine times to inspect, clean, and maintain equipment helps keep everything working properly. It also reduces the frequency of alerts related to technical malfunctions, like a low battery or loose connection. Likewise, replacing aging monitors with new technology can ensure a sounding alarm is a clinically consequential one. And cleaning or replacing electrodes daily also helps, as fresh electrodes deliver high-quality tracings and better skin-electrode contact.
2. Decrease clinically inconsequential alerts
One factor in alarm fatigue is the alarm noise that increases patient anxiety. The purpose of alarms is to inform clinicians when care is necessary, not to intensify their pain or discomfort. Reducing the number of alarms that sound due to clinically inconsequential events can help decrease alarm fatigue. For example, changing a monitor’s thresholds when appropriate could help. One example comes from Boston Medical Center (BMC). By switching cardiac monitor thresholds from “warning” to “crisis,” daily audible alarm averages dropped from 12,546 to 1,424—a whopping 89 percent. This change not only increased nurse responsiveness, but it also dropped noise levels from 92 decibels to 70. BMC ensured that when a cardiac alarm sounded, it meant the event was clinically consequential and needed attention, prompting nurses to react to any instance.
3. Funnel alerts to the right people
Clinical alerting solutions today make it possible for different alarms to be routed directly to the appropriate person. By bypassing the nursing station and sending alerts to the right on-duty clinician’s preferred mobile device (smartphone, Wi-Fi phone, tablet, or pager), hospitals can reduce the number of calls or overhead announcements that have to be made. This reduces the amount of noise and promotes a quieter environment for resting and healing. And, most importantly, patient care and satisfaction are enhanced when alerts are responded to faster.
4. Triage alerts with software
Nurses and physicians can get help triaging alarms with the help of intelligent software. Clinical alerting software can act as the first stage of triage by “incorporating the facility’s preset priority levels and using built-in logic to pass along the highest levels of alerts first.” This makes the job of the nurse more efficient through enhanced meaningful communication: They only receive alerts to their mobile device that require immediate attention and are actionable. Further, hospitals can use the software to build escalation paths that help ensure critical alarms always receive a timely response from a caregiver, even if the clinician assigned to the patient is unable to respond to the alert.
5. Get rid of the noise
The constant ding of hospital alarms is what ultimately causes alert fatigue. Thousands of beeps and buzzes throughout the day eventually turn into white noise that is ignored. One large stride toward combating alarm fatigue is to track events that are truly meaningful to staff, alert more intelligently with automated settings for quiet times with lower acuity events, and ensure that the right role is getting the right notification based on content and priority. With clinical alerting and secure messaging solutions, alerts can be sent securely to the appropriate clinician’s preferred device. Spok clinical alerting can even add clinical context to these alerts by integrating with the EHR and ADT systems. Individual event settings can drive the right notification to the right role with the right priority (which does not always need to be a loud one). Once information is delivered appropriately, clinicians are able to respond faster when they have all of the information they need at their fingertips, such as patient name, diagnosis detail, medication allergies, and physician observations. By investing in clinical alerting technology that converts alarms to notifications delivered clinicians’ mobile devices, the sheer noise will be cut down, making for quieter hallways and rooms everywhere. All of these things provide greater staff adoption of communications technology in the healthcare enterprise to positively affect patient safety initiatives.
6. Tailor alerts to patient characteristics
A huge dent can be made in reducing the number of sounding alarms by resetting device parameters for individual patients depending on their specific condition. One example is incorporating renal function test results into a patient’s alert systems so that alerts for nephrotoxic medications are triggered only when the patient is at high risk. Alarms that require immediate attention for one patient may not be important for the next, so tailoring what the monitors are doing will reduce the volume of alarms as well as indicate that a problem truly does need attention.
7. Invest in advanced clinical alerting
While we’ve primarily been discussing clinical alerting for patient monitoring devices and nurse call systems in this post, clinical alerting can include many other types of systems. Spok clinical alerting can integrate with virtually any system in the hospital, including but not limited to bed management, building automation, critical test results, fire alarms, HVAC, operator consoles, and security. Clinical alerting that is integrated with all of the systems that contain valuable information creates an enterprise-wide approach to the management, prioritization, and response to key events. Ultimately, being able to reach mobile team members within seconds of a critical alert improves overall staff productivity, workflows, and the comfort and safety of everyone in your facility.
8. Stop false alarms
“False alarm” refers to an instance when monitoring equipment indicates a physiologic event, when no actual event occurs. According to the NIH, 72 to 99 percent of alarms are false. Too many false alarms lead nurses to override alarms, which compromises patient safety. Take steps to decide which monitors are necessary for each patient and, as mentioned above, set the appropriate thresholds for that patient.
Start to combat alarm fatigue today
It’s clear that alarm fatigue is a critical patient safety issue, yet effective alarm management can be difficult if you don’t know where to start. Our team here at Spok has years of experience not only with developing and implementing clinical alerting technology, but also working alongside hospitals and health systems to shape their alarm management strategy and procedures. To start the fight against alarm fatigue, give us a call: We offer the critical solutions needed to foster meaningful communications across the hospital, reduce the disturbance caused by thousands of alarms throughout the day, and improve the experience of patients and providers alike.
Topic: Alarm fatigue