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Alarm fatigue in nursing

January 23, 2020

Have you ever been in a situation where you know something isn’t right and you feel dread for a millisecond before adrenaline kicks in? Where all you feel is a heavy pit in your stomach before your skills and experience take over?

It was my third and last night shift for the week as a staff nurse on a high acuity floor. I had the same assignment from my previous shifts, so the night was going smoothly, and I was caught up with my work. To help my teammates out, I started doing safety checks on some of the patients. I opened one of the doors expecting to find the patient asleep, but instead found the bed empty.

Dread.

I ran to the other side of the bed where I found the patient lying on the floor. She was cool to the touch.

Adrenaline.

I called a code, we started ACLS (advanced cardiac life support), and about 40 minutes later, we got a pulse and had her stabilized.

The culprit: Alarm fatigue

If you were to hit pause and rewind a few hours during that shift, you would see that the patient’s telemetry monitor had been alarming frequently at the nurses’ station. Each time the nurse went into the room to check on the patient, she was sitting comfortably or in her bed—undisturbed and asymptomatic.

The nurse reapplied the leads but the monitor continued to alarm. The nurse applied new leads, adjusted the parameters, and followed all the right steps for addressing the intermittent false alarms. Nothing seemed to resolve the issue and the patient was getting tired of the near constant interruptions. At that point, the nurse made a crucial decision to start silencing the monitor. Each time the alarm went off, the nurse hit silence.

Though no one can know for sure exactly what happened to this patient between safety checks, it’s possible she experienced a cardiac event during this time of silencing. It’s also conceivable the patient fell trying to get out of bed and the resulting alarm went unnoticed. The silenced alarm as a result of alarm fatigue was very likely a contributing factor to a series of events that changed this patient’s life forever as a mother, sister, daughter, and wife.

We’ve all read the research and reports on alarm fatigue and the negative outcomes from nuisance alarms. We know silencing can be risky. But, if you were that nurse, what would you have done? All it takes for patient harm is one true alarm to fall silent among the noise of the otherwise non-actionable notifications.

This story is just one of many that illustrate the potential real-life implications of alarm fatigue in nursing.

Not only can heavy alarm workloads contribute to compromised patient safety, but they can also be factors in nurse burnout and low job satisfaction. I’m not surprised 92% of clinicians agreed that burnout is a “public health crisis” in a 2019 Spok survey.

Based on observations in my experience, when a nurse reaches the point of burnout, there is a cascading effect where motivation, energy, concentration, decision-making capacity, and mood are all decreased. The symptoms of burnout can exacerbate alarm fatigue—leading to missed alarms and delayed responses that negatively impact patient safety and care. Moreover, burnout and alarm fatigue don’t discriminate on hours worked or patients served—these symptoms can occur at the start of a shift, when hours of caring for patients are still left.

Not only do nurses suffer from the constant din of alarms, but alarm noise also contributes to poor sleep quality and a suboptimal healing environment for patients too. It’s important to recognize the balance between alarm management, patient safety, and patient healing.

If heavy alarm workloads are left unmanaged and there is no policy in place to combat alarm fatigue and the symptoms of burnout, nurses may experience lower job satisfaction. In a 2019 AMN Healthcare survey of 20,000 registered nurses, 66% say they worry their job is affecting their health, and 44% say they often feel like quitting. At the same time, the nurse shortage is getting worse. More than one-third of RNs in the AMN survey are baby boomers, and 86% of baby boomer nurses plan to retire in the next five years.

As a former critical care nurse, I’ve seen the real impacts of alarm fatigue—where highly-competent and passionate nurses who are exposed to an excessive number of alarms face negative outcomes. In our 2019 survey on burnout, 65% of clinicians say their organization lacks appropriate means of addressing burnout and 47% rarely or never discuss it at their organization.

Though there is no universal solution to either burnout or alarm fatigue, I believe creating an organizational pathway where nurses can seek support, share experiences, and build resilience can help address the detrimental outcomes of alarm fatigue. I also feel hopeful knowing I’m part of an organization on the cutting edge of clinical alerting technology that has helped our customers prevent alarm fatigue.

If you’d like to share your experiences with alarm fatigue or solutions that can help, we’d love to hear them.

 

Topic: Alarm fatigue

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By Ashley Franks, RN, Senior Clinical Advisor
Ashley is a clinical advisor at Spok. She has over 10 years of experience in the clinical, pharmaceutical, and healthcare IT fields. Ashley has worked at the bedside as a cardiothoracic and ICU critical care nurse. Prior to joining Spok, Ashley held roles in patient and nurse education and in clinical applications management. She earned her BSN from the University of Tennessee Health Sciences Center and a BA from George Mason University.