Beep! Bing! Buzz! Ding! Ring! Bleep!
Everyday, throughout the day, hospitalists and other healthcare workers are inundated with alerts and warnings and notifications from medical and communication devices. The sheer number of alarms can be extremely overwhelming.
“In any given unit, there may be hundreds of alarms per patient, per day,” says Ronald Wyatt, MD, MHA, medical director of the division of healthcare improvement at The Joint Commission in Oakbrook Terrace, Ill. “That amounts to tens of thousands of alarms each day.”
And, although the intent of these alarms may be good, studies show that 80% to 99% of alarms generated by such medical devices as ventilators, blood pressure monitors, and electrocardiograms are false and/or don’t actually require any clinical intervention.1-4 What’s even more alarming is that clinicians become desensitized—even immune—to the sounds, experiencing what has been called “alarm fatigue.” In response to the constant barrage of noise, clinicians may turn alarms down or off, or adjust alarm settings outside limits that are safe and appropriate for the patient.5
The extent to which alarm fatigue has affected patients is unknown. From 2009 to 2012, The Joint Commission reported 98 alarm-related events. Of these, 80 resulted in death, 13 in permanent loss of function, and five in unexpected additional care or extended stay. Because sentinel event reporting to The Joint Commission is voluntary, Dr. Wyatt estimates that the organization is notified of less than 10% of such events.
Maria Cvach, DNP, RN, MSN, CCRN, DNP, assistant director of nursing for clinical standards at The Johns Hopkins Hospital in Baltimore, Md., says that from 2005 to 2008, there were 566 alarm-related deaths reported to the U.S. Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database. “Most experts agree that this is grossly underreported,” says Cvach, who has led alarm system improvement efforts at Hopkins since 2006.
In addition to being a patient safety issue, alarm fatigue has other consequences, Cvach says. Patients and families lose trust in staff when alarms go unanswered. Excessive noise can result in patient and staff harm. Research demonstrates that noise can negatively affect patients’ cardiovascular and immune systems and can increase length of hospital stays. Staff may develop stress symptoms and headaches. In addition, hospitals could face litigation from missed alarms and patient events.
From Bad to Worse
Experts agree that alarm fatigue is getting worse system-wide. ECRI Institute, a nonprofit organization that uses applied scientific research in healthcare to establish best practices for improving patient care, has listed alarm hazards as the number one health technology device hazard for the past three years. This persistent danger has made the top 10 since the list’s inception.6
Cvach says alarm fatigue is fairly easy to recognize.
“If you’re on a unit and hear alarms but do not see anyone addressing them, you are probably witnessing alarm fatigue,” she says. “If you ask staff what is alarming and they indicate that they didn’t notice an alarm ringing, it is likely alarm fatigue. Staff have indicated that sometimes alarms are like ‘white noise.’ [Alarms] go unnoticed because they are considered part of the environment and [staff] are accustomed to them.”
Jairy C. Hunter III, MD, MBA, SFHM, hospitalist and associate CMO for care transitions at Medical University of South Carolina (MUSC) in Charleston, believes alarm fatigue is a problem at every hospital, including his own. In addition to being bombarded with medical device alarms, he is constantly receiving notifications via cell phone, pager, and computers.