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What is Alarm Fatigue?

Alarm fatigue is something many healthcare workers suffer from daily. "Alarm fatigue, as defined by the American Association of Critical Care Nurses, is a sensory overload that happens when clinicians are faced with or exposed to an excessive number of alarm alerts, which can bring about desensitisation to alarm sounds and a high rate of missed alarms" (Nyarko et al., 2023).

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Introduction to capstone project whitney shilling

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What is the problem?

Alarm fatigue is a serious problem in hospital staff that needs to be addressed. Not only does alarm fatigue lead to burnout in nurses, but it also endangers the patients. Unfortunately, the overwhelming number of alarms in the hospital can lead to nurses disregarding these alerts altogether. "The sensory overburden caused by such an excessive amount of alarms may lead to delayed reactions to alarms or to ignoring them completely" (Lewandowska et al., 2020).

Who is affected?

Alarm fatigue affects multiple people, primarily nursing staff. Nursing staff are more likely to become overstimulated, disregard critical alarms, or even become burnout victims. The second largest party affected by alarm fatigue is the patients. Patients are more likely to have poor outcomes due to alarm fatigue, which can directly harm them due to disregarding alerts.

How?

Alarm fatigue occurs when nurses are exposed to excessive alarms in the hospital.

Where?

Alarm fatigue primarily occurs in the hospital setting; however, this phenomenon can also occur in clinics and even in caregivers' homes for patients with assistive devices.

When?

Alarm fatigue occurs when nurses are overexposed to multiple alarms, many of which are nuisance alarms. "Research demonstrates that the majority of alarms are non-actionable, and staff can develop alarm fatigue trying to determine which alarms are valid and which are not" (Baker & Rodger, 2020).

Why?

As technology advances, healthcare monitoring has become more computerized with automated alarms and notifications. Many of the alarms that occur in the healthcare field are non actionable alarms and considered to be nuisance alarms. In result, alarms that do require action tend to be missed due to the sheer amount of alarms that occur during a short period of time.

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Direct adverse outcomes related to alarm fatigue

Clinical impact: "As the alarm fatigue levels of the participants increased, their medical error tendencies increased. It was determined that a one-unit increase in the alarm fatigue level of intensive care nurses increased their tendency to make medical errors by 0.263 units (p < .001)" (Gündoğan & Oral , 2023).

The Impact of Alarm Fatigue on Healthcare Systems

"Excessive number of alarms and false and nonactionable alarms may lead to alarm fatigue. Alarm fatigue could easily contribute to burnout. Burnout may reduce nurses' sensitivity to alarms, thus affecting patients' safety due to insufficient response to the alarms" (Nyarko et al., 2023).

Alarm fatigue can lead to multiple consequences. However, burnout is one of the most problematic results of alarm fatigue. Burnout in the healthcare system can result in high turnover rates, which in turn negatively effects the healthcare system.

Patient care is always our priority as nurses. Alarm fatigue can lead to many negative patient care results. "First issued in 2013 (Joint Commission, 2013), with its phase II released in 2016, the Joint Commission developed guidelines on alarm management after it issued a Sentinel Event Alert for 98 alarm-related incidents between January 2009 and June 2012. Of these events, 80 resulted in death, 13 in permanent loss of function, and five in unexpected additional care or extended stays" (Steel et al., 2024). These results speak for themselves. Over a period of four years, 97 patients were significantly negatively impacted by alarm fatigue, 80 of which resulted in death, and this is at one hospital.

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Nurses play a crucial role in reducing alarm fatigue. Their current role is to respond to and identify the root cause of alarm fatigue. Because nurses are on the front line of patient care and are directly affected by alarm fatigue, we are also responsible for identifying the root cause of alarm fatigue. Once this is identified, we must advocate for change and continue to educate on the problem.

Is this improving or worsening the issue?

Unfortunately, this is not improving the issue as much as we would like. Nuisance, false, and missed critical alarms are still widely occurring in the clinical setting.

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Analysis: Importance of Nurses Involvement

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Analysis: Importance of Nurses Involvement

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How can nurses help?

According to Maryville University, nurses can help in a variety of ways. Some of these include:

Optimizing nurse schedules so alerts don’t fall on one person

Educating staff on protocols for monitoring systems and managing alarm settings

Evaluating where and when alarms are clinically significant or superfluous

Consistently gathering nurse feedback about burnout and alarm fatigue

Customizing alarms based on each patient’s condition and healthcare needs

Designate actionable responses for each type of alert so nurses know how to respond

Consolidating or disabling redundant alarms

Properly preparing patients for the placement of device hookups and monitoring protocols

Categorizing alarms based on priority levels

Analyzing alarm data to pinpoint and predict when issues arise

Reducing alarm decibel levels or experimenting with different sound types

Regularly maintaining and updating equipment, including changing or charging batteries and installing new software

(Maryville University, 2023)

How will the nurse's involvement improve the issue?

Nurse involvement helps to improve the issue because we are at the direct point of care. Implementing the strategies that are listed above will help to reduce alarm fatigue and, in turn, result in reduced burnout rates, improved patient care, and reduced adverse events.

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Time Restraint:

Time restraint is one of the largest barriers in nursing on many clinical problems. However, time restraint proves to be a major problem with alarm fatigue. Nurses are taught to prioritize urgent matters, and oftentimes, adjusting alarm settings and handling non-emergent alarms are not a priority. This is not due to negligence, but rather having higher urgencies with medications, patient care, and more.

Heavy Workload:

Heavy workload is another barrier to reducing alarm fatigue in medical professionals. When nurses have a heavy workload of patients, they oftentimes have minimal time to handle every alarm that occurs. A heavy workload can also lead to desensitization to these alarms. With multiple alarms sounding at once, it can become difficult to determine where alarms are coming from, and which alarm to prioritize first.

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1. Adjust Alarm Settings

Alarm settings can be modified based on your patient's current condition. For example, if your patient is tachycardic consistently, adjust the alarm settings to a higher heart rate that would be concerning for that specific patient's needs. "For instance, alarm parameter thresholds may be set too tight. This can result in false alarms. Alarm settings may also be generic — not adjusted to the individual patient and their condition — making alarm results false, inaccurate or a nuisance as they are not relevant to the patient’s specific condition or needs" (Anderson, 2024).

2. Identify and Prioritize Critical Alarms

Ensuring that staff is aware of what alarms signify a critical need is essential in preventing adverse events. "Unfortunately, highly sensitive alarms in healthcare settings can lead to sacrificing specificity or accuracy. Overly sensitive or inaccurate alarms may sound constantly, overwhelming nurses and other staff while also desensitizing them. This 'crying wolf' leads to delayed response and missed alarms" (Anderson, 2024). Ensuring that the staff knows the difference between nuisance and critical alarms is vital to patient care.

1. Provide Staff Training and Education

"Within the policy, alarm settings and parameters should be customized and adjusted based on the needs of staff and individual patients as well as the environment. In addition, staff must decide where alarms are not needed and assure that equipment is maintained properly" (Anderson, 2024). This is important to educate your staff on. Education on how to adjust alarm settings and ensuring the staff is aware of the Sentara policy on adjusting settings.

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https://docs.google.com/document/d/1BOVabXqHL7T5Yb7wHBv1P2c-GhHA6qFpafzDPRHaXFE/edit?tab=t.0