Solutions for "alarm fatigue" are complex

Customizing default settings and properly maintaining batteries are among ways to combat staff becoming desensitized by thousands of alerts. A long-term plan also is important.

By — Posted Aug. 4, 2010

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Monitors beep, infusion pumps buzz and ventilator alarms sound. Such signals are routine at hospitals, but sometimes they're so routine that they become background noise, eliciting little, late or no response from those they're designed to alert.

Too often, medical professionals become desensitized -- overwhelmed by the sheer number of clinical alarms constantly pulling them from one patient to the next, said Kathryn M. Pelczarski, director of the ECRI Institute's Applied Solutions Group.

"Alarm fatigue is a pervasive problem that can lead to missed alarms and delayed alarm response," she said. "And missed alarms and delayed alarm response can lead to patient harm, and even patient death."

Pelczarski spoke July 21 during a Web conference on how to combat clinical alarm fatigue, which was hosted by the ECRI Institute, a nonprofit health services research organization based in Plymouth Meeting, Pa.

Alarm fatigue is a "vexing problem in clinical medicine," said Julian M. Goldman, MD, medical director of biomedical engineering for Partners HealthCare System and attending anesthesiologist at Massachusetts General Hospital.

Pelczarski said solving the problem requires long-term dedication. Hospitals and their care units must evaluate their needs and develop alarm management plans. Responsibilities should be delegated and staff should be able to tailor alarm defaults for particular units or patients, such as adjusting a monitor alarm for a long-distance runner with a lower heart rate than average.

Low-battery alarms can be minimized by routine upkeep. Staff members should be taught to apply monitoring devices properly and keep probe sites clean, Pelczarski said.

Johns Hopkins Hospital in Maryland began a pilot project in its medical progressive unit in December 2005 to prevent clinical alarm fatigue, said Maria Cvach, RN, the hospital's assistant director for nursing. An internal evaluation found that 16,934 alarms sounded in the unit during an 18-day period.

"It's actually staggering when you look at it," Cvach said.

The hospital formed a task force that examined the purpose and accuracy of alarms within the medical progressive unit. Default alarm settings were adjusted to appropriate levels, and staff underwent alarm management training, said Kelly Creighton Graham, RN, a patient safety analyst and consultant with ECRI.

The result was a 43% decrease in critical alarms. "It was a vast improvement and the beginning of a culture change," Graham said.

Developing plans is just the first step. Progress should be monitored continually, staff members should be held accountable to ensure they stay engaged in the process, and hospitals and equipment manufacturers should collaborate to make improvements, Dr. Goldman said.

"That technology is always changing, so it's important to keep abreast of what is out there," Cvach said.

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