Caregiver Alarm Fatigue
A subtle problem has been growing inside the modern hospital environment. The trend towards increased usage of alert/alarm generating patient monitors seems like a logical step towards better patient care. It certainly makes sense that the more caregivers can know about patients’ conditions the better they can react should an emergency arise. However, there have been multiple incidents that suggest that this is simply not the case.
The most high profile incident occurred in January when a patient at Massachusetts General Hospital (MGH) died of a cardiac arrest. As it turned out, the patient’s cardiac arrest monitor had been in alarm mode for over 20 minutes before the patient died, yet nurses failed to notice the scrolling tickertape notices in the hallway or the beeps in the central nursing station. In addition, an unknown person had completely turned off the separate audible alarm on the physical bedside monitor the night before.
So what exactly causes this disconnect between caregivers and monitoring technology? Alarm fatigue. As more monitoring devices are added into the hospital environment, each additional alert adds weight until nurses feel overwhelmed. As a result, caregivers experience alarm fatigue. Alarm fatigue is the condition where caregivers begin to give up trying to manage the onslaught of alerts, and start to ignore them instead. In extreme cases, such as the situation at MGH, caregivers begin turning down the volume of audible alerts or even turning off alerts completely.
Preventing Alarm Fatigue
Stopping alarm fatigue isn’t simple. Obviously, eliminating alerts/alarms isn’t an acceptable solution, since that would defeat the purpose of patient monitoring devices. Yet something must be done or the problem will only continue to develop as the hospital environment gets more complex.
The solution lies not in eliminating alerts, but in more efficient management of them. Without an automatic and organized approach to managing alerts, caregivers are forced to juggle them manually. Manual management of alerts can be effective, as long as the number of alerts stays at a reasonable level. However, as more alerts are added to the environment, an alert management system becomes more necessary.
Developing an Effective Alert Management System
Today, new technologies such as Dalcon Alert include an Alert Management System designed to help caregivers organize alerts. Dalcon Alert’s Alert Management System automatically tracks all active alerts. Active alerts are displayed on a large screen monitor at the nursing station and are automatically updated in realtime with alert type, location, and length of duration. The alert queue is designed to allow caregivers to quickly prioritize active alerts, and canceled alerts are automatically removed from the queue.
Reducing Unnecessary Alerts
In addition, Dalcon Alert allows nurses to receive alerts via text message to wireless phones. A successful Alert Management System involves quality design. As a result, caregivers should only be receiving relevant alerts.
For example, caregivers should only receive non-critical alerts from their assigned patients, not from each patient on an entire floor. Because Dalcon Alert utilizes wireless phones assigned to each caregiver, relevant alerts can be tailored to the individual caregiver.
Because all alerts are managed by the Alert Management System, non-critical monitoring devices can have their audible alerts turned down in order to reduce hospital ambient noise. Any reduction in hospital ambient noise has been shown to increase the quality of patient care significantly.
Hospital Noise Pollution a Growing Problem
One of the largest complaints of hospital patients and staff nationwide is the abundance of noise in the hospital. Uncomfortable and unsafe noise levels inhibit the healing process of patients that need it most.
In fact a recent study at Johns Hopkins University Hospital has shown that loud hospital environments can have a major negative impact on patients including:
• Elevated blood pressure levels.
• Sleep disruption.
• Decreased oxygen saturation.
• Decreased rates of wound healing.
The consequences of a loud environment on staff include emotional exhaustion and burnout as well as a raised risk of medical errors due to miscommunication. Recently, a patient at Massachusetts General Hospital died because his heart monitor had been turned off by a staff member. The investigators cited “alarm fatigue” as a cause of the problem. Alarm fatigue occurs when nurses become overwhelmed by the number and variety of alarms in the healthcare environment. As a result, nurses begin ignoring or even turning off alarms.
A Mayo Clinic study performed several years ago showed peak noise levels at night in one facility rising to 113 decibels, equivalent to a chainsaw or jackhammer.
Major sources of noise include hospital ventilation systems as well as overuse of the hospital paging system and an abundance of alarms. The Johns Hopkins study noted that though audible alarms were significantly quieter than other sources of noise, patients ranked them as being more irritating than more intense sources.
New Technology as a Solution to Hospital Noise Pollution
Dalcon provides solutions that, as a secondary benefit, help eliminate hospital noise pollution.
Dalcon Alert for Remote Patient Monitoring connects with various patient monitoring devices such as heart monitors, IV pumps, ventilators, pulse oximeters, and more. When a patient monitoring device triggers an alarm connected to Dalcon Alert, the system sends a text message to wireless phones (or pagers) held by hospital staff.
Because Dalcon Alert allows hospital staff to more efficiently manage hospital alarms, alarm fatigue is significantly reduced. Also, since Dalcon Alert incorporates wireless phones or pagers to be carried by hospital staff, use of the overhead pager can be dramatically decreased as well.
MGH Patient Death Raises Concerns about Patient Monitoring Device Alarm Effectiveness
A male patient at Massachusetts General Hospital died last January after the crisis alarm on his heart monitor was accidentally switched off and left off. The patient was not discovered to be in crisis until a nurse came by during a routine check. The hospital has not said how long the man had been in crisis before the nurse came by.
The patient’s death highlights a growing problem for hospitals nationwide. Failure by staff to acknowledge and respond to alarms is one of the most frequent and serious problems facing hospitals today. The ECRI Institute, an independent nonprofit organization that researches ways to improve patient care, recently released its list of “Top Ten Health Technology Hazards” for 2010. “Alarm Hazards” ranked in at No. 2, passing other high-ranking health risks such as “High Radiation Dose from Computed Tomography” and “Retained Devices and Un-retrieved Fragments Left in Patients.”
A Nationwide Problem
Across the nation, hospitals are taking extra time to examine the effectiveness of alarms on patient monitoring devices. Every year, deaths are reported because alarms either malfunction or are turned off, unheard, or ignored. Kathryn Pelczarski, director of ECRI’s applied solutions group, says that there were 237 alarm-related deaths between 2002 and 2004, and alarms made up 12 percent of the 2,200 medical device problems reported to ECRI between 2000 and 2006.
“Alarm Fatigue” a leading Cause of the Problem
As hospital technology has expanded both in terms of application and complexity, the number and types of alarms have also expanded. As a result, nurses and other caregivers often find themselves overwhelmed to the point that alarms lose their urgency. Pelczarski, calls this problem “alarm fatigue.” When alarm fatigue occurs, nurses begin ignoring and even turning off alarms. Additionally, since nurses are busy responding to a vast array of alarms, it can become difficult for them to hear and recognize each individual alarm.
New Remote Patient Monitoring Technology as a Solution
Today, new technologies and tools are emerging to help hospitals overcome this obstacle in providing quality patient care.
Dalcon Alert is one such tool that provides caregivers with an efficient way to acknowledge and respond to multiple alarms. Dalcon Alert is a Remote Patient Monitoring system that simultaneously connects with various patient monitoring devices such as heart monitors, IV pumps, ventilators, pulse oximeters, and more. When a patient monitoring device triggers an alarm connected to Dalcon Alert, the system sends a text message to wireless phones (or pagers) held by hospital staff.
The system is highly customizable. For example, less critical alarms can be sent only to the nurses who are responsible for the patient whose device generated the alarm. Highly critical alarms, such as heart monitor alarms, can be sent to the entire nursing staff to assure that such alarms do not go unnoticed.
Dalcon Alert also routes alarms to a PC display at the nursing station running the system’s Alert Management software, allowing nurses to manage all active alarms. Alarms cannot be removed from the Alert Management queue until dealt with at the point of care. As a result, accidental staff negligence is eliminated.
