So what exactly is alarm fatigue? There is not yet a standard definition, but summit participants offered a variety of interpretations and examples. Many of them describe the consequences of alarm fatigue, such as:
• A nurse or other caregiver being overwhelmed with 350 alarm conditions per patient per day.
• Patients’ inability to rest with the multitude of alarms sounding in the room.
• A true life-threatening event lost amid the noise of multiple devices with competing signals—often leaving staff uncertain of which to address first or how to respond.
They also noted that technology is driving process, rather than the other way around.5
Recently, Wong, Mabuyi, and Gonzalez3 found that more than 95% of hospitals are concerned about alarm fatigue. That concern has now extended beyond individual hospitals and gained the attention of The Joint Commission (TJC). Following reports of 80 alarm-related deaths that occurred between January 2009 and June 2012, TJC issued a Sentinel Event Alert6 in April 2013, addressing medical device alarm safety in hospitals. The commission noted that “these devices present a multitude of challenges ... for health care organizations when their alarms create similar sounds, when their default settings are not changed, and when there is a failure to respond to their alarm signals.”
Taking the quest for a solution a step further, in June 2013, TJC approved a new National Patient Safety Goal (NPSG) on clinical alarm safety for hospitals.7 The NPSG, which took effect in January 2014, requires that hospitals initiate improvements to ensure alarms on medical equipment are heard and responded to in a timely fashion.7
Implementation of this NPSG will occur in two phases. In Phase I (which started in January 2014), administrators will be required to “establish alarm system safety as a hospital priority” and identify the most important signals to manage based on their own internal situations (including an assessment of the risk to the patient if the alarm is ignored and whether the alarm unnecessarily contributes to the noise level). In Phase II (commencing January 2016), hospitals will be expected to develop and implement specific policies and procedures, including clinically appropriate settings for alarms and who has the authority to change the settings or set parameters to “off.” Education on alarm system management will also be required for all those in the organization who may interact with the monitoring equipment.7
We must find ways to minimize the noise and stress, for our sakes as well as our patients’—but we must do so without sacrificing safety. How do you see this playing out? Share your thoughts and ideas with me at NPEditor@frontlinemedcom.com.
Personally, I can see it now: A hospital with all the technology of the future, but without the “bells and whistles.” Finally, peace and quiet!
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