Nurses are the backbone of the healthcare industry. They work long hours and face many challenges on a daily basis. One of the biggest contributors to nurse burnout is alarm fatigue. This is when nurses become overwhelmed and/or desensitized by the number of alarms they are receiving and therefore miss or even ignore them. This can be dangerous for both nurses and patients alike. In this blog post, we will discuss the dangers of alarm fatigue and how to prevent it from happening in your hospital, ward, or institution.
What exactly is alarm fatigue?
Alarm fatigue is when clinicians, especially nurses, become desensitized to the overabundance of alarms they are hearing and become desensitized to the point that they may miss alarms and/or have a delayed response. When nurse burnout occurs, it can lead to mistakes being made, and even accidents. In some cases, patients have even died as a result of alarm fatigue. In 2010, there was a horrific incident at Massachusetts General Hospital, one of the leading academic medical centers in the world, where a young patient with heart issues passed away after staff ignored her alarms for over 23 minutes. During the investigation, it was found that over 10 different nurses were on duty that morning, and none could recall hearing any warnings or beeps. This is just one example of how alarms are ignored or go unheard, or are turned off by staff who find the noise aggravating**.
How extreme is the alarm fatigue situation today?
With an average of 771 alerts per bed per day in the ICU, 81% of nurses report there are too many alarms. With all of these alarms, 85-99% are false positives or clinically insignificant. So, nurses are being inundated with noisy alarms, many of which are not actionable or significant. As one can imagine, this is stressful and exhausting. There are dozens of devices in the hospital that generate alarms, with the intention of aiding caregivers in critical environments. Unfortunately, the combination of all these devices and overly conservative settings with critically ill patients leads to an overabundance of alarms that would be overwhelming for anyone.
How does alarm fatigue contribute towards nurse burnout?
Alarm fatigue is a bigger contributor to nurse burnout than the healthcare industry appreciates. When nurses are constantly bombarded with alarms, it’s easy for them to block them out in order to focus on their job. This can lead to mistakes, accidents, and desensitization to important alerts. It also leads to mistrust of the technology that they’re supposed to be relying on to care for the patient in the most critical environment. It’s no wonder nurses are leaving the profession at an alarming rate, especially in these critical care environments. There are several factors, including understaffing, long hours, lack of resources, and high stress work environment. But there is no doubt that some of the chaos contributing to this high stress is increased monitoring that generates yet more information, leading to even more alerts that, unfortunately, don’t help.
How can we prevent alarm fatigue?
One part of the solution is having an overall alarm management strategy. This means understanding which alarms are important and which can be ignored. It also means setting proper triggers and settings for patient monitoring devices. Device thresholds should be set according to each patient, but often they are left on standard, overly conservative, settings. This can lead to an overwhelming number of alarms going off, most of which are non-actionable, leading to a noisy, stressful environment for providers, patients, and their families. 59% of nurses associate these ‘nuisance’ alarms with improperly set thresholds and alarm accuracy. These devices are growing in numbers, with increasing features and controls, most of which seem to get limited usage. Having a periodic review of alarm settings across a ward to determine if new default settings and protocols should be incorporated is fundamental to a successful, sustainable, overall alarm management strategy.
Another part of the solution is to have a dedicated alarm management team. A committee or team that periodically reviews the noise levels in departments, the overall number of alarms, and number non-actionable alarms is key. Most institutions today are not tracking these metrics, but intuitively know that these numbers are bad. The teams that have tracked this information and reported on it have found 90+% non-actionable alarms, and egregious numbers regarding overall alarms. Unfortunately, clinicians have learned to live with this noise as the status quo.
A third solution is focused on training. As a matter of fact, training is listed as a top issue when surveying nurses about burnout. This can include teaching clinicians and administrators about the dangers of ignoring alarms, how to set proper device settings/thresholds, proper application of monitoring equipment (ecgs leads, etc), common alarm/alert errors, and how to incorporate an alarm management plan.
A smart solution, however, is applying technology to automate much of these efforts surrounding alarm management. CalmWave is a venture-backed startup using AI to automatically set device thresholds, group alarms, and monitor a wide array of data using machine learning. They also use this data to provide a measure of the Operations Healths of the clinicians and department, which is used to track employee health and retention. CalmWave aims to not only give your clinicians actionable insights at a simple glance, resulting in alarm remediation, but also to provide predictive indicators of patient deterioration and nurse burnout.
So, what next?
Alarm fatigue is a real problem that needs to be addressed in the healthcare industry. The COVID19 pandemic helped to expose the inefficiencies in the critical care environments, alarm fatigue being one of them. Fortunately, technology has rapidly advanced and matured in the past few years, giving rise to an opportunity to disrupt this space and drive long needed change. By leveraging advanced artificial intelligence solutions, in combination with prior clinical playbooks demonstrating successful approaches, hospitals can start incorporating system wide changes that can make a huge impact. By fixing alarms, we can also directly impact a challenge everyone feels today, nurse burnout. The digital health, AI-based technology is finally mature enough to create a safer and healthier work environment for everyone involved. Request a CalmWave demo today to learn what you can be doing right now to reduce alarm fatigue and prevent staff burnout.
Sources:
- 1AJN, American Journal of Nursing: July 2010 – Volume 110 – Issue 7 – p 16 doi: 10.1097/01.NAJ.0000383917.98063.bd
- Kowalczyk, Liz. “‘Alarm Fatigue’ Linked to Patient’s Death.” The Boston Globe, 3 Apr. 2010.