If you haven’t already heard the buzz (or chime or ding) about alarm fatigue, then listen up, because it’s only getting louder. Hospitals are known for being stressful and anxiety-provoking environments because they involve one of the most critical things in our society: human lives. What many people don’t realize before stepping through those doors is that hospitals are incredibly loud, particularly in critical care departments like the Intensive Care Unit (ICU). One study found that sound levels in an internal ICU reached 94 decibels–almost as loud as a motorcycle.
Alarm fatigue is the phenomenon in which clinicians become desensitized to alarms and even miss them because they get so used to the constant stream of noise emanating from patient monitors. This affects patients and their caregivers as well. Imagine how stressful it would be to worry about a loved one’s critical medical condition while constantly hearing the beeps, dings, and chimes of all the monitors hooked up to her and the patients around her. Not only do these alarms cause direct anxiety about a loved one’s condition (i.e. That alarm sounds urgent, is she having a heart attack??), but they also directly affect the care that said loved one is receiving. If healthcare providers are experiencing alarm fatigue, then they’re at high risk for making clinical mistakes–and it’s not their fault at all. It’s the incessant noise emanating from medical alarming systems. So why is there so much NOISE?? Here are 3 top causes of alarm fatigue in hospitals:
#1. Too many false alarms
As crazy as it sounds, nearly 85-90% of the alarms that go off in ICUs are non-actionable–meaning they are false positives and are not indicative of critical patient conditions. Why are these alarms sounding then? The answer to this question lies in the development and production of the vitals signs monitors themselves. These monitors were created to track patients’ vital signs, like heart rate, blood pressure, and oxygen saturation, to ensure that medical emergencies were promptly caught and attended to. However, the companies that manufacture these monitors do not want to take on any risk from potentially producing false negative alarms (i.e. an alarm not going off when it should), which leads them to incorporate very broad, one-size-fits-all alarm thresholds. But humans aren’t one-size-fits-all, are they? Each individual patient has his or her own ‘normal’ ranges for vital signs like heart rate and blood pressure. And these unique ranges can and do fall outside of present alarm thresholds, producing false positive, noisy alarms that don’t require action. These false alarms bog down the mental capacity of clinicians, causing them to become desensitized to the sound of the alarms themselves and potentially missing those 10-15% of alarms that are truly critical and life-threatening. This is extremely dangerous, and it’s wreaking havoc on both the clinicians’ mental states and the health of the patients they care for.
#2. High alarm volume
The sheer volume of alarms generated by medical devices can cause alarm fatigue among healthcare providers. ICUs are equipped with a range of medical devices, including cardiac monitors, ventilators, and infusion pumps, all of which generate alarms that can be overwhelming. It can be challenging for healthcare providers to prioritize and respond to alarms effectively when there are too many alarms going off simultaneously. Yet each of these unique monitors serves a purpose, right? Oftentimes when a patient’s condition deteriorates, multiple vital signs will be abnormal. For example, patients in cardiac arrest will often show drastic changes in both their heart rate and SpO2 levels. Rather than having both of these alarms sounding when this happens, what if medical alarms were grouped? Reducing ICU alarm volume by grouping alarms based on medical conditions and using Early Warning Scores will not only diminish the effects of alarm fatigue, but can also provide critical insight into how to properly care for patients.
#3. Improper clinician training on medical alarming technology
Believe it or not, vital signs monitor alarm thresholds can be altered manually to fit the ranges of individual patients. But many nurses don’t have the proper training and/or familiarity with the specific equipment being used. Rather, clinicians are thrust into the chaotic ICU environment taught to just accept the status quo of incessant noise as ‘part of the job.’ Noise doesn’t have to be part of the job, though. If vital signs monitoring systems had more intuitive controls (and instructions), then clinicians would be more apt to optimize alarms and reduce ICU noise and fatigue. Additionally, nursing educators and managers should be provided the proper explanation on how and why to alter alarm thresholds so that they are empowered to take action against alarm fatigue given the right tools to fix it. Education on vital signs monitor settings also prevents critical mistakes when clinicians may try to quiet medical alarms without the proper knowledge on what they are actually doing.
Conclusion
If alarms weren’t already ringing in your mind about alarm fatigue in ICUs, they better be now that you know a few of the top causes. Keep in mind, there are additional complex issues contributing to alarm fatigue, many of which are discussed in the CalmWave Blog. While these causes may seem scary and hard to solve, advancements in data aggregation tools using artificial intelligence (AI) are working to reduce alarm fatigue. CalmWave is championing this effort with their AI-based Operations Health technology. Their technology hits on many contributors to scourge, notably:
- Optimizing and personalizing alarm thresholds to reduce false positives without compromising on efficacy.
- Bucketing patient alarms into ‘incidents’ based on different critical medical conditions to diminish the sheer number of alarms going off while providing more comprehensive insight into patients’ conditions.
- Educating and empowering nurses to make changes to factory settings on vital signs monitors via videos and instructions.
CalmWave is the future of the quiet ICU, a place where clinicians are not fatigued, patient care is optimized, and hospitals become a little less scary and stressful than they have been. Schedule a demo today to learn more.
Sources:
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- Khademi et al., “Noise pollution in intensive care units and emergency wards”
- Woo & Bacon, “Alarm Fatigue”
- Lewandowska et al., “Impact of Alarm Fatigue on the Work of Nurses in an Intensive Care Environment–A Systematic Review”