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For Caregivers, ‘Alarm Fatigue’ is a Real Concern

If you’ve ever spent the night in a hospital, you’re likely aware of the preponderance of alarms designed to alert healthcare practitioners about potentially life-threatening events. And while the point of these alarms is to help healthcare providers do their jobs, the reality is that these alarms can at times be more harmful than helpful. Why? Because of a phenomenon known as “alarm fatigue.” Here’s a closer look at the problem, along with research underway aimed at improving patient safety by reducing alarm fatigue.

Alarm fatigue
Will they come running when you need them or will alarm fatigue set in?

What is Alarm Fatigue?

As defined in the journal AACN Advanced Critical Care, “Alarm fatigue is sensory overload when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms.”

Just how prevalent are alarms in hospitals? According to research published in PLoS One based on a study of alarms and intensive care unit patients, just under 382,000 audible alarms sounded over a 31-day period. The number of audible alarms per bed per day? A staggering 187. As many as 99% of these alarms, meanwhile, may be fake. The US Department of Health and Human Safety Patient Safety Network (PSNet) offers an eye-opening way to look at it: “If only 10% of these were true alarms, then the nurse would be responding to more than 170 audible false alarms each day, more than 7 per hour.”

Because alarm fatigue is a threat to the health of patients — 138 deaths have been attributed to it over a five-year period — it has been declared a Joint Commission National Patient Safety Goal.

Growing Knowledge About Alarm Fatigue

While scientists have until now attributed the problem of alarm fatigue to caregivers becoming so desensitized to alarm sounds from patient-monitoring devices that they begin to tune them out, the latest research indicates that the problem may be something else entirely:  caregivers may simply be unable to differentiate between the onslaught of alarms. According to “A Formal Approach to Discovering Simultaneous Additive Masking Between Auditory Medical Alarms,” “A relatively understudied source of response failures has to do with simultaneous masking, a condition where concurrent sounds interact in ways that make one or more of them imperceptible due to physical limitations of human perception.”

In other words, according to lead author Matthew Bolton, Ph.D., assistant professor of industrial and systems engineering at the University of Buffalo, “When you have a hodgepodge of different machines from different vendors, everything is sort of thrown together without much thought given to the coordination of them.”

While this isn’t a problem in false alarm cases, it represents a huge threat to patient safety when an unheard alarm is actually indicating a life-threatening emergency.

A New Tool in the Fight Against Alarm Fatigue? 

In response to these new insights into the causes of alarm fatigue, Dr. Bolton and his team at the University Buffalo are developing a technique for identifying “auditory blind spots” using a new, computer-based tool. Here's how it works.

Explains ScienceDaily, “Tapping into MP3 code To address the problem, Bolton researched the science behind audio file formats. Among those he examined was MP3, the popular audio coding format launched in the 1990s, which uses sophisticated models of human hearing to compress audio data by removing sounds that are masked. Bolton combined these human hearing models with model checking (an automated, computational approach for finding problems in complex systems) to assess masking in a common patient-monitoring device with six different alarms. He found that each alarm could be at least partially masked when other alarms went off simultaneously and that one high-priority alarm could be completely masked.”

Funded by a grant from the U.S. Department of Health and Human Services, the hope is that the new technology will be useful in reducing preventable deaths due to alarm fatigue. Specifically, Bolton plans to use the tool to devise strategies for coordinating and improving the international medical alarm standard in partnership with the Association for the Advancement of Medical Instrumentation (AAMI) Foundation.

Other Strategies for Reducing Alarm Fatigue

In addition to eliminating masking, a number of other approaches may also be valuable in reducing alarm fatigue, including making medical devices more accurate in order to reduce false alarms, reviewing whether some non-emergency audible alarms might be more useful as inaudible text message alerts, and tailoring alarm settings on an individual basis depending on each patient’s unique situation.

Alarm fatigue
Limiting audible alarms to true emergencies may also reduce alarm fatigue.

Hospitals can also reduce alarm fatigue on an institutional level. Says PSNet, “We recently conducted a human factors analysis and determined that clinicians (nurses, physicians, and monitor watchers) found it difficult to respond to alarms or adjust alarm settings when working at the central monitoring station. Importantly, most participants reported they had not had training on how to use the monitoring equipment. This highlights the need for education and training of all staff that interacts with monitoring devices. Training should be provided upon employment and include periodic competency assessments.”

The overall takeaway? While alarm fatigue is a threat to public health and wellness, the combination of knowledge, technology, and practical strategies can help mitigate the problem and promote safer hospital environments for patients. Additionally, home medical alert systems add an additional layer of safety for patients and peace of mind for home caregivers, too. For more useful content on everything from senior caregiving to medical alert systems, be sure to sign up for our newsletter.

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Comments

  1. I have a feeling that more than 138 deaths over the last five years were due to alarm fatigue. It’s highly likely that many cases were not reported as so. I have always thought that doctors and nurses seemed almost immune to the alarms going off when either I or a family member was in the hospital. This concept explains it perfectly.

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