Hospitalists Key to Addressing Medical Device Alarm Fatigue

“Personally, I feel that I suffer from it [alarm fatigue],” says Dr. Hunter, a member of Team Hospitalist. “When I’m not at work and check my phones, I may realize that I missed answering a few notifications.”

He says that sometimes too much information “may be a bad thing, because we aren’t able to discern what is important and what isn’t. Studies have shown that, in general, people are not good at multi-tasking.”⁷

Staff have indicated that sometimes alarms are like ‘white noise.’ [Alarms] go unnoticed because they are considered part of the environment and [staff] are accustomed to them.”–Maria Cvach, DNP, RN, MSN, CCRN, DNP

Reduction Efforts

Dr. Wyatt believes the corrective actions organizations have implemented to reduce alarm fatigue are not optimal, because the problem is worsening. In addition, the number of patients who are connected to alarm-based devices will continue to increase.

He maintains that hospitalists are uniquely positioned to “team up” with housestaff and tackle this issue.

“Unlike other physicians, [hospitalists] are in the hospital around the clock,” he says.

Dr. Wyatt suggests a good starting point is determining the baseline number of device alarms per day. Then answer these questions:

• How many required clinical intervention?
• How many resulted in harm or death?
• What are the organization’s current monitor alarm default parameters?
• How can we adjust alarms to indicate actionable alarms?

Another tip: Work with engineers and equipment manufacturers to customize alarms and notifications, so staff can readily recognize those that need immediate attention.

Cvach says that unnecessary patient monitoring results in excessive nuisance alarms. Patients should only be monitored when clinically necessary. To determine necessity, refer to the American Heart Association’s Practice Standards for Electrocardiographic Monitoring in Hospital Settings.⁸

“Alarms should be individualized for patients to make them most useful,” she explains. “Defaults should be customized based on the patient population.”

Cvach also recommends momentarily pausing alarms when assisting patients with turning, suctioning, bathing, and so forth, and changing electrodes regularly.

From a personal perspective, Dr. Hunter suggests that hospitalists turn off as many nonessential notifications as possible and have separate devices for work and personal usage. Reset the tolerance for only certain important types of messages.

“I indicate specific parameters for a nurse or another provider to call me in certain circumstances,” Dr. Hunter says. “That grabs my attention more than a text or e-mail.”

Telling Patients

Vladimir N. Cadet, MPH, an associate with ECRI Institute’s Applied Solutions Group in Plymouth Meeting, Pa., says hospitalists should communicate to patients and their family members, many of whom also suffer from alarm fatigue, the importance of allowing health practitioners to address alarms to minimize the potential for delayed responses or missed alarms.

Patients should be told to notify staff if a medical device alarm goes unanswered, Cvach adds. To facilitate adequate sleep, patients can request earplugs or put on restful music.

Karen Appold is freelance writer in Pennsylvania.

References

1. Lawless ST. Crying wolf: false alarms in a pediatric intensive care unit. Crit Care Med. 1994;22(6):981-985.
2. Tsien CL, Fackler JC. Poor prognosis of existing monitors in the intensive care unit. Crit Care Med. 1997;25(4):614-619.
3. Chambrin MC, Ravaux P, Calvelo-Aros D, Jaborska A, Chopin C, Boniface B. Multicentric study of monitoring alarms in the adult intensive care unit (ICU): a descriptive analysis. Intensive Care Med. 1999;25(12):1360-1366.
4. Atzema C, Schull MJ, Borgundvaag B, Slaughter GRD, Lee CK. Alarmed: adverse events in low-risk patients with chest pain receiving electrocardiographic monitoring in the emergency department: a pilot study. Am J Emerg Med. 2006;24(1):62-67.
5. Keller JP, Diefes R, Graham K, Meyers M, Pelczarski K. Association for the Advancement of Medical Instrumentation. Why clinical alarms are a “top ten” hazard: how you can help reduce the risk. Horizons. Spring 2011. Available at: http://www.aami.org/htsi/alarms/pdfs/Alarms%20Horizons_Secure_Watermarked.pdf. Accessed March 8, 2015.
6. ECRI Institute. Top 10 health technology hazards for 2015. Available at: https://www.ecri.org/press/Pages/ECRI-Institute-Announces-Top-10-Health-Technology-Hazards-for-2015.aspx. Accessed March 8, 2015
7. Weigl M1, Müller A, Sevdalis N, Angerer P. Relationships of multitasking, physicians’ strain, and performance: an observational study in ward physicians. J Patient Saf. 2013 Mar;9(1):18-23. doi: 10.1097/PTS.0b013e31826b7b87.
8. Drew B, Califf RM, Funk M, et al. Practice standards for electrocardiographic monitoring in hospital settings. Circulation. 2004;110:2721-2746.