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Fargo hospitals look for cure to ‘alarm fatigue’

Critical Care Supervisor Breeanna Hook, R.N., stands Wednesday, March 4, 2014, with some of the medical monitoring equipment used at Essentia Health in Fargo. Michael Vosburg / Forum Photo Editor

FARGO – Breeanna Hook used to go home from her nursing shift on the critical care unit and dream of alarms going off and having to scramble frantically to respond.

“I’d go home and go to sleep and all I’d hear were alarms going off,” said Hook, a registered nurse and critical care nursing supervisor at Essentia Health.

A modern critical care room bristles with technological devices to keep a patient alive – pulse and blood-oxygen monitors, ventilators, cardiac monitors – each equipped with sound alarms to summon a nurse when something is wrong and needs attention.

One study estimated that equipment in a single critical care room can generate between 150 to 400 alarms in a day – a frequency that can cause “alarm fatigue,” a tendency for nurses to sometimes disregard alarms when too many prove not to be urgent.

In spite of the high frequency of alarms, studies suggest that 85 percent or more of alarms actually don’t require clinical intervention.

Alarm fatigue, in other words, is a hospital version of the familiar children’s fable “The Boy Who Cried Wolf.”

The Joint Commission, the health care accrediting body, has directed hospitals to address alarm fatigue, citing studies showing the phenomenon can result in patient care errors and even deaths.

In announcing the alarm safety initiative two years ago, the Joint Commission reported that its Sentinel Event database identified 98 alarm-related patient deaths over a recent 3½-year period.

Another 13 patients suffered permanent loss of function, and five more required unexpected additional care. Typical alarm-related mishaps included falls, delays in treatment and medication errors, according to the Joint Commission.

And the problem is “recognized as underreported,” the accrediting body concluded.

In recent years, hospitals and medical equipment manufacturers have begun to address the issue, as it has become more widely recognized as a significant problem.

At Essentia, for instance, nurses and others already were working to reduce noise in a “Quiet at Night” initiative to improve patient satisfaction and outcomes.

As nurses well know, noise isn’t merely annoying to patients; too much noise detracts from healing.

“On a floor on a typical day, it’s constant alarms,” said Hook, who is a member of Essentia’s team to address alarm fatigue. “You want to be able to quickly respond.”

But, she added, referring to alarms, “It can add potential to distract you.”

Creating policy

Hospitals, which last year were told to make alarm system safety a priority and to begin to identify patient risks and best practices, next year must have in place policies and procedures for managing alarms.

Sanford Health has conducted an assessment of all clinical alarms across its Fargo region “to determine areas of focus,” Becky Moch, executive director of nursing, said in a statement.

Administrators also surveyed front-line staff and physicians “for feedback regarding the impact of clinical alarms and patient care,” she said. “We are evaluating the effects of decreasing unnecessary alarms to determine the impact of change.”

Educating and training nurses is a critical component of alarm safety, said Gayle Bye, manager of the critical care unit at Essentia.

Efforts to improve alarm safety and provide a quieter patient environment have shown results, she said.

“Our patient satisfaction scores have indicated we’re getting quieter,” Bye said.

How much of that can be attributed to decreasing unnecessary alarms?

“It’s hard to put a number on it,” Bye said.

Hook added, “Nobody’s out there counting the alarms.”

Although there is widespread agreement for the need to increase alarm safety, there are no cookie-cutter solutions, said Deb Schneibel, Essentia’s inpatient manager for performance improvement resources.

Ultimately, many agree, the solution is an individual one, tailored to the patient, with the attending physician setting the proper alarm parameters to avoid unnecessary distractions.

“I think alarm fatigue is something we will always be working on and trying to get better,” Hook said. As for the alarms going off in her dreams, “That goes away over time. I haven’t dreamt about alarms in a long time.”

Patrick Springer

Patrick Springer first joined the reporting staff of The Forum in 1985. He can be reached by calling 701-241-5522. Have a comment to share about a story? Letters to the editor should include author’s name, address and phone number. Generally, letters should be no longer than 250 words. All letters are subject to editing. Send to letters@forumcomm.com

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