By Lynn Razzano RN, MSN, ONCC (Clinical Nurse Consultant)

Increasingly we are seeing publications, alerts and evidence of the clinical phenomena entitled: “Alarm Fatigue”. What is the scope of this latest hazard and what are the new implications for clinical practice change.

The Joint Commission 2014 NPSG is about to be implemented and reinforces the defined problem called alarm management that is caused from Clinicians experiencing alarm fatigue. What have you done to start the implementation process of this NPSG? Increasing staff education, instilling alert reminders in the Health Record and the Nursing Care Plan are a start, but what other thoughts come to mind?   Ideas that come to mind – addition of a safety alarm checklist and imbedding it in patient safety rounds, and increased oversight in all areas where continuous monitoring is occurring.

The ECRI has issued a Top Ten Technological Hazard List for 2014 and although ECRI acknowledges that patient monitors are undoubtedly beneficial, ECRI says that the frequency of alarms can be detrimental:

“Excessive numbers of alarms—particularly alarms for conditions that aren’t clinically significant or that could be prevented from occurring in the first place—can lead to alarm fatigue, and ultimately patient harm. That is:

• Caregivers can become overwhelmed, unable to respond to all alarms or to distinguish among simultaneously sounding alarms.
• They can become distracted, with alarms diverting their attention from other important patient care activities.
• They can become desensitized, possibly missing an important alarm because too many previous alarms proved to be insignificant.”

Implications for Clinical Practice to prevent Alarm Fatigue:

The goals of acting on prevention start with premier staff education so all clinicians involved in use of continuous monitoring equipment clearly know there role in maintaining appropriate alarms in maximum working state. This encompasses development of and maintaining valid clinical annual competencies, tracer methodology in direct observation and querying clinicians using monitoring equipment about reason and purpose of alarms. Proper alarm setting instructions or a checklist could accompany all monitoring equipment. Alert signs hung outside the patient’s door or cubicles are both visual cues which would serve as reminders. Electronic alerts could be imbedded in the physician order section and activated whenever there is an order for continuous monitoring equipment.

Moreover, a recent national survey found that hospitals would like tools to more easily and accurately assess a patient’s condition, such as a single assessment indicator. Seven out of 10 hospitals (70.7 percent) would like “a single indicator that accurately incorporates key vital signs, such as pulse rate, SpO2, respiratory rate, and etCO2.”

Could such a single assessment tool be implemented successfully?

Alarm Management and the potential for alarm fatigue has become a national patient safety issue that is preventable and needs to be recognized in order to reduce patient harm and decrease cost expenditures. Clinicians need to be aware of this and recognize this to the extent of developing and implementing, for example, a single assessment indicator as mentioned above. The necessary staff training and education should occur continually on the use of the assessment tool until it is verified as a best practice standard of care.

Quality checks and auditing should be ongoing in real time to readily identify when the standard practice and assessment has not been utilized and followed up on in the care of a specific patient or groups of patients.  Pro active corrective action plans can then be readily implemented and mandatory re- education using mentors can be instituted to ensure no further adverse patient occurrences.

What other tools or training would you recommend or like to see in your clinical practice?

• Alarm Fatigue
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