How to Combat Alarm Fatigue on the Medical-Surgical Floor

Lindsay Alexander

On the Medical-Surgical floor, alarms can be constant. You may hear hundreds of alarms during a single shift. Too many false alarms can distract you from what you do best — focusing on your patients.

Frequent false alarms don’t just waste time. They can exacerbate alarm fatigue and increase the risk of missing alarms that require immediate attention. This can lead to negative patient outcomes.¹

That’s why clinicians are innovating new ways to optimize alarms. They’re tailoring default settings to each patient. They’re using data-driven monitoring for accurate, timely readings. They’re reducing false positives, combating fatigue, and saving time.

Learn more about how smarter alarms can help you reclaim time and improve outcomes. In this blog post, we’ll examine the challenges associated with frequent alarms, and how you can manage them.

Issue #1: Many Alarms May Be Unnecessary

In a typical shift, clinicians may hear up to 1,000 alarms on the Medical Surgical floor.² However, many alarms can be triggered due to generic device settings or malfunctioning electrodes. Experts estimate that between 85 and 99 percent of alarms do not require an intervention.³

Too many false or insignificant alarms can contribute to fatigue. The result may include a greater risk of missing important alarms— including those indicating a significant decline in the patient’s condition.³

Related: Smarter alarms and monitoring can help you save time and improve care. See how.

Issue #2: Excessive Alarms Can Waste Valuable Time

Frequent alarms, combined with other interruptions, can quickly add up. In a single shift, a clinician can experience an average of 46.3 interruptions — which can waste up to ten percent of their time.^4,5

While responding to alarms and other patient needs, clinicians can walk up to five miles throughout a 10-hour day shift.⁶ This may limit the amount of time they can spend with the patient — nine minutes on average per shift for hospitalists.⁵

Related: See where time gets lost on the Medical-Surgical floor. View the infographic.

Issue #3: Alarm Fatigue Can Negatively Affect Patient Outcomes

Frequent false alarms can affect clinician fatigue and quality of care. One review showed that up to 90 percent of interruptions resulted in consequences including treatment delays and loss of concentration.⁷ In some extreme cases, clinician fatigue led to missing high-priority alarms, such as a code blue event or cardiac arrest.¹

Alarm fatigue may also affect job stress and patient satisfaction. For every ten percent of nurses reporting job dissatisfaction at one hospital, the share of patients who would recommend the hospital declined by two percent.⁸

Related: Data-driven technologies can help you focus on the alarms that matter most. Learn more.

Four Ways to Combat Alarm Fatigue

Here are four ways smarter alarm management can help you save time and improve care.

Customize patient monitoring parameters, such as alert levels for heart rate and peripheral oxygenation. Doing so can reduce false alarms associated with default factory settings. One clinical team saw a 50 percent reduction in alarms after customizing thresholds.⁹

Robust, data-driven algorithms can help provide a more accurate and timely picture of your patient’s conditions. Integrating multiple sources of patient monitoring data can help reduce false alarms — by up to 92.5 percent.¹⁰ In one study, automated vital signs monitors led to a 13 percent increase in patient survival rate.¹¹

Changing electrodes and preparing patient skin can help reduce irregularities that trigger false alarms. One clinical team reduced average alarms per bed by 46 percent.¹²

Early Warning Scores (EWS) can help you detect red flags early and respond on time. In one case, EWS helped shorten length of stay by an average of 0.4 days.¹¹ Combined with wireless patient monitoring, EWS helped reduce falls and increase patient survival by 6 percent.¹¹

Explore time-saving innovations that can help you improve care. Visit the resource site.

References:

1. Pelter M, Drew B. Harm from alarm fatigue. Patient Safety Network. https://psnet.ahrq.gov/webmm/case/362/Harm-From-Alarm-Fatigue. Published Dec. 2015. Accessed Mar. 19, 2019.

2. Ruskin KJ, Hueske-Kraus D. Alarm fatigue: impacts on patient safety. Curr Opin Anaesthesiol. 2015;28(6):685–690. doi: 10.1097/ACO.0000000000000260.
3. Patient Safety Advisory Group. Medical device alarm safety in hospitals. The Joint Commission Sentinel Event Alert. http://www.jointcommission.org/assets/1/18/SEA_50_alarms_4_5_13_FINAL1.PDF. Published Apr. 8, 2013. Accessed Mar. 19, 2019.
4. Weigl M, Müller A, Zupanc A. Hospital doctors’ workflow interruptions and activities: an observation study. BMJ Qual Saf. 2011;20:491–497. doi:10.1136/bmjqs.2010.043281.
5. Tipping MD, Forth VE, O'Leary KJ, et al. Where did the day go? A time-motion study of hospitalists. J Hosp Med. 2010;5(6):323–328. doi: 10.1002/jhm.790.
6. Hendrich A, Chow MP, Skierczynski BA, et al. A 36-hospital time and motion study: how do medical-surgical nurses spend their time? Perm J. 2008;12(3):25–34.
7. Monteiro C, Avelar AFM, Pedreira M da LG. Interruptions of nurses’ activities and patient safety: an integrative literature review. Rev Lat Am Enfermagem. 2015;23(1):169–179. doi:10.1590/0104-1169.0251.2539.
8. McHugh MD, Kutney-Lee A, Cimiotti JP. Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff. 2011;30(2):202–210. doi:10.1377/hlthaff.2010.0100.
9. American Association of Critical-Care Nurses. Alarm management. Crit Care Nurse. 2013;33(5):83–86. http://ccn.aacnjournals.org/content/33/5/83.full. Accessed May 1, 2019.
10. Borges G, Brusamarello V. Sensor fusion methods for reducing false alarms in heart rate monitoring. J Clin Monit Comput. 2016;30(6):859–867.
11. Bellomo R, Ackerman M, Bailey M, et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med. 2012;40(8):2349–2361. doi: 10.1097/CCM.0b013e318255d9a0.
12. Cvach MM, Biggs M, Rothwell KJ. Daily electrode change and effect on cardiac monitor alarms: an evidence-based practice approach. J Nurs Care Qual. 2013;28(3):265–271. doi: 10.1097/NCQ.0b013e31827993bc.

TOPIC: Microstream™ Capnography, Medical-Surgical, Procedural Sedation