Running head: ALARM FATIGUE 1

Evidence Based Practice in Action

Alarm Fatigue

Siera R Stokes

Westminster Nursing College

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Many families and caregivers are unaware of the fact that countless hospital

personnel become fatigued and desensitized to the beeping of monitors and alarm

systems examining patients during their stay. Alarm fatigue is an incredibly serious

problem that consists of health care team members either silencing, ignoring, or simply

not processing the cacophony of alarms going off throughout each day and night.

Employees are not trying to be ignorant towards the noise, there are simply just so many

alarms heard each day that their response becomes dulled to each beep. The States News

Service (2014) explained,

Alarm fatigue occurs when nurses and other clinicians are exposed to a high

number of physiological alarms generated by modern monitoring systems. In

turn, alarms are ignored and critical alarms are missed because many alarms

are false or non-actionable.

This phenomenon has been an evolving issue, and is currently taking place in hospitals

throughout the world. The States News Service (2014) also stated that

A cardiac monitoring expert at the University of North Carolina at Chapel Hill,

and her colleagues at the University of California San Francisco, revealed more

than 2.5 million alarms were triggered on bedside monitors in a single month.

With this many alarms beeping, it is understandable how one can become immune to the

noise and accidentally ignore it without actually processing it.

This is an extremely concerning problem that has yet to be resolved. The

significance is that with different alarms being ignored or silenced throughout the day

patients may not be receiving adequate care, or there may possibly be critical situations

that could have been avoided if the alarms had been tended to earlier. Majority of the
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monitors in hospitals tend to be cardiac monitors; which are obviously observing

potential problems and these alarms need to be heard and acted on. Alarm fatigue can

cause potential harm to patients or worsen present problems. Kurnat-Thoma (2016)

taught that

Depending on the hospital unit type, several hundred alarms per patient may

occur in a single day. In environments where there is a greater frequency of

false alarms, clinicians manage the sensory overload by disabling, silencing,

or ignoring alarms, which increases the likelihood that a true critical patient

alarm is missed. This phenomenon is called alarm fatigue, and at its worst, a

missed critical true alarm can lead to patient injury and death

As for now, many alarms are silenced numerous times without any interventions.

Parameters are usually set by specialists, which may require further adjusting to minimize

the amount of alarms being set off, however the specialists are not in the patient’s room

frequently so the parameters may stay set at specific boundaries for prolonged amounts of

time. Alarm fatigue impacts patients in numerous ways including: beeping, which tends

to keep interrupt sleep, irritation to family members, increased risk for missing critical

alarms, and reduces the known severity of a situation if an actual problem occurs.

Currently, the main practice when responding to alarms is to react to the alarm

and handle the situation appropriately or to “silence” the alarm if there is an important

matter and respond to it when the nurse has a chance to. The only help offered is from

monitor watchers. While explaining what this means, Funk (2016) stated

Monitor watchers may be trained technicians, emergency medical technicians, or

nurses. When monitor watchers are nurses, they may be tasked with watching
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telemetry monitors in addition to patient care responsibilities. Monitor watchers

may be located on the unit being monitored, in a different unit in the hospital, or

in a centralized area away from the units.

Monitor watchers are not utilized in every hospital, however their presence is increasing.

A clinical study was completed by researchers at Cincinnati Children's Hospital Medical

Center to see if monitor watchers improve the care provided and decreased the amount of

alarms that were ignored or silenced, and concluded with mixed opinions (Cardiovascular

Week, 2014). Along with monitor watchers, the other possibility for decreasing alarm

fatigue is to personalize the parameters set on the monitors for each patient and to change

them as needed if the patient’s health is improving or declining. According to the clinical

study these two implementations are currently supported and proven to decrease alarm

fatigue. By personalizing the parameters for each patient, it would lessen the amount of

unnecessary alarms sounded each day and would thus help nurses realize the importance

of the alarms that are set off. Cardiovascular Week published a statement about

personalized parameters explaining, “The process reduced the median number of daily

cardiac alarms from 180 to 40, and increased caregiver compliance with the process from

38 percent to 95 percent.” The clinical study performed provided a variety of results

ranging from stating that monitor watchers were extremely helpful while some shared

that they were not helpful. One participant indicated, "I have had to educate [the monitor

watchers] many times that the rhythm they identify [is] NOT fatal or dangerous (i.e.,

noise). I receive about 10 calls during a typical shift. They do receive a basic rhythm

class, but so many times they call over false rhythms." Another participant said, "I think

monitor watchers ... provide a false sense of security. I've taken care of multiple patients
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in our cardiac ICU after arrests where resuscitation was delayed because no one was

paying attention." On the other hand, there were positive responses such as, "I like the

system of having a person whose job it is to watch the monitors. As a staff RN, I am

much too busy to be checking the monitor as frequently as I think it should be checked."

After reviewing this article, it is apparent that both of these interventions have the

potential to be useful, but need some improvement. Adjusting parameters would require a

specialist to visit the patient regularly to see if the current settings are appropriate and

would need to be changed when necessary. If all hospitals were to use monitor watchers,

it may be necessary for them to receive more instruction and education on which beeps

are vital and which are not. Furthering education would be especially important on floors

including cardiac patients where they need close ECG monitoring.

Presently, these interventions are being implemented at various hospitals that

provide the opportunity to allow nursing students, but not on all of the units. Students

have witnessed monitor watchers who alert nurses through Vocera if there is a change on

patient’s ECG readings and that was the extent of it. Students have also seen specialists

change the parameters for patient’s monitors on a few ICU floors, however majority of

their patients have not received this individual care. After seeing these interventions try to

be executed it is apparent that there are some barriers preventing complete adherence.

First, the monitor watchers need to be taught what to watch for in cardiac strips and also

for ranges in vital signs that are acceptable. Second, there needs to be clear and quick

communication between monitor watchers and nurses if there is a serious problem. As for

changing parameters on monitors, it isn’t completely feasible for specialists to change the

parameters when a nurse decides it is appropriate, but may be possible if the physician
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allows time each day to do an assessment and then decide if the settings need to be

changed. There also needs to be some sort of indicator as to when the parameters should

be changed for each patient or a policy set in place as to keep things organized and

uniform amongst hospitals and each unit.

Overall, there is no obvious solution and many possibilities may need to be

attempted before finding a resolution for alarm fatigue. More research should be done on

the topic to see what interventions have helped or not helped as well. Alarm fatigue is

something all healthcare providers need to be conscientious of and strive to make an

improvement to decrease the likelihood of patients being harmed. With healthcare

members working together there may be a viable solution to the problem that continues to

worsen.
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References

Funk, M., Ruppel, H., Blake, N., & Phillips, J. (2016). Use of monitor watchers in hospitals:

characteristics, training, and practices., 50(6), 428(411).

Jahrsdoerfer, M. (2016). Case Study: Reducing Interruption Fatigue through Improved Alarm

Support. 50(2), 109-113.

Kurnat-Thoma, E., & Shah, K. (2016). A Community Hospital's Evaluation of Alarm

Management Safety Factors.

McKinney, M. (2013). Lives at risk. Hospitals face hurdles addressing alarm fatigue. Modern

healthcare, 43(15), 14.

Modern monitoring systems contribute to alarm fatigue in hospitals. States News

Service, 4 Dec. 2014. Academic OneFile

Project reduces alarm fatigue in hospitals by 80 percent. (2014). Cardiovascular Week.