1 © ECRI Institute 2011 Wake up! This is alarming! ALARM FATIGUE Kara Polichetti

2 © ECRI Institute 2011 Alarm fatigue occurs when clinical personnel fail to respond appropriately to alarms due to excessive or inability to understand the priority or critical nature of alarms. As a result, clinical personnel will be desensitized to alarms, and will ignore them and even turning them off. What is Alarm Fatigue?

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4 An Alarming Challenge  More and more devices with alarms  More and more patients are connected to one – or many alarm-based devices  alarms per patient per day can be typical in a critical care unit  Alarm-based devices are not standardized in many institutions  Flexible alarm setting features allow for inconsistent use of alarms

5 Alarm Management is Complex

6 Culture Conundrum If the nurses would just do their job, we wouldn’t have a problem. We don’t have any problems. We’ve never had an alarm event. Why should I rush to put the leads back on? They’re just going to come off again. It’s not my job! I’m too busy to deal with this ! What’s the use? Nothing is ever going to change. It’s the vendor’s fault! This is the way we’ve always done things. No foundation for improvement

7 ALARM FATIGUE Why is it important?  The Food and Drug Administration (FDA) received 566 reports of patient deaths related to alarms on monitoring devices from 2005 through 2008  The ECRI Institute has identified alarm hazards as their number 1 top hazard for 2012  JCAHO recognized Alarm Fatigue as critical and integrated this into their accreditation standards

8 The Consequences are Alarming “Alarm Fatigue” a Concern for New Haven Hospitals. New Haven Register, June 11, 2011 And Still in the News

9 A Typical Event “ Patient admitted with chest pain and shortness of breath---Was on a monitored unit. At 3:25 am, patient’s nurse noticed the leads were off and on checking on the patient found him in the bathroom unresponsive. Resuscitation efforts were unsuccessful. Monitor showed the leads had come off at 2:32 am …” Alarm Interventions During Medical Telemetry Monitoring: A Failure Mode & Effects Analysis, A Pennsylvania Patient Safety Advisory Supplemental Review, March 2008

10 Example of Alarm Fatigue  Ventilator-dependent patient – frequent coughing  Coughing triggers high-pressure alarm  Frequent response to alarm by nurse with no real problem  Pressure alarm limit increased to minimize the number of false-positive alarms  An accident waiting to happen Patient movement crimps breathing circuit Secretions clog the endotracheal tube Inadequate ventilation (inhalation or expiration)

11 Some Questions to Ask  Does the nurse understand the purpose of the high-pressure alarm?  Was the nurse’s competence in ventilator use validated?  Does the hospital have a policy for who can and cannot set ventilator alarms?  Is there a policy on how ventilator alarms should be set? If so, is it generic or does it consider specific circumstances? Does the hospital have ventilator responsive-valve features, which can reduce nuisance high-pressure alarms?

12 Causes  Studies have shown as many as 99% of ICU alarms are false or non-critical alarms.  These are called nuisance alarms and are the leading contributor to alarm fatigue  Alarms fail to function as expected  It is difficult to distinguish which machine's alarm is going off  Nurses may block out noise in order to concentrate on current task.

13  Nurses have an overabundance of notifying devices (nurse calls, pagers, phones, overhead pagers, and monitor alarms)  Lower patient to nurse ratios increase the number of relevant alarms per nurse  Monitors with undirected alarms alert all nurses instead of specific nurses NURSES PROBLEMS?

14  Underreporting Some estimates suggest that the actual number of alarm-related deaths is ten-fold higher or more than what problem data shows  Ability to do analytics on data is very limited I literally had to read every report (around 20) in a recent problem reporting analysis  Actual reports often don’t have much information Typical language (paraphrased) - During use of device alarm did not sound and patient died Problem Reporting Data

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 Assess if sufficiently staffed with enough nurses  How many nuisance/false-positive alarms are there in the unit per day  Tiered response system would allow for quicker response time and delegation  Set individual parameters  Actionable/tailored alarms would create less nuisance alarms  The combination of all alerts to one device, "Smart alarms" to monitor multiple device in relation to each other  Centralized monitoring with allocated staff member to alarm personnel  Pop up screens  EDUCATION & TRAINING!!! How can we improve?

17 References

18 THANK YOU!!!