Monitor alarms are designed to alert caregivers to changes in a patient’s condition and can save lives, but majority of the alarms do not require clinical intervention. However, as the number of alarms encountered by clinicians on a daily basis rises, it has become difficult for caregivers to distinguish between clinically significant alarms and nuisance alarms. As a result, alarm fatigue has become a serious issue, which puts patients at risk. The purpose of this paper is to discuss the research findings of two articles to explore more efficient and effective methods to reduce nurse desensitization to clinical alarms.
Topics of Interest
In Christensen, Dodds, Sauer and Watts (2014) article gathered information on nurses’ perceptions while working in a regional critical care unit (ICU, CCU, HDU) in Australia. Cvach’s (2012) article reviewed seminal research to find effective ways to decrease monitor alarm fatigue. The articles were found in the PubMed database using the keywords “alarm fatigue” and “clinical alarms”. The articles were chosen to provide effective information on ways to minimize monitor alarm fatigue. The two articles discussed can help clinicians understand alarm fatigue and the adverse effects it has on nurses and patient safety. With education and proactive measures provided by the research articles, healthcare staff can assist in decreasing the excessive alarms and the undesirable outcomes that often accompany them.
Methods and Purpose
In Christensen et al. (2014) article, a descriptive pilot survey consisting of a 10 piece open-ended multiple choice questionnaire was conducted. The sample population consisted of 48 well trained, bachelor degrees and a few with master degrees, nurses on a 13 bed unit. The questionnaire was developed by the researchers’ observations on problem areas associated with alarm fatigue. The article aimed at evaluating the nurses’ perceptions of alarm setting and management in a critical care unit. The findings found that nurses felt irritated with inappropriate alarm settings and the high volume of noise on unit, resulting in delays in response times. False alarms were the main culprit in the nurses’ opinions. The interventions supplied by the article were individualizing alarm limits, buddying systems, a charge nurse making rounds, and the development of smart alarms with algorithms that cover multiple conditions (Christensen et al., 2014). In Cvach’s (2012) article, an integrated review synthesized research and non-research findings of seventy-two articles, published between 1/1/2000 and 10/1/2011.
The author used the John Hopkins Nursing Evidence Based-Practice model to measure and evaluate the articles for this review. The data collected were categorized into 5 main themes: excessive alarms and the effects on nurses, nurse’s response to alarms, alarm sounds and audibility, technology to reduce false alarms, and alarm notification system (Cvach, 2012). The purpose of this integrated review was to find out if the volume of noise (false alarms vs true alarms) disrupts the nurse’s response and perception to physiologic clinical alarms. The 3 main recommendations provided by the researcher were to implement the use of smart technology, generate change within the hospital’s environment and protocols, and use of precautionary measures by healthcare staff in order to reduce monitor alarm fatigue.
Level of Evidence and Grade of Recommendation
According to the Evidence Based Health Care Practice Guidelines used by the National Guideline Clearinghouse, Christensen et al. (2014) article would be given a level IV with a C grade of recommendation due to the study being a descriptive pilot survey (Ecces, Grimshaw, Shekelle, & Woolf, 1999). A grade of C was awarded because the interventions listed in this article, such as individualizing alarm parameters, buddying systems, a charge nurse making rounds are recommended and would be applicable to practice. Cvach’s (2012) integrative review article would be given a level 1B with a B grade of recommendation (Ecces et al., 1999). Level 1B due to the integrative review having a least one randomized controlled trial. A B grade of recommendation was given because majority of the evidence found applies to most patients and if implemented would provide effective change in the area of reducing nurse desensitization to alarms. Some solutions found by the author are still in the testing or developing stages and would be recommended when additional evidence is presented.
Applicability to Practice
Clearly, alarm fatigue can result in desensitization amongst nurses leading to ignoring and/or disabling alarms due to the abundance of false alarms. The interventions discussed in Christensen et al. (2014) article are simple and cost-effective interventions that show a reduction in alarm fatigue. Although the development of smart alarms is still in the testing phases, this option appears to have the most potential in significantly reducing alarm fatigue. In Cvach’s (2012) article, suggestions were made to decrease alarm fatigue by implementing changes made to technology. Smart alarms, alarm technology that integrates short delays, standardizing alarms sounds, and animating steps on monitor equipment for troubleshooting. The first suggestions involving technology changes are relevant to practice but not practical. In order for these changes to impact practice today, alarm technology needs to be developed and tested before we can truly see if this is an effective solution. The second recommendations discussed were to generate changes within the hospital by setting up committees to do risk assessments, explore and set alarm protocols, model staffing to increasing workloads, use of closed-loop alarm notification systems to healthcare providers, noise reductions, and continuous training for staff on the alarm devices (Cvach, 2012).
Small changes and internal exploration of the problem by management within each hospital is a respectable start to unveil and individualize each unit’s problem with alarms. Lastly, staff is urged to use proper skin preparation, replacing ECG probes regularly, individualizing alarm parameters, and proper documentation are beneficial strategies that should be implemented into practice to decrease monitor alarm fatigue (Cvach, 2012). These precautionary measures show a significant reduction in nuisance alarms. The finding suggested in these articles provide healthcare with a variety of options to begin the process to alleviate the problem of alarm fatigue.
At the writer’s hospital, interventions are being tested to reduce alarm fatigue. One example, is that the risk management committee has set up an occurrence sheet that is completed every time the HUGS (infant security system) system gives a false alarm. Annual proper training for staff on the HUGS system has also been implemented in a attempt to reduce the human errors made when applying, tightening, and discharging the tag. The interventions implemented are the first phases of the writer’s hospital to decrease alarm fatigue placed on nurses. The research findings of these two articles gives new insight and ideas to implement into practice.
Technology is supposed to provide a safety net, but failed responses to alarms can endanger patients. Healthcare providers, researchers, and manufactures, working collaboratively, can make a difference on this important issue. The articles, presented in this assignment, bring to light the significance that alarm fatigue plays on nurses and patient safety. These research articles show evidence that with small implements of change and progress made with the development of alarm technology, a reduction in alarm fatigue is attainable.
Christensen, M., Dodds, A., Sauer, J., & Watts, N. (2014). Alarm setting for the critically ill patient: A descriptive pilot survey of nurses’ perceptions of current practice in an Australian Regional Critical Care Unit. Intensive & Critical Care Nursing, 30(4), 204-210. doi:10.1016/j.iccn.2014.02.003. Cvach, M. (2012). Monitor alarm fatigue: an integrative review. Biomedical Instrumentation & Technology, 46(4), 268-277. Eccles, M., Grimshaw, J., Shekelle, P.G., & Woolf, S.H. (1999). Developing clinical guidelines. West J Med, 170(6), 348-351. www.guidelines.gov