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When someone is exposed to a frequent number of alarms, no matter what type or in what context, that person can easily become fatigued from the sound of them going off all the time. When that happens, the person becomes completely desensitized to the alarms, and that can lead to not answering the alarms in a timely manner, or even missing some of them completely (Aztema & Schull, 2006). At some point, the person starts to "tune out" the alarms, because he or she hears them so frequently that they cease to have the meaning they should. They become background noise, and that slows reaction time (Mondor & Finley, 2003). There are a number of situations in which this can occur, and there are various industries that see the problem of alarm fatigue occurring among workers. One of these industries is healthcare, where nurses and other healthcare workers can find that they ignore alarms or do not even hear them go off, because they are so desensitized to them and have been listening to them for so long.
When a person hears something so frequently, and it generally does not mean anything truly important, it can be easy to make the assumption that it is never important. It can also be easy to not even realize the alarm is going off, because it generally does not mean anything important is taking place. The brain filters out the alarm noise, and it may not even register with the person anymore. In most cases that is not a serious problem, but there are times when the alarm goes off for a true emergency. When that happens, the person may find that there are serious and unintended consequences to not hearing the alarm and going to see why it was going off. Avoiding serious health consequences due to ignored alarms is very important for any healthcare facility, but how that can be done is something that has to be more carefully addressed in the future.
The Healthcare Environment
To understand the issues with alarm fatigue in healthcare, it is important to understand the healthcare environment properly. Most healthcare settings are noisy places. Even though the noises are relatively muted, they are still certainly cacophonous and overwhelming for those who are not used to them. Ventilators, blood pressure monitoring devices, heart monitors, and other supporting devices all make noise, and they all have different alarms that can and do go off to indicate that the patient may need assistance (Wee & Sanderson, 2008). That is seen in hospitals, but also in nursing homes, hospice settings, and virtually any type of healthcare facility where one or more people need constant or near-constant monitoring of some kind that is done by machines. With all the beeping and clicking that is taking place, important alarms can go overlooked (Bliss, Fallon, & Nica, 2007). It can also take time for a person to realize the alarm is going off, and that slowed response time can also be an issue for many patients' well-being (Siebig, et al., 2010).
Hospitals are the biggest issue when it comes to alarm fatigue, because there are so many people who are hooked up to various types of monitors. The noises from all of the different monitoring systems can often blend together and become overly problematic for the nurses and other healthcare workers because they learn to ignore the alarms as background noise. When a patient experiences a legitimate emergency, the nurse or other healthcare personnel may not realize it in time, because they are so used to hearing the various alarms (Blum & Tremper, 2010). They do not notice the alarms as they should. They are alarms, and they are meant to be alarming, in that they are designed to go off when there is a problem that requires medical attention. Some of them go off for simple things, though, that are not true emergencies, and that can lead to nurses ignoring them (Lacherez, Seah, & Sanderson, 2007). They assume it is another false alarm, or they tune it out and fail to hear it at all. Both of those can be highly problematic for patients who truly need care, and who might not get that care when it is most crucial (Borowski, et al., 2011).
The most significant unintended outcome has been patient deaths. Thirteen serious injuries and 80 deaths have been reported, all citing alarm fatigue as the cause (Graham & Cvach, 2010). Naturally, that is indicative of a problem that has to be corrected before more patients are harmed by it. It may not be easy to correct, but the unintended outcomes are too severe to ignore. The injuries and deaths, while extremely tragic, are also not the only problems that are seen when it comes to poor outcomes from alarm fatigue in hospitals. Other problems include an obvious desensitization to the alarms, and the resulting disruption in proper patient care that can come from that desensitization process (Bustamante, Bliss, & Anderson, 2007). Patient and staff anxiety, lowered immune system response, and sleep deprivation are all problems that have been seen as resulting from alarm fatigue, as well (Bustamante, Bliss, & Anderson, 2007). Critical events that required nursing or other staff assistance have been overlooked, and monitoring equipment has been misused in order to stop the level of alarms that go off in a particular patient area (ECRI, 2011).
The workload for some nurses and other hospital staffers has increased because of these issues, leading to more fatigue. In turn, that can cause further problems with alarms being missed and overlooked (McNeer, et al., 2007). Communication difficulties can arise from that, and patients can become dissatisfied with their care. Time can be wasted, and there can be investigations, treatments, and referrals that are completely unnecessary. In short, there are a significant number of problems that can arise because of alarm fatigue, and these issues come about mostly from nurses missing out on alarms that should have been answered -- and answered more quickly (Korniewicz, Clarke, & David, 2008). The more issues that are seen surrounding alarm fatigue, the more it becomes clear that something should be done about the issue before it becomes even more detrimental to the health of the patients and the working ability of the nurses.
The goal is not to simply find and list the problems, but to point out the ways in which the problems can be corrected. Among the potential suggested solutions for alarm fatigue has been to change the sounds the alarms make (Siebig, et al., 2010). If they are softer and "friendlier," for example, people might not tune them out so much. That could lead to nurses recognizing the alarms more easily, especially with other noise and commotion going on, and could also help them be more relaxed in the healthcare setting. Tuning out jarring, uncomfortable alarms is something nurses do with frequency, often because the alarms are jarring and uncomfortable (Lacherez, Seah, & Sanderson, 2007). A different kind of noise may be much more successful when it comes to making sure the nurses can hear them properly and will respond to them on a consistent basis. The different noise could also help nurses identify the alarm sounds more easily, making it more likely that they would respond to them (Lawless, 1994). However, making changes to the alarm noises themselves is not the only way to help combat alarm fatigue.
Another way to reduce the fatigue that comes with too many alarms, and often false alarms, is through a more centralized system (Lacherez, Seah, & Sanderson, 2007). That would allow the alarms to go off in one central location, instead of at the bedside of each patient. Then a clinician could evaluate the alarm and determine whether the nurse or other staff member assigned to that patient should check on the patient or not. This has the opportunity to quiet the hospital environment considerably, and also help nurses and other personnel stop tuning out alarms (Mondor & Finley, 2003). If the nurse or other person is needed, the only alarm or other indication of that will come from the central system. That makes it easier to remember and work with, and also makes it far less likely that the nurse will tune out the alarm or other type of page (Mondor & Finley, 2003). The downside, of course, is that one person must decide whether to intervene or not for a number of patients, putting a lot of pressure on that person (Schmid, et al., 2011). Alarms would likely need to be adjusted to be more specific and less sensitive if this were to be an effective way to handle patient issues (Siebig, et al., 2010).
There are a number of different things that can be done in order to make alarm fatigue less likely to occur. While that does not guarantee that the fatigue will be eliminated, it certainly moves in the right direction…[continue]
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