Abstract
This paper provides a literature review of the topic of alarm fatigue and alarm management. The sources used were all published from 2016 onward and dealt in some way with alarm fatigue or with the challenges of alarm management. The papers were selected using databases ProQuest, PubMed, Springer, NCBI, and ScienceDirect. The keywords used for searching were “alarm fatigue,” “alarm management,” and “alarm fatigue patient safety.” The results of the review showed that alarm fatigue is represented as a serious problem for nurses for multiple reasons: 1) it prevents them from paying close attention to alarms that could be serious and thus there is a risk of not responding in a time of real crisis; 2) it can lead to patient safety errors, as nurses seek to avoid the constant wave of alarms by altering their volume or sensitivity; 3) it can cause problems with morale; and 4) there is no evidence-based practice or guidance that has been recommended for dealing with alarm fatigue. In short, there is no clear way to address alarm fatigue, and researchers differ on the extent to which alarm management can be effectively utilized. This literature review concludes that there is an obvious need for alarm fatigue to be addressed. The PICO question it asks is: For nurses in an in-patient general hospital, does alarm management (differentiating the priority of alarms) compared to no alarm management have an impact on alarm fatigue?

Keywords: alarm fatigue, alarm management, managing alarm fatigue, alarm fatigue patient safety

Introduction

Alarm fatigue is an expression that consists of two terms that have two very different meanings. Alarm is a term that conveys a meaning of surprise and a state of alert and that communicates a need to respond immediately. Fatigue is a term that conveys the opposite meaning—weariness, lack of responsiveness, inability to act due to tiredness. When put together the expression “alarm fatigue” suggests a quite troubling phenomenon particularly when it occurs among nurses: nurses are trained to respond to alarms and provide needed care to patients when an alarm sounds; however, because of the fact that there are now so many different alarms constantly going off in a unit, nurses can become indifferent or unresponsive to them, which can put patients at risk. Because alarm fatigue is a relatively new problem in nursing research, it is still unclear as to how it affects nurses (Lewandowska et al., 2020). While there has been ample literature published on the issue, the extent to which it is an actual problem for nurses and, if it is, what can be done about it are questions that have let to be substantially answered (Hravnak et al., 2018). As researchers have shown, it is unclear how precisely to manage alarms so as to prevent fatigue (Cho, Kim, Lee & Cho, 2016). This study thus addresses the gap in the literature by focusing specifically on the problem of whether alarms can be managed to reduce alarm fatigue. It is an important question to ask because patient safety is the ultimate issue here: if alarm fatigue is not prevented, patient safety can suffer as a result.

Review of Literature

The literature on alarm fatigue and alarm management shows that alarm fatigue is a problem for nurses and for patient safety, and that alarm management may have potential to address the situation but so far there are questions remaining (Baker & Rodger, 2020; Cho et al., 2016; Hravnak et al., 2018; Lewandowska et al., 2020). The key to understanding this issue is to first understand alarm fatigue, what it is, and how and why it occurs. Then one can begin to examine the possible solution of alarm management to see what researchers have found about that.

Alarm fatigue is said to be caused by sensory overload: nurses are often surrounded by various alarms that go off throughout their shift. Because there are so many similar alarms sounding, nurses can become tired of them or fatigued by them so that they do not respond to alarms with the same vigor and assertiveness required for patient safety (Baker & Rodger, 2020). Baker and Rodger (2020) examine the ins and outs of alarm fatigue by conducting a qualitative literature review of the subject. They look at what other researchers have found and show that often one cause of alarm fatigue is that nurses do not even know whose job it is to respond to certain alarms. They have trouble differentiating one sound from another or recognizing whose role it is to respond (Baker & Rodger, 2020). Another issue is that if a nurse is busy, that nurse might simply assume that the next closest nurse will respond to the alarm; so there is a lack of communication, understanding and protocol in nurse workstations regarding how to react to alarms (Bakere & Rodger, 2020). That is one reason Cho et al. (2016) have found that alarm management can be prone to failure. Human error is still an issue no matter what system is in place. It is the same with trying to manage a computer system safely: firewalls may be in place, but systems can still be hacked because of errors committed on the part of end users. End users are always the riskiest factor in the equation, and in alarm management it is no different: nurses are still only human and must be trained thoroughly to understand their roles, the different alarms, when to respond and so on, and all of that takes time and comes on top of already existing training that must be implemented for new nurses (Cho et al., 2016). Additionally, new technology and monitoring devices can change everything and lead to disruptions that throw off carefully cultivated response protocols and systems in place.

Hravnak et al. (2018) in their study of alarm fatigue point out that most of bedside alarms are non-actionable, which means there is no need for immediate response. This fact is what causes nurses to ignore alarms as well, as they experience sensory overload due to a constant stream of alarms all shift long that serve no real purpose. This becomes a problem when an actual issue does arise and nurses fail to respond because they believe it to be another non-actionable issue, same as all the others (Hravnak et al., 2018). Hravnak et al. (2018) provide a qualitative literature review of what is currently going...…too sensitive machines. Nurses train themselves to ignore them just to keep their sanity. This raises the question of why these machines, which by all accounts are programmed to be sensitive, are in use in the first place.

Third, nurses feel that these computers, alarms and machines take too much of their time and that they actually keep them from tending to their patients in a better way. Instead of spending time with patients and tending to their needs, they spend half their time filling out forms on the computer and having to ignore their patients while they do so. This hurts their patients’ sense of self and it pains nurses to have to ignore patients while they follow protocols and put information into machines. Nurses would like fewer computer interactions and more patient-interaction.

What all of this means is that nurses are being overwhelmed by machines and these machines are adding unnecessary burden to their shoulders and preventing them from engaging with patients in a healthy way. Often these machines are introduced into an environment not for patient safety but rather for facility safety; they facilities believe that these machines will reduce the risk of medical malpractice.

The problem is that they are also increasing the risk of nurse demoralization and alarm fatigue. Alarm fatigue can in turn bring about the very thing that the facilities do not want to see happen. Thus, in some ways it is a Catch-22 situation. The question is what can the health care industry do about it?

One possible way to address this situation is to come up with an effective way to manage alarms. Alarm management may consist of using a system of differentiated alarm sounds that can help nurses better deal with the environment in which they are working so that there is less trouble in terms of providing quality care. More research is needed on alarm management and its effect on reducing or preventing alarm fatigue among nurses.

Conclusion

Alarm fatigue is a major problem among nurses that researchers are spending more time focusing on. They have found that it does impact patient safety, but the problem is that there is to date no clear evidence-based solution to the problem. More research should be conducted in terms of how alarm management can be implemented to prevent alarm fatigue. Alarm management approaches have differed among researchers in the past, but one option is to differentiate the priority of alarms. This may require tweaking current machine learning and enabling machines to better understand what type of alterations from the norm to ignore or to communicate to staff. Every aspect of this problem has to be studied in more detail because it may not be just a matter of training nurses to understand their machines or to differentiate alarm sounds. However, nurses do need better training in terms of understanding their roles when an alarm sounds. If a nurse is busy and another nurse is nearby when an alarm sounds, both nurses need to know what to do in that situation. Nursing protocols need to be standardized, but that cannot be done until there is evidence-based practice that has been validated in research and in the field.