Reducing Alarm Fatigue in Hospital

PROFESSIONAL CAPSTONE 9

Alarm Fatigue and How to Reduce It

Abstract

Alarm fatigue is a fundamental problem facing healthcare professionals today. It is defined as sensory overload that occurs when healthcare professionals are exposed to the constant noise of medical device alarms, leading to desensitization that results in delayed response or missed alarms altogether (Chromik et al., 2022). The hypothesis statement for the proposed research project is that alarm management training would be beneficial in reducing alarm fatigue as well as the number of false and nuisance alarms at the selected project site. This text presents information to support the above hypothesis statement and outlines the benefits of the proposed project on patients, the facility, business operations, medical professionals, and the society. Evidence from randomized clinical trials, quasi-experimental studies, and integrated reviews shows that staff education would effectively reduce alarm fatigue among nurses, although the greatest effect would be felt when the education program is complemented with other interventions. The proposed project will be beneficial to patients by improving overall patient experience and reducing the risk of alarm-related adverse events. To the facility, the project’s benefits will be felt through an improved reputation resulting from improvement patient care. The project will also significantly improve the organization’s profits, as well as the psychological well-being, cognitive performance, and overall working conditions of medical professionals. The benefit to the society will be felt when the project findings are used to inform practice change in other healthcare organizations.

Alarm Fatigue and How to Reduce It: Research Project First Submission

The proposed project seeks to reduce alarm fatigue among nurses at the clinical site. Alarm fatigue is sensory overload that occurs when healthcare professionals are exposed to the constant noise of medical device alarms, leading to desensitization that results in delayed response or missed alarms altogether (Chromik et al., 2022). The project hypothesizes that alarm management training or education for healthcare staff would be beneficial in reducing alarm fatigue and the number of false and nuisance alarms. This research project first submission provides evidence to support the above hypothesis statement and outlines ways in which the project findings will be beneficial to patients, the facility, business operations, medical professionals, and the society.

Evidence to Support the Hypothesis Statement

Studies have shown that alarm management training helps reduce alarm fatigue and the risk of missed alarms among healthcare workers. In one randomized controlled-trial carried out in a Chinese hospital involving 93 ICU nurses, the researchers found a significant association between alarm management training and alarm fatigue. The 93 nurses were randomized into the experimental group (47 nurses) and the control group (46 nurses). Nurses in the control group received usual training, while the intervention group received specialized alarm management training in addition to the usual training. Statistics on the number of nonactionable alarms as well as alarm fatigue scores taken before and after the intervention showed significantly fewer nonactionable alarms and lower alarm fatigue scores among those in the intervention group relative to those in the control group.

These findings were replicated by another study, an integrative review, by Nyarko et al. (2022), bringing together 13 studies for review. Results of the reviewed studies showed that educational interventions significantly improved nurses’ perceptions and attitudes towards alarms, reduced non-actionable and false alarms, and improved alarm management practices. Lewis et al. (2019) also reports similar findings, although the intervention encompasses a range of strategies based on the CEASE bundle developed by the American Association of Critical Care Nurses (AACN). CEASE is an innovative, nurse-driven, evidence-based, patient-centered monitoring bundle that enhances patient monitoring through a combination of interventions, including alarm management education, customization of alarm parameters, appropriate monitoring parameters, regular change of ECG electrodes, and suspension of alarms that could produce false alarms during patient care (Lewis et al., 2019). The results of the study showed that implementing the CEASE bundle decreased the occurrence of nuisance alarms by 24 percent and the number of daily alarms by 31 percent (Lewis et al., 2019).

Generally, the literature seems to support the hypothesis that alarm management education is an effective way of reducing the number of nuisance alarms as well as alarm fatigue among nurses.

Benefits of the Project to Patients

The project findings will contribute to improved patient safety at the clinical site. Generally, alarm fatigue triggers delayed responses or inaction to alarms, which could be harmful to patients, causing death in extreme cases. Lewandowska et al. (2020) reports that between 2009 and 2012, the US reported 98 adverse events resulting from delayed action or inaction to an alarm, and 80 of these events resulted in a patient’s death. According to the US Food and Drug Administration (FDA), approximately 100 alarm-related patient deaths are reported in the US every year (Ruskin & Hueske-Kraus, 2015).

Alarm fatigue and excessive alarms pose three main threats to patients. The first is desensitization to alarms, which results in either delayed or inadequate responses such as disabling all alarms or silencing the alarm without proper investigation (Ruskin & Hueske-Kraus, 2015). This poses a threat to patient safety as it increases nurses’ response time, often leading to death in the event of an emergency. For instance, Lewandowska et al. (2020) explain how due to alarm fatigue, nurses silenced a low-heart-rate alarm without investigation, leading to the death of the patient. Poorly managed alarms also threaten patient safety by causing frequent disruptions in care processes, which increases by 25 percent the risk of clinicians making mistakes upon resumption (Ruskin & Hueske-Kraus, 2015). Finally, poor alarm management often results in unnecessary or frequent alarms that increase levels of noise pollution, triggering delirium in patients and interfering with speedy recovery (Ruskin & Hueske-Kraus, 2015).

The project aims to implement a staff education program that will improve nurses’ alarm management skills, resulting in a decline in the number of unnecessary alarms and alarm inaction among nurses, thus reducing the risks posed to patients and creating a more conducive environment for speedy recovery.

Benefits to the Healthcare Facility

The first and most obvious benefit of the project to the healthcare facility is an improved reputation resulting from fewer alarm-related adverse events. Adverse events related to alarm fatigue or any other causes taint a facility’s reputation, resulting in declining patient numbers and lower revenues. Through the proposed staff education program on alarm management, it is expected that the facility will report a decline in the number of unnecessary and non-actionable alarms that increase the risk of desensitization. Consequently, there will be a decrease in the incidence of alarm-related adverse events and deaths and an improvement in the quality of patient care, resulting in an improved reputation.

The facility will also report improved effectiveness in healthcare delivery, while creating a conducive patient environment with fewer unnecessary alarms and lesser noise pollution. For instance, through the project, the facility’s nurses will be trained on the causes of nuisance and false alarms such as poor workflow, inappropriate monitor settings, failure to adjust alarm thresholds to patients’ baseline values at admission, dry electrocardiogram electrodes, and so on (Ruskin & Hueske-Kraus, 2015). This will increase the nurses’ ability to prevent nuisance and false alarms, thus reducing noise pollution and making the hospital environment more conducive for all.

Benefits on Business Operations

While they are not profit-making entities, healthcare organizations have to manage their costs and maximize their revenues to remain operational (Bai & Zare, 2020). The proposed project will help the organization realize both of these. First, the project helps increase operating efficiency by reducing the costs associated with alarm-related adverse events. Alarm-related adverse events impose an additional cost burden on the facility in terms of legal fees when patients and their families pursue legal means to prove negligence or when investigating agencies find that alarm fatigue contributed to the event’s occurrence. Besides the legal fees, the facility may also have to incur an additional burden of financial settlement, both of which push up hospital costs, thus eating into the profit levels. Further, poor alarm management among staff may drive operational costs up by forcing the facility to continually invest in new technologies and systems in a bid to reduce nuisance and false alarms, yet unintended actions by staff may be the primary contributor to these false alarms.

At the same time, alarm fatigue reduces operational revenues – a high incidence of alarm-related adverse events reduces patients’ trust, which reduces patient numbers, thus leading to declining hospital revenues. The proposed project seeks to subject nurses to an alarm management training where they will acquire skills on how to identify and address causes of nuisance and false alarms. Ultimately, this will help reduce alarm fatigue among nurses, thus reducing the occurrence of alarm-related adverse events and the associated costs. The quality of patient care will improve as a result, leading to a positive reputation, and an increase in the number of patients, which will result in revenue growth. The overall effect of the project on the facility’s business operations will be an increase in operating revenues and a reduction in costs resulting from higher levels of efficiency, which will translate to higher profits that could be ploughed back to grow business operations.

Benefits to Medical Professionals

Alarm fatigue has a significant negative effect on medical professionals. Nuisance and false alarms affect the working conditions of medical personnel, increasing the risk of mistakes that often lead to adverse events. Medical professionals, who spend most of their time monitoring patients in their care, often have to deal with hundreds of sound signals generated by injection pumps, respirators, monitors, and many other devices (Lewandowska et al., 2020). It is estimated that, on average, a nurse on duty at a mid-size facility will respond to between 150 and 400 alarms per patient (Lewandowska et al., 2020). Unfortunately, a good number of these alarms, between 85 and 90 percent are false or do not require any clinical action (Lewandowska et al., 2020). These false and nuisance alarms cause huge disruptions in patient care and often drive medical professionals to lose trust in the alarm monitoring systems. The proposed project eases the work of medical professionals by educating them on the causes of false and nuisance alarms, and ways of reducing the risk of such. This will reduce the number of alarms to which medical professionals have to respond, thus making them more effective in their response.