Alarm Fatigue, Silencing Many Hospital Alarms Leads To Better Health Care

Nurses Safety

Published

Did you hear the piece on NPR's Morning Edition this morning? You can hear it at the link below.

http://www.npr.org/blogs/health/2014/01/24/265702152/silencing-many-hospital-alarms-leads-to-better-health-care

Basically it talks about what a lot of us already know. More is not better with device alarms in healthcare. Alarms go off too often in hospitals, and after a while we tend to tune them out. This can lead to deleterious consequences for the patients.

Apparently the Joint Commission has made a top goal to decrease alarms that are not needed. This will lead to better patient outcomes (and happier nurses too!)

Specializes in NICU, PICU, PACU.

I agree about the NICU. Our PO alarms are set 86-94 and go off constantly. And with the upgrade that was just installed on our monitors all the alarms sound the same, except for asystole. Sometimes after all those kids have been alarming all day you do get slack and am like oh crap, that is the HR alarm. Bad setup.

To further a related issue, how about disabling the key tones on IV pumps? How many times have us night folks successfully checked on a pt only to wake them when adding volume to their IV?

And a little common sense when setting the alarms in the first place? My 135-lb teen was awakened every hour, 24 hours a day, because in the pediatric hospital it was their protocol never to allow more than one hour's worth of fluid in the volutrol set, and the impetus to refill it was the alarm going off loud enough to hear at the nurses' station. While the fluid caution is completely understandable with babies and small children (though definitely not the sleep deprivation), and even larger kids with precarious medical conditions, for a hefty medically-normal adolescent ortho trauma patient it's completely stupid.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I remember when that happened... one of my good friends works at said hospital and while they were investigating what was going on, they were paying nurses overtime to do 4 hr shifts to sit at the desk and stare at the monitors to make sure nothing urgent was overlooked. I just read that the case settled out of court for $850k.

ETA part of the problem, I think, is that with the advent of all this technology we monitor too many patients who don't really need it. When I worked in the hospital, it was part of the admission orderset that Residents automatically clicked to do continuous CR monitoring and continuous O2 sat monitoring so officially the whole floor was ordered to be monitored. And this was pediatrics so the majority of the alarms were because the kids pulled the monitor leads off.

That's it? I know The Joint Commission was ALL over them!
Specializes in Pedi.

And a little common sense when setting the alarms in the first place? My 135-lb teen was awakened every hour, 24 hours a day, because in the pediatric hospital it was their protocol never to allow more than one hour's worth of fluid in the volutrol set, and the impetus to refill it was the alarm going off loud enough to hear at the nurses' station. While the fluid caution is completely understandable with babies and small children (though definitely not the sleep deprivation), and even larger kids with precarious medical conditions, for a hefty medically-normal adolescent ortho trauma patient it's completely stupid.

That was our rule in the pediatric hospital too. Supposedly to force nurses to check the site hourly for signs of infiltration. I think it's stupid because it's like "we don't trust you to actually assess the site hourly so we make this rule so you HAVE to respond to the alarm every hour." Yeah, I was one of the nurses that didn't follow that stupid rule when I worked in the hospital. I did check my IVs every hour though, don't need a stupid beep to tell me to do that.

And a little common sense when setting the alarms in the first place? My 135-lb teen was awakened every hour, 24 hours a day, because in the pediatric hospital it was their protocol never to allow more than one hour's worth of fluid in the volutrol set, and the impetus to refill it was the alarm going off loud enough to hear at the nurses' station. While the fluid caution is completely understandable with babies and small children (though definitely not the sleep deprivation), and even larger kids with precarious medical conditions, for a hefty medically-normal adolescent ortho trauma patient it's completely stupid.

Our policy is to visualize every hour and set the alarm for a max of 2 hours of fluid at a time. It can be a pain to dig that arm out of the bedsheets every hour, but I have also seen an arm blow up in an hour with a new infiltration. It happens fast! And in the peds world, there is high liability even with the big patients. I have had several parents figure out where the silence button on the pump is.

I agree about the NICU. Our PO alarms are set 86-94 and go off constantly. And with the upgrade that was just installed on our monitors all the alarms sound the same, except for asystole. Sometimes after all those kids have been alarming all day you do get slack and am like oh crap, that is the HR alarm. Bad setup.

We have some cardiac repair patients whose normal sats are 75% to 85%. So we have to set the alarms accordingly. Which is fine if they are on O2, we know to turn it down if they are above 85% to prevent shunting. But if they are not on O2 and get too high, then what? Ask them to hold their breath for a minute?

Specializes in Nurse Scientist-Research.
Which is fine if they are on O2 we know to turn it down if they are above 85% to prevent shunting. But if they are not on O2 and get too high, then what? Ask them to hold their breath for a minute?[/quote']

First off, admitting I'm no pedi cardiac nurse but in the NICU (as previously mentioned) we have the high PO alarm. But we have standing roses that if the kid is on 25% or less (and certainly on RA), we can turn off the high alarm. You should address this with your unit as this is precisely the kind of nuisance alarm that needs to be minimized. At least for your kids on 21% or RA you guys should be able to turn off the high alarms unless the MDs have some intervention in mind.

Specializes in Neuro ICU and Med Surg.

In adult ICU's we have the basic EKG monitoring, the ICP monitor, respiratory monitor, vent, SCD's, tube feed, etc . Then they added a mat to our beds to remind us to turn our pt q2h. The phones that ring constantly, the doorbell to let visitors in, the desk phone that rang so crazy loud with a call from the visitors lounge it startles you when you are at the desk. The tube system, the doors that slam when they close to all supply rooms.

And a little common sense when setting the alarms in the first place? ...While the fluid caution is completely understandable with babies and small children (though definitely not the sleep deprivation), and even larger kids with precarious medical conditions, for a hefty medically-normal adolescent ortho trauma patient it's completely stupid.

Unfortunately nurses are getting blamed for not using common sense when it's the hospital policies that lack sense.

Peds hospital policy is hourly checks. Doesn't matter if the patients is 1 day or 25 years. Hourly checks. I don't do them, I get in trouble. Don't want hourly checks? Unfortunately you'll have to go to the adult hospital.

As for setting alarms on monitors, our policy requires an MD order for any change to the limits. So to change the limits, I have to call the MD, convince them that it needs to be changed (which if you're dealing with MDs that are writing orders for monitors on patients that don't need monitors, good luck convincing them to write an order to change the limits), and write the order and THEN finally go adjust the monitor. Ain't nobody got time for that. It's just plain easier to ignore the monitor. And human nature is to do the easy thing.

As long as hospitals write policies to protect themselves from stupid nurses, we're going to be stuck with stupid policies. And stupid policies NEVER allow for common sense.

But if they are not on O2 and get too high, then what? Ask them to hold their breath for a minute?

That's what pillows are for. :yes:

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