Alarm Fatigue Design Feedback

Published

Hi,

I am an undergraduate Biomedical Engineering student constructing a design alongside a group to address the issue of alarm fatigue. One of our designs involves the use of a wristband with a digital display. The display would show different colors depending on the type of warning shown and would vibrate for severe alarms. How do you think an idea like this would work and/or not work? All feedback is appreciated.

It is an interesting idea. A few things come to mind.

Big picture: I don't think that this will actually fix alarm fatigue. Rather, it will just create a new type of alarm fatigue. If you're getting false alarms to your wristband every two minutes, you'll start ignoring that, too (just like we ignore audio alarms). It reminds me of being on a huge, super-annoying group text; if your phone is vibrating in your pocket every ten seconds, you're going to start ignoring it.

I still think that this idea has merit since it can be used to make a quieter hospital setting (there are tons of studies about how noisy hospitals can be, especially in ICUs where sleep disturbance can lead to ICU delirium). However, the only way to fix alarm fatigue is to ensure that only true emergencies are setting off the alarms in the first place (i.e. minimizing false alarms), which this product does not do.

I don't know how I'd feel about wearing a vibrating wrist band when I'm doing fine psychmotor skills. For instance, if I were in the middle of starting an IV, placing a PICC, drawing labs, or doing an art stick and my arms literally started vibrating, I might get kind of annoyed. Some patients alarm all of the time, and the band could go off several times mid-skill. However, I also wouldn't want to take it off every time I do those skills since it would be a safety issue--if nobody is wearing the wrist band, then how do you know an alarm is going off?

Which brings me to my next thought: I worry that there might be safety concerns about an alarm that can only be recognized by a single person who is wearing the wristband. There are instances where we listen for one another's alarms, which you can't do with this product. Also, if the band is frequently being taken on and off (i.e. removed during skills, handed off between coworkers for breaks), I worry that this could be a huge safety issue if people forget to put it back on, since without having the wristband on your person, nobody is getting the alarms (vs. an audio alarm, where somebody will still hear it).

How would this work when the nurse steps away? If I run to the restroom, do I need to hand off my wrist band every time to ensure somebody is listening for my alarms? Usually if my patients are nearby, the nurse can just listen because they can hear my alarms (as well as their own) in the distance. When I'm at lunch, I'd usually leave my phone with my neighbor (so they can hear my alarms)--would they need to wear both wristbands?

Every time you take the band off, you risk somebody forgetting to put it back on, which could mean missing an alarm for a fatal condition. It is not uncommon for people who float around doing skills in different rooms (i.e. charge nurses, PICC nurses) to leave their phones in the wrong room; it's no big deal if there's an audio alarm since somebody will hear it, but it might be a bigger issue if it's just vibrating.

There also needs to be a fail-safe in case somebody *doesn't* respond to the alarm. With regular audio alarms, if a high alert 'red alarm' has been ringing long enough unanswered, somebody is going to go investigate. For instance, let's say I'm stuck in isolation mid-dressing change and my other patient starts alarming; if a loud 'red alarm' goes unanswered for more than 30 seconds, usually one of my neighbors will hear it and go investigate (since it's so unusual for an ICU nurse not to respond to a red alarm). However, if it's only going to my wristband, there's no way for anybody else to hear the alarm and respond. The same is true if somebody takes the wristband off and forgets to put it back on; without the audio, there's no way to let everybody else know that there's a problem.

2
Up Vote Up Vote ×
Specializes in OR, Nursing Professional Development.

We have a system utilizing smart phones. The staff caring for a patient assign themselves to the patient, and any non-emergency alarms/call bells (and the patients actually have a menu of options to choose from when using the call bell) go to their phones as a text message. Any emergency alarms and bed alarms go to all phones being utilized by all staff on the unit.

2
Up Vote Up Vote ×
Specializes in CMSRN.
On 1/25/2020 at 9:08 PM, adventure_rn said:

Big picture: I don't think that this will actually fix alarm fatigue. Rather, it will just create a new type of alarm fatigue.

However, the only way to fix alarm fatigue is to ensure that only true emergencies are setting off the alarms in the first place (i.e. minimizing false alarms).

THIS!?.

1
Up Vote Up Vote ×
Specializes in retired LTC.

Hey, it would be nice if OP stopped back with some comments re suggestions made.

OP, are you there?

Up Vote Up Vote ×
On 1/27/2020 at 11:20 AM, amoLucia said:

Hey, it would be nice if OP stopped back with some comments re suggestions made.

OP, are you there?

Still here,

This blew up more than we expected it to and we are still reading through everyone's responses. Our project is extremely early in development (really only concept generation at this point), so we are still solidifying the ideas that we have.

There will be full responses to the suggestions made very soon. Thanks for all the feedback, it has been extremely helpful seeing responses from real caregivers in the medical field.

Up Vote Up Vote ×
Specializes in retired LTC.

TY for your comeback. Nurses will respond in earnest when we feel that we could be contributing to anything that improves pt care and our own work situations.

Up Vote Up Vote ×
Specializes in Mental Health.

Have you shadowed any nurses yet as part of your research? I think it would make it much easier for you to put your idea together if you experienced a couple of twelve hour shifts for yourself, if you haven’t already.

Up Vote Up Vote ×
Specializes in retired LTC.
2 hours ago, Rionoir said:

Have you shadowed any nurses yet as part of your research? I think it would make it much easier for you to put your idea together if you experienced a couple of twelve hour shifts for yourself, if you haven’t already.

PP - Great idea. But I wonder if a facility would authorize it?

Up Vote Up Vote ×

I haven't read all the responses, but....

The cause of alarm fatigue is not how the alarms are presented. The problem is that the alarms are not set correctly and alarm when nothing alarming has happened.

I was in a high acuity UK ICU that was very quiet. I asked why there were not a gazillion alarms, and was told they turn off the ones that aren't important. Crazy concept. We can't seem to manage that here.

Up Vote Up Vote ×
Specializes in Critical care.

I’m in an ICU and I can’t see this working in that setting. However, I worked on a tele unit before that and carried a pager that was programed for my patients and another nurse’s patients. It didn’t show me the monitor, but would vibrate and alarm the room so I could check the heart monitor on one of our screens. I could see a device worn more like a watch being beneficial since it wouldn’t need taken out of a pocket every time it alarmed.

In the ICU we have too many false alarms and way to many different things we monitor. We try to adjust our alarms as best we can, but we can’t turn off the v-tach alarm or similar alarms for patients with lots of artifact (such as getting frequent chest PT). My unit is also way too big for a little band- we don’t carry anything, but have monitors and screens all over the hall and in every room. Critical or lethal alarm will pop up on every screen/monitor in the unit.

Up Vote Up Vote ×
+ Join the Discussion