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

nurseprnRN, BSN, RN · Jan 27, 2014

The hospital that did the study is in Boston. The Boston Globe reported it last week. They say they cut alarms by 85% and had no increase in adverse patient effects as measured by codes or rapid responses.

imintrouble, BSN, RN · Jan 28, 2014

I worked in a vent dependent LTC. The RTs would be furious at me when an alarm would be sounding, and I didn't run to check on it. "I didn't hear it" would be met with skepticism, but I honestly wouldn't hear them. The whole tune it out thing kicked in.

I think it was a self defense mechanism, as I'd dream about those alarms at night and wake in a panic.

anon456, BSN, RN · Jan 28, 2014

I worked in a vent dependent LTC. The RTs would be furious at me when an alarm would be sounding, and I didn't run to check on it. "I didn't hear it" would be met with skepticism, but I honestly wouldn't hear them. The whole tune it out thing kicked in.
I think it was a self defense mechanism, as I'd dream about those alarms at night and wake in a panic.

I can so relate to that! We have our peds t/v patients hooked up to continuous pulse ox and/or cardiac monitoring, as well as their home vents. The kids will often take the pulse ox off and then it has a red alarm every 5 minutes until they are down for the night. The toddlers learn to get our attention by disconnecting their circuits. And then if they cry or cough it alarms. I still run to each of the red alarms or vent alarms because sometimes they are legit. I had one kid who had stopped breathing and was blue as could be when the RN on my unit checked on the red alarm. (patient was fine but needed bagging for three minutes and I called a code blue.) But yeah, sometimes I do experience alarm fatigue.

KRVRN, BSN, RN · Jan 28, 2014

NICU pts usually have tight sat limits, with a lowr and an upper alarm set. NICU pts desat and over sat a lot. Alarm fatigue can definitely be a problem.

Esme12, ASN, BSN, RN · Jan 28, 2014

There have been many deaths reported nation wide attributed to alarm fatigue, including a prominent Boston Hospital, and it is felt it is under reported...it is a pervasive problem. I also think it can be related to staffing. As ICU's increase their ratios to 3:1 and telemetry units lay off monitor techs....they unanswered alarms will increase.

As PCU's see and increasing acuity with drips and sheaths...something needs to be done.

nightengalegoddess · Jan 28, 2014

Yes!!! Great article!!!! Please everyone....we do not need to respond to your PAIR PVCs all night long! Please, customize that monitor or fix that patient! Have courage to customize!!!!

TiffyRN, BSN, PhD · Jan 28, 2014

There certainly needs to be work done by the monitor companies to give us more accurate monitors. In addition to that nurses need to learn to customize their monitors more accurately. I work with many who don't understand this and don't take the options to minimize or silence nuisance alarms.

Biggest offender in my unit is the blood pressure alarm; in the absence of an arterial line or pressors, we generally check BPs once a shift, sometimes twice. If the infant is in anyway agitated, you will likely get a high BP alarm. It's very easy to change all your monitors to where the BP alarm only flashes a message; without audible alarm. No need to add an audible alarm to the environment unless low BP is a known issue.

Nurses do tend to start to tune those alarms out; I've seen it. With kids where the alarms constantly (falsely) alarm for apnea due to poor placement of leads or quality of monitors, the nurses will miss when the infant has a true bradycardia or desaturation because they have tuned out the alarms from so many false alarms.

Do-over, ASN, RN · Jan 28, 2014

I try to adjust my monitor alarms for each patient, but need to get in the habit of checking alarm settings every shift on the monitors and vents. I personally think making the alarms meaningful/appropriate for each patient is an important step.

I have experienced the fatigue/burnout. Its not just the vent/monitor alarms. Phones, bed alarms, call lights, etc. all add the to chaotic noise of any given unit.

Wile E Coyote, ASN, RN · Jan 28, 2014

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?

curlygirlie3 · Jan 29, 2014

Our pneumatic tube system alarms when we have more than the allotted amount of tubes at the station. The hospital just added this feature it is not only annoying but backward thinking. Another pet peeve is SCD alarms. Leg compression devices are not life and death, especially when the patient is already on an anticoagulant!

KelRN215, BSN, RN · Jan 29, 2014

There have been many deaths reported nation wide attributed to alarm fatigue, including a prominent Boston Hospital, and it is felt it is under reported...it is a pervasive problem. I also think it can be related to staffing. As ICU's increase their ratios to 3:1 and telemetry units lay off monitor techs....they unanswered alarms will increase.
As PCU's see and increasing acuity with drips and sheaths...something needs to be done.

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.