Alert fatigue and sensory overload

[Emergent, RN]

I think we're all aware of the Vecuronium error by now. It was a horrific mistake by a careless nurse.

I've seen nursing evolve in my career. There used to simpler, easier to navigate systems. But it seems like, every year, the work flow becomes a more complicated obstacle course to navigate. Alarms, safety alerts, multi step processes, warnings flashing left and right. Name alert! Look alike, sound alike! Mandatory prompts piled on, not to mention the bookkeeping and charge capturing features built into EMRs, requiring the mental energy of nurses.

Of course, we all have different psychological make ups. People's brains work, and process information differently. Some are highly sensitive to sensory overload. Others have more trouble staying focused due to their lower thresholds, sometimes called ADD. I personally dislike calling normal variations in people disorders though.

I don't think the creators of many of these systems have really accounted for the above factors. Often, these are reactionary systems to previous errors. There are new ones every year, they keep getting piled on.

After awhile, people start to tune it all out. They just click, click past it all, trying to keep up. I think this a problem worth exploring.

[llg, PhD, RN]

I totally agree with you on this. Too many steps, too much complexity, etc. contributes to the very errors they are meant to prevent.

[Emergent, RN]

Of course, nursing isn't the only field dealing with this problem. I think, generally in society, this is also contributing to anxiety and depression in people. I do believe that stress levels are eroding our quality of life and contributing to a plethora of mental health problems.

[Wuzzie]

Although I would never dispute the value of the electronic safeguards we have in place there is a part of me that thinks all this technological hand-holding has made us complacent and, dare I say it, lazy.?

[JKL33]

Re: Laziness - I think some of that is true and that they have, in some cases, helped cover up the long-standing issue of mediocrity. I'm not sure that some of the goal isn't to flat out enable mediocrity.

What else am I supposed to think when hearing on numerous occasions that "we" need to take action to minimize critical thinking and to minimize the very need to think critically, itself?

At some point - if those are the actions one is taking, then that is the exact result one will get. And as soon as you go through even a couple of "generations" of this brilliant grand plan (which may occur on a very short timeframe in healthcare, like 1 year or so) - well now you are making significant progress in reducing critical thinking.

[JKL33]

And I do dispute the value of some entities' beliefs about what is an electronic safeguard, and the ways in which they are used. Perfect case in point: vecuronium messaging that it is only to be used with a STAT order.

Totally worthless noise.

The warning (in red) on my screen telling me that I'm late for vital signs on a totally stable patient = worthless noise. Multiply that x10 if I've already done and electronically reviewed those V/S using a particular (and valid, and taught-in-training) method of recording vital signs, but doing so doesn't trigger that message to go away. As it was explained to me, there's another charting area that "drives" the notification. So unless I chart it there, too, I can't make that go away.

Ditto for multiple other notifications that have their own drivers.

[Wuzzie]

4 minutes ago, JKL33 said:

Re: Laziness - I think some of that is true and that they have, in some cases, helped cover up the long-standing issue of mediocrity. I'm not sure that some of the goal isn't to flat out enable mediocrity.

Yeah, I don't anticipate any hospital printing a banner that says " A good number of our nurses are mediocre but don't worry, we have safeguards in place to protect you".

As a profession I think we have gotten a little too big for our britches. Nobody wants to admit that some of us are brilliant, most of us are average and waaaayyy too many are just plain scary stupid.

[Daisy4RN]

I agree 100% that there are just way too many alarms and/or forms to fill out. Bedside nurses are just running around like chickens with their heads chopped off for the majority (if not entire) day. Last hospital I worked at I tried to point out that the extra forms (new form for every mistake somebody in the hospital made), phone calls, alarms etc. were causing more harm than good because they were taking time away from the nurses ability to critical think. Of course we all know how far that went! As far as the meds, when I started we had all pt meds (except narcs) in the pt room in a locked drawer. We took the (paper) MAR in the room and gave meds. Sometimes we were interrupted but usually it was pretty quite, no phone calls etc. Alarms are tuned out for sure and don't even get me started on the EMR double, triple charting!