Hospitals are supposed to be environments for healing, and intensive care patients need to get as much rest as they can to heal. Along with their other duties that help patients heal, the clinical staff are supposed to monitor clinical alarms for changes in patient condition. Clinical alarms are meant to alert clinicians when one of the parameters being monitored has moved outside the range that was set as normal for the patient. However, when staff members are continuously exposed to these alarms, they become desensitized and may disable or silence alarms without checking the patient. Alarm fatigue has been defined by the ECRI Institute as a condition of sensory overload for staff members who are exposed to an excessive number of alarms.1 Several incidents have been reported involving patients who have died in hospitals because the staff have not responded to the alarms that were meant to alert them to a problem.2
The Joint Commission has established the 2014 National Patient Safety Goal (NPSG) on clinical alarm safety3 to help hospitals begin to address this issue. The NPSG requires hospital leaders to make alarm safety a priority. It also requires clinicians to take the following items into account when selecting the most important alarms to monitor:
* Obtain input from the clinical and medical staff
* Identify alarms that would cause harm to the patient if they were not attended to or if they malfunctioned
* Identify alarm signals that are unnecessary or that contribute to alarm fatigue
* Review previous events that involved alarms
* Review published best practices3
In addition to the items required in the 2014 NPSG, the NPSG requires policies and procedures to be in place to manage alarms by 2016.
Resources
Several other sources of information are available to help hospitals deal with the problem of alarm fatigue. These sources include the American Association of Critical-Care Nurses (AACN) Practice Alert on alarm monitoring that can be found at http://www.aacn.org,4 and webinars available through the Association for the Advancement of Medical Instrumentation (AAMI)5 that are sponsored by multiple organizations, including AACN and Philips.
The AACN Practice Alert on clinical alarm monitoring was rolled out during AACN's National Teaching Institute in Boston, Massachusetts, in May 2013. The intent of this practice alert was to enhance the healing environment in hospitals by giving clinicians and hospital administrators some guidance on how to address the issue of alarm fatigue. This practice alert is full of evidence-based protocols to help clinicians decrease the number of false or "nonactionable" alarms that tend to increase the stress of staff and patients. This alert also has communication points to use in the hospital with the interdisciplinary team and guidance on bedside problems that need to be addressed, such as proper preparation of the skin before placing the electrocardiogram lead. All of these resources are practical tools for clinicians and administrators to help create healthy work environments.
The AAMI webinar series includes sessions that were conducted in the fall of 2013. A total of 7 webinars can be found on http://www.aami.org. These webinars include topics such as the Joint Commission's NPSGs and how to manage alarms at the bedside.4
As a result of numerous false alarms and multiple alarms that are the result of inappropriately set parameters, clinicians in hospitals are struggling to decrease the stress brought on by alarm fatigue. Although this problem is difficult for the staff to deal with, efforts from the appropriate multidisciplinary team, including physicians, nurses, and biomedical and ancillary staff, can help hospitals address the issue and make patients safer. The result of a good process with a multidisciplinary approach is usually a work environment that is healthy and allows much-needed rest for the patients who are most vulnerable to complications.
Conclusion
Making alarm safety a priority in the organization will be safer for the patients and families. Hospitals must continue to decrease nuisance alarms and evaluate their own systems and processes to ensure that they have not set up systems that result in sensory overload for the staff and for the patients and their families. Many resources are available to help deal with this situation, and the appropriate team members must be involved in the work to resolve issues of alarm management. Without this team approach, the problems cannot be resolved appropriately. It is not just a matter of lead placement anymore, but of setting up systems and policies to manage the problems together in an organization. Once that is done, the intensive care unit can be a place of healing for the patients and will support a healthy work environment for the staff.
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