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08.04 Avoiding Alarm Fatigue

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Overview

  1. What is alarm fatigue?
    1. Sensory overload
      1. Constant sounds in the clinical setting
        1. Medication pumps
        2. Bed alarms
        3. Monitors
        4. Ventilators
        5. Feeding pumps
        6. Paging system/call bells
  2. Created by
    1. A high rate of false alarms
    2. Inadequate training on monitors
    3. High set alarm parameters
    4. Inadequate staff response
    5. Alarm malfunction

Nursing Points

General

  1. Nursing implications
    1. Desensitization
    2. Missed true alarms
    3. Patient safety concerns
    4. Sentinel events

Therapeutic Management

  1. Avoiding alarm fatigue
    1. Nursing strategies
      1. Decrease false alarms
        1. Proper skin prep for ECG electrodes
        2. Change ECG leads daily
      2. Customize parameters/thresholds
        1. Clinical groups
        2. Individual patients
      3. Monitor only clinically indicated patients
      4. Clean equipment
        1. Decreases technical malfunctions
          1. Low battery alarms
    2. Facility strategies
      1. Development of
        1. Alarm management protocol
        2. Alarm management team
          1. Reduce unnecessary alarms
      2. Provide alarm education and training

Nursing Concepts

  1. Clinical judgement
  2. Health promotion
  3. Patient-centered care
  4. Safety

Reference Links

Video Transcript

Hi guys! Today I want to talk to you a little bit about alarm fatigue and how to avoid it! So maybe you are just about to start your nursing career or maybe you’re in your first year, in either situation I am positive that you have been in a clinical setting and have heard the non-stop beeping and alarming of machines. When we first start out as nurses we don’t think about it but after years of shifts a scary and potentially dangerous situation can occur known as alarm fatigue and I’m going to talk to you a little bit about that today!

So what exactly is alarm fatigue?  Basically, guys, this is sensory overload from the constant constant sounds and noises in the clinical setting.   Think about we have medication pumps, ventilators, monitors, bed alarms, feeding pumps, phone calls, paging systems, etc.  Although all of these things are necessary in our setting to care for patients sometimes it can have the opposite effect and in the next slide, I’m going to talk a little more about that!


So with the alarming, it has been found that a super high percentage of these alarms are actually false and when I say high the research states somewhere between 75 and 99%….that is crazy!  Because of this, it is only natural that we tend to believe that most alarms are not legit which only reinforces the alarm fatigue. Also, guys inadequate training on monitors, alarms that have inappropriate parameters for a patient, and equipment malfunctioning all create unnecessary and excess beeping, noise, and alarms that create the “tuning out” action of the nurse. 

Why as nurses should we care about this?  Well, all of these issues cause us to be desensitized which results in missing the real, true alarms which are important when we are taking care of a patient.  And guys, when true alarms are missed this, creates patient safety concerns and unfortunately sentinel events. This is such an issue that in 2014 the Joint Commission added alarm fatigue as a National Patient Safety Goal.

What can we do as nurses to avoid alarm fatigue?  There are a few simple things we can do to focus on decreasing false alarms.  One of these things is to properly prep our patient’s skin before applying ECG leads.  That might sound so silly and simple but think about it….how many times is your monitor beeping because you have a lead off?  To add to this, changing your patients leads daily can also decrease monitor alarms. Also, guys customizing monitor parameters and thresholds for particular clinical groups or even individual patients can help to decrease alarms…from one patient to the next they are so different so it makes sense that they could possibly have different monitoring parameters.  Another very simple but effective technique is to clean the equipment, this helps to prevent any technical malfunctions. Finally monitoring only clinically indicated patients is super important to decreasing alarm fatigue. 

Facilities are also starting to put some things in place to avoid alarm fatigue.  The development of alarm management protocols is showing to be helpful for instance with certain parameters like I mentioned in the previous slide.  Also, have set teams who are specifically in charge of alarms throughout the clinical setting is also beneficial. Finally, guys, although I’m sure you probably assume that every nurse is trained on every piece of equipment sometimes things fall through the cracks.  When facilities focus on providing alarm education and training to nurses alarm fatigue is decreased.

Ok so let’s take a look at some of the important points of this lesson.  Alarm fatigue is sensory overload from constant sounds from monitors, feeding pumps, ventilators, medication pumps, bed alarms, etc. Alarm fatigue is reinforced by the high rate of false alarms, inadequate training, high set alarm parameters and thresholds, and alarm malfunction. The nursing implications of alarm fatigue is it causes desensitization, missed true alarms which it leads to patient safety issues and even sentinel events. So how do we avoid alarm fatigue? As nurses, we want to decrease false alarms and this might mean prepping the skin appropriately before applying ECG monitors, customize parameters and thresholds, and monitoring only patients who actually need it.  As a facility alarm management protocols and be developed as well as teams and education on alarms.

So what nursing concepts can we apply to avoid alarm fatigue?  Obviously, the main purpose of a medication or bed alarm is to keep our patients safe so that is absolutely a relevant nursing concept.  We have to use our clinical judgment as nurses to manage the use of alarms so that might means re-evaluating the parameters for a particular patient or even group of patients. 

We love you guys! Go out and be your best self today! And as always, Happy Nursing!

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