Fatigued with Alarm Fatigue?

For most who people work in a hospital, going to work usually means listening to a daily soundtrack of beeps, dings, and buzzes. Far from being background noise, this discordant symphony is composed of coded messages, each one important for what they tell caregivers about their patients. If you haven't heard the term "alarm fatigue" already, then you are out of the loop on a problem that most hospitals cite as a major patient safety concern.

When doctors, nurses and caregiver staff are exposed to hundreds or thousands of alarms on a daily basis, the alarms are no longer performing their function of alerting staff during an actual emergency. With so many false alarms, hospitals and patients find themselves in the proverbial "boy who cried wolf" situation. However, before doing a complete overhaul of all the alarm systems or every piece of equipment in the hospital, there are several factors to consider:

  • Are there simple procedural fixes that can cut down on false alarms?
  • Is all the equipment calibrated correctly for the patient's needs?
  • Do any of the false alarms stem from a lack of connectivity?

What is alarm fatigue and why is it important?

The Joint Commission (JCOH) released its National Patient Safety Goal for addressing alarm fatigue back in 2013.  JCOH found that doctors, nurses and clinicians experience alarm fatigue from overexposure to the constant noise of alarms, to the point where they are so overwhelmed by the sounds that they fail to react to them properly (e.g. ignoring, turning down, or turning off alarms). This creates disasterous results for both hospitals and patients alike, and renders the alarms useless for the purpose they serve.

Based on a sample from the intensive care unit at Johns Hopkins Hospital in Baltimore, on average, hospital staff are exposed to 350 alarms per bed, per day. Most alarm related problems are also vastly underreported, thus making the findings of what we do know merely the tip of the iceberg in battling the problem. For this reason, JCOH has made addressing alarm fatigue a top priority, with Phase I implementation in 2014, and Phase II implmentation beginning in January 2016.

Since 2014, your hospital should have accomplished the following:

  • Established alarm system safety as a critical hospital priority
  • Identified the most important alarms to manage based on input from staff, risk to patients if the alarm is unattended or malfunctioning, potential for harm, and whether or not it is a critical need or a contributor to unncessary noise
  • Determined clinically appropriate settings for alarm signals
  • Authorized policies for when alarm signals can be disabled or parameters changed, who has the authority to set or change those parameters, and who is authorized to turn those parameters off.
  • Establish who is monitoring and responding to alarms, as well as setting procedures for checking signals for accuracy, proper operation, and detectability

At this point, you have already educated, or are in the process of educating your staff about the correct procedures associated with your alarms. With the decrease in background noise, hospital staff is better equipped to respond to alarms when they occur.

Great! Now what?

A SIMPLE WAY TO IMPROVE PATIENT SATISFACTION...

With a quieter hospital and less alarm fatigue, theoretically patient satisfaction should improve because hospital staff should be more responsive. However, what if they click on their nurse call systems and still no nurses or staff arrive?

Conduct a simple audit of the beds in your hospital. Physically walk into each room and check to see how many beds are connected to the nurse call systems. Chances are, not all of them are connected. In fact, there's a likelihood that the vast majority of the beds that should be connected to a nurse call system are not connected, because someone simply forgot. While hospital staff frequently have many other priorities and tasks on their minds, responsiveness to a patient through the nurse call system is a relatively small fix that can reap massive rewards.

That might lead into another problem. More often than not, the cables that connect nurse call systems are 37 pin cables that are rendered useless from a single damaged pin. Or, in the midst of taking a hospital bed from one room to another, nurses might damage the cable or the wall in their hurry, and forget to unplug all the cords. This can lead to false alarms and service calls because of damaged cables and plugs, or no alarms at all. Lack of nurse call connectivity, broken equipment, and no alarms all result in the same outcome: lower patient satisfaction.

Thankfully, this is where the Blackjack cable comes in. With a simple snap, the built in magnets make sure that the bed is connected to the nurse call system. When beds need to be moved, there is no need to worry about broken headwalls or damaged pins. Staff can focus on the tasks that they do best--taking care of the patients.

Sources:

http://www.jointcommission.org/assets/1/18/jcp0713_announce_new_nspg.pdf

http://www.fiercehealthcare.com/story/patient-safety-goal-aims-end-clinical-alarm-fatigue/2013-12-16

http://www.npr.org/sections/health-shots/2014/01/24/265702152/silencing-many-hospital-alarms-leads-to-better-health-care

http://www.fiercehealthcare.com/story/hospitals-rank-alarm-fatigue-top-patient-safety-concern/2014-01-22