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Battling alarm fatigue for improved patient care and safety

January 8, 2020 ‐ PSQH

By: Jordan Rosenfeld

Medical alarms are meant to alert medical staff when a patient’s condition requires immediate attention. Unfortunately, there are so many false alarms — they’re false as much as 72% to 99% percent of the time — that they lead to alarm fatigue in nurses and other healthcare professionals. One study found that medical staff encountered 771 patient alarms per day.¹

Key causes of alarm fatigue, according to The Joint Commission’s National Patient Safety Goals², include:

Alarm parameter thresholds were set too tight
Alarm settings not adjusted to the individual patient’s needs
Poor ECG electrode practices resulting in frequent false alarms
Inability of staff to hear alarms or detect where an alarm is coming from
Inadequate staff training on monitors and alarms
Inadequate staff response to alarms
Alarm malfunction

Whatever the cause, alarm fatigue can lead medical staff, particularly nurses, to become desensitized to the sounds of alarms. They also may find it challenging to differentiate between urgent and less urgent alarms. As a result, nurses may miss necessary alarms, which interrupts care, contributes to job-related burnout, and compromises patient safety.¹

The FDA reported 566 alarm-related deaths in 2005-2008, and 80 deaths and 13 severe alarm-related injuries between January 2009 and June 2012.³

The problem has become so significant that in 2008 the ECRI Institute started including false alarms on its list of Top 10 Health Technology Hazards. In 2020, alarm, alert, and notification overload ranked sixth in hazard status.⁴

Addressing false alarm fatigue

To help tackle the issue, The Joint Commission’s National Patient Safety Goals in 2013 provided recommendations to help medical institutions reduce the number of false alarms^.2

The Joint Commission advocated for convening a multidisciplinary team to review trends and develop protocols to make clear whose role it is to address and respond to alarms. In addition, the Joint Commission recommended:

Training staff on protocols
Analyzing and measuring the causes of alarms
Building a culture of safety
Staying on top of product recalls

A recent study also recommended that patient conditions should be better assessed, so that alarms only sound when warranted. Nurses interviewed for the study said that most alarms lacked clinical relevance and did not contribute to their clinical assessment or planned nursing care.⁵

False alarms and electrocardiography

Reducing the risk of false clinical alarms is also a key consideration when choosing ECG cable and lead wire systems.

Most ECG lead wires are reused over 50 times, which leads to wear and tear that can degrade their quality over time. According to one industry review of ECG lead wires, the most common problems include broken lead wires or clips, broken connector pins, worn lead wires, and frayed cords.⁶

A single-patient-use cable and lead wire system with a push button design, like the Kendall DL™ cable and lead wire system, may provide a better option. The lead wire is secured to the electrode with a pressure-less push button that ensures a secure fit even with highly mobile patients.

One peer-reviewed study found that a single-patient-use cable and lead wire system with a push button design reduced false alarms by 29% for no-telemetry, leads-off, or leads-fail alarms. The study compared three brands of disposable lead wire connectors and found that the Kendall DL™ ECG lead wire system had greater retention forces than the other products.⁸

Lowering costs and reducing harm

By reducing false alarms, hospitals can potentially reduce some of the costs associated with nursing care, given the time spent by nurses responding to alarms. In one study, almost half of the time nurses were the ones to respond to alarms.³

Additionally, battling alarm fatigue would contribute to meeting the Joint Commission’s patient safety goals for 2020, which includes reducing “the harm associated with clinical alarm systems” as one of the top priorities.⁷

Key takeaways

As mentioned above, medical facilities are urged to review and assess their policies and procedures to reduce the frequency of false alarms. Specifically, research suggests that Kendall DL™, a single-patient-use lead wire system, may reduce the rates of false alarms, which ultimately may result in improved patient safety and care delivery.

About the author:

Jordan Rosenfeld writes about health and science. She’s written for The Atlantic, The New York Times, and Medical Economics.

SOURCES:

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