Hot Topic in Nursing: Alarm Fatigue in ICU

If you keep your eye on nursing journals and blogs, you will see plenty of people talking about one of the hottest topics in nursing today: alarm fatigue in Intensive Care Units (ICU). In 2012, the ECRI Institute rated alarm fatigue as the number one hazard in the ICU environment.

The Problem

nursing program alarm fatigue in icuWhen you walk into an ICU room, you will see a ton of equipment sitting around a patient’s bed. Almost all of those items have at least one alarm. A few have multiple alarms. You could have a dozen or more potential alarms in a single room.

The reasons for the alarms going off can vary widely.  An alarm can go off:

  • If a problem occurs on the equipment
  • If the equipment or a portion of it becomes disconnected
  • If the equipment senses the patient is in distress
  • If the equipment gets unplugged and has a battery back-up

Those are just a few of the alarms that are there to tell the nursing staff if a problem is occurring.

The problem is that the nursing staff can become desensitized to the sounds of the alarms. In some cases, clinicians have been known to disable, silence, or just plain ignore alarms completely. Missed critical alarms can lead to patient injury and even death.

What Causes Alarm Fatigue?

Here are a couple of the reasons:

  • The number of false alarms is a major contributor to alarm fatigue. One study showed that in an emergency room setting, the percentage of false alarms from equipment hooked to cardiac patients sat at over 99 percent.
  • The sheer number of alarms can be a problem as well. A typical 8-hour shift can see nurses responding to 75 or more alarms in a typical ICU. Out of all of those alarms, only one or two is of a critical nature. Others are false or non-emergency alarms.
  • Staff members are also contending with the various alarm-type sounds emanating from their computers and cell phones.

Both of these show why nursing staff become desensitized to the alarms over time.

How Does the Staff Respond to the Alarm Situation?

The consequences of false alarms and overwhelming numbers of alarms can be significant:

  • False alarms create an environment where the staff does not trust the credibility of the system. They can become slower to respond to an alarm.
  • Alarms interfere with the normal routines of the nursing staff. Nurses are often taken away from routine care to handle alarms. To keep up patient care standards, nurses learn to ignore or delay response to alarms.
  • To keep alarm noises to a minimum, nursing staff may disable alarms completely or lower the volume considerably. This increases the rate of missed alarms significantly.

The consequences of missing alarms due to alarm fatigue are life-threatening in many cases. Between 2005 and 2008, the FDA received over 560 reports on patient deaths related to equipment alarm problems. Many of these were linked to alarm fatigue. The number of injuries reported is many times higher.

What is the Solution?

The medical community is responding:

  • The first line of defense is increasing awareness among nurses and making everyone aware of a potential problem.
  • Another immediate solution being pursued is routine monitoring of all alarm settings. When found turned off or disabled, the situation can be rectified immediately and the person who did it can be managed or counseled.
  • Medical equipment manufacturers are working to reduce the number of false alarms produced. They are looking at making the equipment smarter to catch false alarms before they happen.
  • Better education on how to use the equipment is another approach being used.  This can lower the number of false alarms.

The consequences of alarm fatigue are very real and pose a danger to patients. Anyone looking to enter the nursing profession needs to be aware of it and learn how to manage it.