The Truth About Alarm Fatigue in Healthcare
As someone who has worked in the medical field for many years, I can tell you that alarm fatigue is very real. In case you are unaware of its meaning, alarm fatigue is what happens when healthcare workers become overwhelmed and desensitized to medical alarms due to the high frequency of hearing them in the workplace.
Healthcare workers Patients What? Easy? Simple Parameters Monitoring Deep medicine
How Alarms Affect Healthcare Workers
This is a problem that affects everyone including physicians, nurses, nursing assistants, secretaries, etc in multiple ways by overwhelming them with noise. They may not know who to help first or who needs help in general because of all of the chaotic sounds causing them to scramble around just to address them all. This in turn often interrupts and delays other important tasks.
The alarms come from a wide variety of machines and devices to the point where you may not even know which one it is coming from. Some of them sound very similar to each other. Oftentimes the ones considered less important will be louder and will therefore drown out the important ones.
They have also been known to cause headaches and frustration. It often gets to the point where it affects your sleep even in the quietness of your own home. I myself, as well as others, have admitted to waking up in the middle of a deep sleep and nearly falling out of bed attempting to address an alarm that we were dreaming about.
The scary part for many workers is that they often get to a point where they won't even hear the alarm anymore. This sounds horrible but unfortunately it does happen. It is just human nature. When we are exposed to the same sounds for hours at a time, our brains naturally begin to tune it out. It is a coping mechanism of sorts so we do not become overwhelmed by a constant stimulus.
There have been documented cases where an alarm was not addressed and in turn caused harm or even death to a patient. This is not always because the healthcare workers were negligent. They often don't even recall hearing an alarm. They have become so accustomed to them that it goes in one ear and right out of the other without phasing them.
How Alarms Affect Patients and Visitors
Hospitals, which should be quiet environments helping patients to heal, are often bombarded by frequent and loud alarms hindering the healing process by keeping them awake and stressed. They usually don't know what is causing the alarms. Even if it is a false alarm or something minor, they are often afraid for their lives.
This it true for their visitors too. Many of them are often worried for their friends and loved ones not knowing if the alarm is for something life threatening. It can cause resentment towards healthcare workers if they see them casually addressing the alarm in an untimely fashion. Even if the alert is something almost meaningless, in the patient and families' minds, it is considered a top priority and should be addressed immediately.
It is also important to keep in mind that when patients are intubated and sedated, they often can still hear what is going on around them. They just can't express the trauma their minds are going through when they hear something that sounds important such as an alarm is going off. What makes it even worse is the fact that they can't call for help. All they can do is hope and pray it is not for something potentially fatal if not addressed.
Oftentimes care for a patient will be interrupted in one room to address a potentially critical alarm in another only to find out it was something that could have waited or didn't need any attention at all. Although prioritization is stressed in healthcare, many patients feel less important or even insulted if their treatment is suddenly put on hold to cater to someone else.
What Can Be Done About Alarm Fatigue?
Research has shown that up to 99 percent of alarms in the medical field are false alarms. This number is simply staggering. It is no wonder people are being burnt out by them. Although no false alarms at all would be ideal, that isn't very realistic but 99% is a just plain unacceptable. There needs to be a better ratio than this but doing so is much easier said than done.
The Joint Commission, which is a company that accredits thousands of healthcare facilities in the United States, officially recognized alarm fatigue as a serious issue back in 2013. Since 2014, resolving it has been considered a National Patient Safety Goal which means it is considered one of the top priorities for the company and all of its affiliated facilities. Anyone who knows anything about this organization will tell you that this is a big deal.
So what can we do about it? There really is no easy answer but rest assured that it is actively being worked on. Here's the dilemma, yes alarm fatigue is not good for anyone but alarms themselves are very important. They have saved countless lives. Without them, we wouldn't know when things aren't working as they should or when a patient needs immediate attention. So there needs to be a balance.
It would be difficult to argue that alarms save lives more often than not but that does not mean they shouldn't function more efficiently. The deaths they have prevented does not justify the deaths that they have caused. Most of the deaths are caused from them being overused to the point of "crying wolf." Basically they scream for help so often when not needed, nobody believes them when patients actually need help.
Solving It Isn't Easy
There have been lots of studies and experimentation for many years trying to solve this complex puzzle yet it is still far from being finished. It may never be fully completed but there is always room for improvement when it comes to technology especially in the medical field. However, even change that has been proven to be better takes an extra long time to test, validate, regulate, and spread to the masses. We are dealing with people's lives after all.
I say this not to lose hope in fixing the problem but to paint a clearer picture of what we can expect. These things take time, and lots of it. If it were as easy as flipping a switch, it would have been done several years ago. There are literally so many moving parts involved in solving this issue that the end goal almost seems impossible but that shouldn't stop us from trying.
Why does it seem impossible? The sheer number of various kinds of technology with alarm functionality being used in various facilities is nothing short of astonishing. I imagine the stack of instruction manuals written for all of them could fill an entire library. Even if they have similar components, slight differences can make a world of difference in how they work, or how they fail to do so.
Simple Solutions to Reduce Alarms
Solving this problem completely may be a monumental task, but there are often ways to reduce the frequency of alarms. Sometimes, the solution could be as simple as healthcare workers changing routine habits. I will only touch on these subjects briefly because they are already common practice in many facilities but it still needs to be said for those who don't implement these strategies.
Hourly rounding has been proven to significantly reduce call light alarms from patients. Just simply walking in for a few seconds hourly to make sure the patient is stable and doesn't need any assistance can work wonders. Remember the Four P's mnemonic: Pain, Position, Potty, Possessions. Utilize your resources if checking every hour isn't feasible. Teamwork is vital.
Frequently checking disposable items such as telemetry leads and pulse oximeters to make sure they are on properly is another. These are notorious for slipping off and getting out of place. Many facilities practice changing these out daily to make sure they are in full working condition. This will also keep the monitor bank from having to alert others when they aren't reading properly.
Another way is to just keep patients informed. Something as simple as reminding them to call before they get up to go the the bathroom can help reduce bed alarms. Even if they are alert and oriented, they may forget especially if it is dark or they are waking up from a nap. I often see signs in rooms hanging up in clear view from their bed stating "Call don't fall" but it still doesn't hurt to verbally remind them too.
Setting Patient Specific Parameters
Depending on the situation, a single patient can have dozens of gadgets being used to make sure they are being cared for in the best way possible. Not to mention that the human body itself is a complex machine that malfunctions unexpectedly, often to the point of being a mystery as to what exactly is causing it to not function properly.
This makes every situation unique which is often the problem itself. Machines and monitors need to be tailored to each specific patient. What may be abnormal for one person may be completely normal to another. This in turn causes one machine to think that something is wrong when in reality, it is going off when the patient is at their baseline.
The problem is, it is often difficult to program some monitors to accept what is considered normal for some individuals. Some people have large fluctuations in what is normal for them. The cases can often be so abnormal that some machines don't even have the capability to be adjusted to that patient's specific parameters.
Is it realistic to expect every machine and monitor to be adjusted and tailored to each individual in every situation? What if we don't know what is normal for them? What if they come to the emergency room (ER) unconscious with nobody around to say what is normal for them? Not to mention the fact that many individuals don't even know what their baselines are.
This also brings up other issues. Who should be allowed to adjust the parameters of these machines? How much should they be allowed to adjust them? Does there need to be a doctor's order? Even though these questions have already been addressed, it is still difficult to say what is best practice. There are also many cases where these regulations have been broken and it is often difficult to track down who made the inappropriate adjustment.
Unified Monitoring Systems
Another solution is the use of monitor technicians although they are actually one of the prime candidates for alarm fatigue. They typically only watch and relay messages to other employees regarding changes in heart monitors. While this machine is an important one, it is still only one among many. They usually have to watch multiple monitors many of which are almost constantly going off making them extra vulnerable to missing an important reading.
Upon looking into what is being tested, I found that there are a few different groups, such as Spok Messenger, attempting to unify multiple monitors and machines into one all encompassing system. This would allow them to be regulated much more easily. Not to mention the valuable data recorded for further research. It would be similar to the monitor bank only instead of monitoring and regulating heart monitors, they control and regulate every machine throughout one or possibly multiple hospitals.
This would allow the monitors to be silenced in the patient's rooms which would undoubtedly be better for their sanity. They would be disturbed less frequently while trying to sleep and less anxious from not understanding why a machine is yelling at them. It would improve their healing process and most likely improve satisfaction scores of the hospital. Quietness is often a scoring criteria after all.
However, such a process would be a massive undertaking costing countless amounts of money. Commercial medical equipment is some of the most expensive pieces of machinery. All of them would have to either be replaced completely or modified through special software. The software itself would be another huge investment and would undoubtedly require a lot of trial and error in order to improve it through multiple updates. But if such a system saves lives, it is worth it.
Deep Medicine
Another potential solution is to just make the alarms smarter through artificial intelligence (AI). This is quite an ambitious and time consuming concept but rest assured it is actively being worked on. If the machines could be programmed to better detect whether an abnormal reading is a cause for concern, it would know whether to alert healthcare workers for further investigation.
Currently, most of them are pretty dumb to put it lightly. They don't think about the underlying cause of the abnormalities. They simply go off so we can figure that out for ourselves. If machines could detect certain patterns or communicate with each other in order to find the root cause of the issue and figure out if it is simply an error, they could prevent themselves from sending out false alarms.
This concept along with many others are discussed in a brilliant book I read called "Deep Medicine." It explores the advantages and potential disadvantages of AI being further implemented into healthcare. It was written by the cardiologist, geneticist, author, and scientist Eric Topol who has written a total of four books. Judging by how much I learned from this one, I'm sure his other ones would be worth a read as well. Here it is on amazon.
Although alarm fatigue has been an issue for decades now, we should not give up on eradicating it. Every step forward is another potential life saved. What are your thoughts on this subject? Is it something you have dealt with yourself? Do you have any advice or ideas on how to combat this problem? Let me know in the comments down below.
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References:
https://nurse.org/articles/alarm-fatigue-statistics-patient-safety/
https://www.spok.com/messenger/
https://www.mghpcs.org/eed_portal/Documents/PatExp/ADDRESSING-QUIETNESS.pdf
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