Alarm fatigue

Last updated

Alarm fatigue or alert fatigue describes how busy workers (in the case of health care, clinicians) become desensitized to safety alerts, and as a result ignore or fail to respond appropriately to such warnings. [1] Alarm fatigue occurs in many fields, including construction [2] and mining [3] (where vehicle back-up alarms sound so frequently that they often become senseless background noise), healthcare [4] (where electronic monitors tracking clinical information such as vital signs and blood glucose sound alarms so frequently, and often for such minor reasons, that they lose the urgency and attention-grabbing power which they are intended to have), and the nuclear power field. Like crying wolf, such false alarms rob the critical alarms of the importance they deserve. Alarm management and policy are critical to prevent alarm fatigue.

Contents

Healthcare

The constant sounds of alarms and noises from blood pressure machines, ventilators and heart monitors causes a "tuning out" of the sounds due to the brain adjusting to stimulation. This issue is present in hospitals, in home care providers, nursing homes and other medical facilities alike. The US Food and Drug Administration cataloged 566 deaths from ignored alarms in the period 2005 to 2008. [5] The United States-based Joint Commission's sentinel event reports 80 alarm-related deaths and 13 alarm-related serious injuries over the course of a few years. On April 18, 2013, the Joint Commission issued a sentinel event alert that highlighted the widespread problem of alarm fatigue in hospitals. Their recommendations included establishing guidelines to tailor alarm settings, training all members of the clinical team on safe use of alarms, and sharing information about alarm-related incidents. [4] This alert resulted in designation in 2014 of clinical alarm system safety as a National Patient Safety Goal and it remains a goal in 2017. [6] This Goal will force hospitals to establish alarm safety as a priority, identify the most important alarms, and establish policies to manage alarms by January 2016. [7] [8] ECRI Institute has listed alarms on its "Top Ten Hazards List" [9] since 2007; in 2014, alarms were listed as the number one hazard.

Unintended outcomes of alarms

The large number of alarms, especially of false alarms, has led to several unintended outcomes. Some consequences are disruption in patient care, [10] desensitization to alarms, [11] anxiety in hospital staff and patients, [11] sleep deprivation and depressed immune systems, [11] misuse of monitor equipment including "work-arounds" such as turning down alarm volumes or adjusting device settings, [12] [13] and missed critical events. [14] Some additional outcomes include workload increase, [11] interference with communication, [14] wasted time, patient dissatisfaction, [14] and unnecessary investigations, referrals, or treatments. [14]

Solutions

There are many solutions proposed to reduce alarm fatigue in healthcare settings: [15]

Child abduction

The amber alert system used in countries such as the United States and Canada to notify the public of a child abduction has been theorized as being susceptible to alarm fatigue. [18] [19] A 2018 abduction in Thunder Bay resulted in an amber alert being sent to cell phones as far away as Ottawa, some 15 hours' drive from Thunder Bay, followed one hour later by a second alert which notified individuals that the first alert had been resolved. [20] A similar double alert occurred on a single night in February 2019, leading to concerns over alert fatigue. [21]

Public transport

In the New York City Subway, the Metropolitan Transportation Authority installed sirens in 2006 to discourage subway users from using emergency exits to evade fares; the sirens had little effect other than irritating passengers and were removed in 2015. [22]

Alarm fatigue has sometimes contributed to public transport disasters such as the 2009 train collision in Washington, DC, caused by a faulty track circuit which failed to detect the presence of a stopped train. Though the automatic train control system generated alerts notifying train dispatchers to the presence of such faulty circuits, the rate of such alerts was about 8,000 per week. An investigation by the US National Transportation Safety Board concluded that "the extremely high incidence of track-circuit alarms would have thoroughly desensitized [the dispatchers]". [23]

Weather

Some people[ who? ] think the large number of deaths from Hurricane Ida in New York and New Jersey may have been the result of too many warnings. Since 2012, weather alerts have been sent out to cell phones, but in 2020, federal officials set up a three-tier system so people would get this warning for the most serious situations. [24]

See also

Related Research Articles

<span class="mw-page-title-main">Intensive care medicine</span> Medical care subspecialty, treating critically ill

Intensive care medicine, also called critical care medicine, is a medical specialty that deals with seriously or critically ill patients who have, are at risk of, or are recovering from conditions that may be life-threatening. It includes providing life support, invasive monitoring techniques, resuscitation, and end-of-life care. Doctors in this specialty are often called intensive care physicians, critical care physicians, or intensivists.

<span class="mw-page-title-main">Pulse oximetry</span> Measurement of blood oxygen saturation

Pulse oximetry is a noninvasive method for monitoring a person's blood oxygen saturation. Peripheral oxygen saturation (SpO2) readings are typically within 2% accuracy of the more accurate reading of arterial oxygen saturation (SaO2) from arterial blood gas analysis. But the two are correlated well enough that the safe, convenient, noninvasive, inexpensive pulse oximetry method is valuable for measuring oxygen saturation in clinical use.

<span class="mw-page-title-main">Electronic health record</span> Digital collection of patient and population electronically stored health information

An electronic health record (EHR) is the systematized collection of patient and population electronically stored health information in a digital format. These records can be shared across different health care settings. Records are shared through network-connected, enterprise-wide information systems or other information networks and exchanges. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal statistics like age and weight, and billing information.

<span class="mw-page-title-main">Telehealth</span> Health care by telecommunication

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, conditions due to outbreaks, epidemics or pandemics, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap as well as provide distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

A clinical decision support system (CDSS) is a health information technology that provides clinicians, staff, patients, and other individuals with knowledge and person-specific information to help health and health care. CDSS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients, clinical guidelines, condition-specific order sets, focused patient data reports and summaries, documentation templates, diagnostic support, and contextually relevant reference information, among other tools. CDSSs constitute a major topic in artificial intelligence in medicine.

Health technology is defined by the World Health Organization as the "application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of lives". This includes pharmaceuticals, devices, procedures, and organizational systems used in the healthcare industry, as well as computer-supported information systems. In the United States, these technologies involve standardized physical objects, as well as traditional and designed social means and methods to treat or care for patients.

<span class="mw-page-title-main">Hill-Rom</span> American medical technology provider

Hill-Rom Holdings, Inc., doing business as Hillrom, is an American medical technology provider that is a subsidiary of Baxter International.

Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The frequency and magnitude of avoidable adverse events, often known as patient safety incidents, experienced by patients was not well known until the 1990s, when multiple countries reported significant numbers of patients harmed and killed by medical errors. Recognizing that healthcare errors impact 1 in every 10 patients around the world, the World Health Organization (WHO) calls patient safety an endemic concern. Indeed, patient safety has emerged as a distinct healthcare discipline supported by an immature yet developing scientific framework. There is a significant transdisciplinary body of theoretical and research literature that informs the science of patient safety with mobile health apps being a growing area of research.

A Patient Safety Organization (PSO) is a group, institution, or association that improves medical care by reducing medical errors. Common functions of patient safety organizations are data collection, analysis, reporting, education, funding, and advocacy. A PSO differs from a Federally designed Patient Safety Organization (PSO), which provides health care providers in the U.S. privilege and confidentiality protections for efforts to improve patient safety and the quality of patient care delivery

Home automation for the elderly and disabled focuses on making it possible for older adults and people with disabilities to remain at home, safe and comfortable. Home automation is becoming a viable option for older adults and people with disabilities who would prefer to stay in the comfort of their homes rather than move to a healthcare facility. This field uses much of the same technology and equipment as home automation for security, entertainment, and energy conservation but tailors it towards old people and people with disabilities.

<span class="mw-page-title-main">First Databank</span>

First Databank (FDB) is a major provider of drug and medical device databases that help inform healthcare professionals to make decisions. FDB partners with information system developers to deliver useful medication- and medical device-related information to clinicians, business associates, and patients. FDB is part of Hearst and the Hearst Health network.

Medical equipment management is a term for the professionals who manage operations, analyze and improve utilization and safety, and support servicing healthcare technology. These healthcare technology managers are, much like other healthcare professionals referred to by various specialty or organizational hierarchy names.

<span class="mw-page-title-main">Masimo</span> American health technology company

Masimo Corporation is a health technology and consumer electronics company based in Irvine, California. The company primarily manufactures patient monitoring devices and technologies, including non-invasive sensors using optical technology, patient management, and telehealth platforms. In 2022, the company expanded into home audio by acquiring Sound United, and began to manufacture health-oriented wearable devices.

<span class="mw-page-title-main">ECRI Institute</span>

ECRI is an independent nonprofit organization tasked with "improving the safety, quality, and cost-effectiveness of care across all healthcare settings worldwide."

<span class="mw-page-title-main">Nurse call button</span> Button that allows patients in health care settings to alert a nurse

A nurse call button is a button or cord found in hospitals and nursing homes, at places where patients are at their most vulnerable, such as beside their bed and in the bathroom. It allows patients in health care settings to alert a nurse or other health care staff member remotely of their need for help. When the button is pressed, a signal alerts staff at the nurse's station, and usually, a nurse or nurse assistant responds to such a call. Some systems also allow the patient to speak directly to the staffer; others simply beep or buzz at the station, requiring a staffer to actually visit the patient's room to determine the patient's needs.

<span class="mw-page-title-main">Monitoring (medicine)</span> Observation of a disease, condition or one or several medical parameters over time

In medicine, monitoring is the observation of a disease, condition or one or several medical parameters over time.

<span class="mw-page-title-main">Remote patient monitoring</span> Technology to monitor patients outside of conventional clinical settings

Remote patient monitoring (RPM) is a technology to enable monitoring of patients outside of conventional clinical settings, such as in the home or in a remote area, which may increase access to care and decrease healthcare delivery costs. RPM involves the constant remote care of patients by their physicians, often to track physical symptoms, chronic conditions, or post-hospitalization rehab.

Clinical point of care (POC) is the point in time when clinicians deliver healthcare products and services to patients at the time of care.

Medical device connectivity is the establishment and maintenance of a connection through which data is transferred between a medical device, such as a patient monitor, and an information system. The term is used interchangeably with biomedical device connectivity or biomedical device integration. By eliminating the need for manual data entry, potential benefits include faster and more frequent data updates, diminished human error, and improved workflow efficiency.

A rapid response system (RRS) is a system implemented in many hospitals designed to identify and respond to patients with early signs of clinical deterioration on non-intensive care units with the goal of preventing respiratory or cardiac arrest. A rapid response system consists of two clinical components, an afferent component, an efferent component, and two organizational components – process improvement and administrative.

References

  1. "Alert Fatigue". September 7, 2019.
  2. Blackmon, R.B.; A. K. Gramopadhye (1 June 1995). "Improving Construction Safety by Providing Positive Feedback on Backup Alarms". Journal of Construction Engineering and Management. 121 (2): 166–171. doi:10.1061/(asce)0733-9364(1995)121:2(166). ISSN   1943-7862.
  3. Bliss, JP; Gilson, RD; Deaton, JE (November 1995). "Human probability matching behaviour in response to alarms of varying reliability". Ergonomics. 38 (11): 2300–12. doi:10.1080/00140139508925269. PMID   7498189.
  4. 1 2 3 "The Joint Commission Sentinel Event Alert" (PDF). Medical device alarm safety in hospitals. The Patient Safety Advisory Group. Retrieved 21 October 2013.
  5. Medical devices that are music to our ears could save lives
  6. PDF
  7. The Joint Commission. "The Joint Commission Announces 2014 National Patient Safety Goal" (PDF). Retrieved 21 October 2013.
  8. Monegain, Bernie. "'Alarm Fatigue' Endangers Patients." Healthcare IT News. HIMSS Media, 9 April 2013. Web. 24 January 2014
  9. "ECRI Institute Releases Top 10 Health Technology Hazards Report for 2014". Archived from the original on 2016-03-05. Retrieved 2015-09-10.
  10. Healthcare Technology Foundation. "2011 National Clinical Alarms Survey" (PDF). Retrieved 21 October 2013.
  11. 1 2 3 4 5 Borowski, M; Görges, M; Fried, R; Such, O; Wrede, C; Imhoff, M (April 2011). "Medical device alarms". Biomedizinische Technik/Biomedical Engineering. 56 (2): 73–83. doi:10.1515/bmt.2011.005. PMID   21366502. S2CID   17511189.
  12. Meade, Karen; Catania, Kimberly; Lopez, Ben; Connell, Ryan (2019-04-01). "Air-in-Line Alarms: Decreasing Alarms Through Antisiphon Valve Implementation". Clinical Journal of Oncology Nursing. 23 (2): 209–211. doi:10.1188/19.CJON.209-211. PMID   30880809. S2CID   81977608.
  13. Joint Commission. (2013). Medical device alarm safety in hospitals. Sentinel Event Alert, 50, 1–3.
  14. 1 2 3 4 5 Graham, KC; Cvach, M (January 2010). "Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms". American Journal of Critical Care. 19 (1): 28–34, quiz 35. doi:10.4037/ajcc2010651. PMID   20045845.
  15. Copeland, CS (5 February 2019). "National Patient Safety Goals: Reducing the Harm Associated with Clinical Alarm Systems". Vitalacy.
  16. Cantillon DJ, Loy M, Burkle A, Pengel S, Brosovich D, Hamilton A, Khot UN, Lindsay BD (2016). "Association Between Off-site Central Monitoring Using Standardized Cardiac Telemetry and Clinical Outcomes Among Non-Critically Ill Patients". JAMA. 316 (5): 519–24. doi:10.1001/jama.2016.10258. PMID   27483066.
  17. Blum, JM; Tremper, KK (February 2010). "Alarms in the intensive care unit: too much of a good thing is dangerous: is it time to add some intelligence to alarms?". Critical Care Medicine. 38 (2): 702–3. doi:10.1097/ccm.0b013e3181bfe97f. PMID   20083933.
  18. Snow, Robert L. (2008). Child Abduction: Prevention, Investigation, and Recovery: Prevention. Greenwood Publishing Group. ISBN   9780313347870.
  19. Wood, Daniel B. (2017-08-07). "Amber alert fatigue? Alerts on cell phones set Californians buzzing".
  20. "Mobile users warn of 'apathy' after alerts ring out for Thunder Bay abduction". CBC News . 2018-05-14.
  21. "More research needed to determine if alert fatigue is true, says prof". CBC News . 2019-02-16.
  22. Matt Flegenheimer, Exit Alarms in the Subways Are Silenced by the M.T.A., New York Times (January 1, 2015).
  23. "July 27, 2010 Railroad Accident Report – Collision of Two Washington Metropolitan Area Transit Authority Metrorail Trains Near Fort Totten Station Washington, D.C. June 22, 2009". NTSB. July 27, 2010. Retrieved April 10, 2012.
  24. Calvan, Bobby Caina (September 5, 2021). "As flood alerts lit up phones, did 'warning fatigue' set in?". WHYY . Retrieved September 5, 2021 via Associated Press.