Patient Safety Alarms

Many health care settings utilize medical devices that are equipped with safety alarms. These alarms are intended to alert the staff of changes in a patient’s condition. Unfortunately, these medical devices are causing adverse effects to patients and staff. The Joint Commission is an organization that evaluates and sets standards for health care facilities to ensure patient safety. The Joint Commission continues to recognize the need to improve alarm management as one of the 2016 National Patient Safety Goals (Joint Commission, 2016). Although medical devices aid in protecting patients, they have become a safety hazard due to misuse. Nurses can help reform alarm use by reducing inappropriate alerting of medical devices, managing alarm fatigue,

Frequent false alarms account for "80% to 99%" of all equipment alerts. In addition, false alarms cause interruptions to a nurse's workflow leading to mistakes and patient harm (George & Martin, 2014). A cause for false alarms is that monitoring equipment parameters are too sensitive. One solution would be to customize the alerting systems on medical devices according to the population served. Next, medical devices used for monitoring the status of a patient need to be used selectively. Many times monitoring of patients is done unnecessarily. Turmell, Coke, Catinella, Hosford, & Majesk (2016) note continuous cardiac monitoring is “applied inappropriately to a large number of patients, and once applied, patients often continue to be monitored for their entire hospital stay without clinical indication.” Prolonged use of monitoring and frequent false alarms can cause nurses to “devalue monitoring” (Turmell et al.,

Alarm fatigue is defined as “the mental state resulting from too many alerts, thus consuming time and mental energy, which can cause important alerts to be ignored” (Varpio, Kuziemsky, MacDonald, & King, 2012). Therefore, noise overload is the main source of alarm fatigue. Varpio et al. concludes that nurses are “overwhelmed to the point that patient safety is compromised.” In fact, Varpio et al. discusses a study in regard to medical equipment alarms conducted over a five-month period for a pediatric unit. The research revealed “446 patient alarms were generated by the monitors for an average of one alarm every 6.59 minutes” (Varpio et al.). Kowalczyk provides a tragic example of alarm fatigue involving an eighty-seven-year-old man admitted to a hospital and placed on cardiac monitoring (2011). The monitor began alerting at the nurses’ station due to weakening batteries; the batteries died and showed as a flat line on the monitor screen for two hour and ten minutes. No one noticed it and the man died alone. Ten nurses were on duty that day and no one could remember hearing the alarm. Alarm fatigue needs to be identified and managed to prevent harm to