Essay Sample on Alarm Fatigue in Nursing

Background Information to the ProblemHealthcare systems are continuously changing to offer patients with improved and innovative treatment options. However, as care facilities aimed at providing the best care possible including the recent technology that includes various medical devices with multiple alarms and sophisticated settings (The Joint Commitment, 2014). New technology is continuously evolving, but at the same time, there is a notable rise in the issue of alarm fatigue leading to patient safety issues in healthcare facilities. Alarm fatigue in nursing is a serious and real problem, especially in acute care. Alarm fatigue results when nurses are overwhelmed by the multiple alarm signals that can lead to alarm desensitization, which in turn can result in delayed responses or missed alarms (ECRI, 2012).

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As Burgess et al. (2009) highlights, there were over 560 alarm related-deaths in the US alone between 2005 and 2008. Research shows that in the effort to improve the sensitivity of alarms, manufacturers and healthcare facilities have sacrificed specificity. As such, alarms regularly sound making nurses to be overwhelmed and desensitized leading to missed or delayed alarm responses. One of such cases is a well-publicized case where a monitor alarm was set to a soft sound which went on for 75-minutes passing a signal that the battery was low and needed replacement. However, the staff never responded thus the battery finally went off (The Joint Commission, 2013). Later a patient suffered from cardiac arrest and died as there was no alarm working to alert the nurses about the crisis.

In addition to affecting the workflow of a nurse, alarm fatigue is experienced by nurses in various medical surgery units. Alarm fatigue leads to significant impacts of patients' safety and quality care. Ideally, the frequent false alarms create noise on patients thus decreasing their comfort and stress patients resting and recovering. The alarms are upsetting and cause discomfort among patients as they may not be sure of what they mean. Alarm fatigue has a direct relationship with patient safety and quality of care. According to an online survey conducted by Korniewicz et al. (2008) evaluating the effectiveness of clinical alarms, 70% of the respondents cited that frequent false alarms lead to disruptions in the patient care with most caregivers opting to disable the alarms as they were a nuisance.

Findings

Alarm fatigue is one of the significant emerging issues in healthcare, especially in acute care settings. Many organizations have presented their definitions of alarm fatigue with Joint Commission defining it as a constant alarm beeping that result in overwhelmed nurses who then become immune or desensitized to sounds. The findings of this paper reveal that nurses suffer from alarm fatigue and also from workflow disruptions following the alarm fatigue. Consequently, alarm fatigue is a significant nursing problem with great clinical significance.

Method

The study uses a descriptive research design. The method was chosen to allow the research to explore the current healthcare conditions about the problem of alarm fatigue without the implementation of any independent variables. The study sample selected for the study used a non-probability convenience sample on nursing workers. The Inclusion criteria used entails that all the participants need to be registered nurses working at the Miriam Hospital. The validity of the study was maintained throughout the research study through engaging hospital supervisors and experts. Both qualitative and quantitative methods are used in analyzing the data with statistical data being presented in tables.

Aim

The aim of this study is investigating the issue of alarm fatigue on nurses in an adult acute care setting. The primary focus is on the degree to which the nurses faces alarm fatigue as well as this impact it has on the nursing workflow. Below were the research question and objectives guiding this study.

• Do Nurses experience alarm fatigue?
• Does Alarm Fatigue Affect Safety or Quality Care?

Literature Review

Past studies revealed that most of the alarm signals are not clinically relevant following a high range of false alarms that lead to a "cry wolf" situation where nurses only respond to alarm when they deem them reliable. However, as Varpio et al. (2012) explain alarm fatigue has a dire consequence that reveals itself in the patient deaths following unattended alarms. Several deaths have been reported following alarm fatigue such as was the case in Massachusetts hospital in 2010, when a heart monitor alarm was inadvertently left off, following a delayed response by the nurses and clinicians thus failing to provide emergency care (The Joint Commission, 2013). Besides, three patients also died in the state of Pennyslavia. In another case, a patient undergoing an abdominal surgery passed on after 11 days of successful operation. This death was due to the turning off of alarms and never turned on during an intraoperative radiograph leading to unnoticed respiratory distress. Besides, there was a recent death of a 17-year old who suffered from respiratory decompensation following a tonsillectomy since the monitoring device had been muted thus the nurses missed her distress (Kowalczyk, 2011).

According to the Joint Commssion (2013), alarm fatigue is a constant alarm beeping and an over-abundance of information that is transmitted through various medical devices such as blood pressure monitors, and ventilators among others. Thus, nurses become immune or desensitized to sounds and are overwhelmed by information- precisely, the nurses suffer from what is known as alarm fatigue. The Joint Commission in 2013 published a Sentinel Event Alert relating to medical a device alarm safety in health facilities. In the alert was the case of the 60-year old man who passed on in 2010 at the Massachusetts hospital not because of his health issue but due to delayed alarm response (The Joint Commission, 2013). Among the factors that might lead to the death of patients are inadequate or absence of alarm systems, low alarm signals, improper alarm settings, and turning off or alarm, and alarm fatigue (Burgess et al., 2012).

Methodology and Data Presentation

The study makes use of a 9-question questionnaire that has been developed by the researcher. The surveys are made available to the selected nurses who were placed in a well-labeled envelope in each of the chosen study units after the study was approved by the hospital management. A hospital approved informational letter was attached on the first page of the questionnaire explaining the purpose of the study, the expectations from the participants, and the procedures for completing the survey. The researcher's contact information was also provided. All the participants were assured of confidentiality and anonymity of their responses. The participants were also reminded that participation was voluntary and no one was coerced to take part in the study. The participants who agreed to take part in the survey were then asked to complete the questionnaire to the best of their knowledge then drop it sealed in the break room of their unit. The participants were then asked not to include any identifying information on the questionnaire. All the returned surveys were collected and kept in a stored filing cabinet that was only accessible by the primary researcher.

Discussion and Data Analysis

Alarm fatigue is a growing trend in healthcare, especially in care settings. According to the According to the Joint Commssion (2013), alarm fatigue is a constant alarm beeping and an over-abundance of information that is transmitted through various medical devices such as blood pressure monitors, and ventilators among others. Thus, nurses become immune or desensitized to sounds and are overwhelmed by information- precisely, the nurses suffer from what is known as alarm fatigue. Consequently, the research study was carried out to investigate whether nurses at two units of the Miriam hospital suffered from alarm fatigue and if it affected their workflow, as well as the safety and quality of care accorded to patients. 40 of the 44 respondents agreed that they had experienced alarm fatigue in the past six months that preceded this survey. Besides, most of the respondents admitted that false alarms were a cause of disruptions in their work of attending to patients and that they had become permissive in responding to alarms to a point where they would opt to turn off the alarms. Additionally, most 36 of the respondents also agreed that alarm fatigue was also a cause of stress levels while at work thus lowering their ability to attend to patients.

Conclusion and Recommendation

In conclusion, the data analysis reveals that most of the participants had the necessary knowledge of alarm fatigue. The report also shows that alarm fatigue is an existing problem among nurses with significant effects on the patients' safety and quality of care. As a recommendation, the issue of alarm fatigue can be resolved through training and educating nurses on the need to urgently respond to emergency alarms, customizing and optimizing alarms, as well as addressing the system issues in case of any. Additionally, alarm fatigue can be managed through adequate nurse staffing, but this should be done concurrently with treating the alarm fatigue issue.

References

Burgess, L. P., Herdman, T. H., Berg, B. W., Feaster, W. W., & Hebsur, S. (2009). Alarm limit settings for early warning systems to identify at-risk patients. Journal of Advanced Nursing, 65(9), pp.1844-1852

ECRI Institute. (2012). Top 10 Health Technology Hazards for 2013. Health Devices, 41(11), pp.1-24

Korniewicz, D.M., Clark, T., & David, Y. (2008). A national online survey of the effectiveness of clinical alarms. American Journal of Critical Care, 17(1), pp.36-41

Kowalcyzk, L. (2011). State alarms often unheard, unheeded. The Boston Globe. pp.1-6The Joint Commission. (2013). Sentinel Event Alert Issue 50: Medical Device Alarm Safety in Hospitals. http://www.jointcommission.org/sea_issue_50/.

The Joint Commission. (2014). Hospital: 2014 National Patient Safety Goals/ Joint Commission. Retrieved from http://www.jointcommission.org/hap_2014_npsgs/

Varpio, L., Kuziemsky, C., Macdonald, C., & King, W. J. (2012). The helpful or hindering effects of in-hospital patient alarms on nurses. Computers, Informatics, Nursing, 30(4), pp.210-217.