A Concept Analysis: Alarm Fatigue In Health Care

Alarm fatigue is a growing national problem within the health care industry that links medical technology as a serious hazard that poses a significant threat to patient safety within hospitals across the country. Alarm fatigue occurs when nurses encounter an overwhelming amount of alarms thus becoming desensitized to the firing alarms. Alarm desensitization is a multifaceted issue that is related to the number of alarming medical devices, a high false alarm rate, and the lack of alarm standardization in hospitals today (Cvach, 2012). Desensitization can lead to delayed response times, alarms silenced or turned off, or alarms adjusted to unsafe limits, which can create a dangerous situation for the patient. Alarm fatigue

There are various examples of incidences where sleep deprivation has made 911 dispatchers issue wrong services and consequentially cause injuries or death to people needing the services. In one of the recent cases which happened in 2012, a 911 dispatcher in Maryland failed to order an ambulance despite the efforts of a woman who called to report her husband’s troubled breathing (Clarke). While the

In Cvach’s (2012) article, an integrated review synthesized research and non-research findings of seventy-two articles, published between 1/1/2000 and 10/1/2011. The author used the John Hopkins Nursing Evidence Based-Practice model to measure and evaluate the articles for this review. The data collected were categorized into 5 main themes: excessive alarms and the effects on nurses, nurse's response to alarms, alarm sounds and audibility, technology to reduce false alarms, and alarm notification system (Cvach, 2012). The purpose of this integrated review was to find out if the volume of noise (false alarms vs true alarms) disrupts the nurse’s response and perception to physiologic clinical alarms. The 3 main recommendations provided by the researcher were to implement the use of smart technology, generate change within the hospital's environment and protocols, and use of precautionary measures by healthcare staff in order to reduce monitor alarm fatigue.

The definition of Alarm Fatigue is a situation where people become desensitized to alarms in response to excessive exposure (merriam- webster dictionary). Alarm fatigue also causes attention spans to be lowered which affects Nurses readiness for an emergency on their shift. Alarms can be overwhelming and all alarm alerts are designed differently. In an environment of constant urgency Nurses have even been described as ignoring the alarms or being negligent. There are also many different alarm terms, from false alarms and high sensitivity alarms to nuisance alarms. With so many alarm-related terms it is relevant to ensure proper understanding of these the terms to reduce risky

A fatigued nurse can lead to many errors and compromise the care given to a patient. Nurse fatigue has been found to increase depression. If a nurse has an altered mindset to begin with, they will not be able to take care of anyone else adequately. Nurse fatigue can also increase irritability. A nurse with increased irritability could lead the nurse to make irrational decisions. The nurse with sleep deprivation has an increased risk for error. A nurse is responsible for administering drugs. When a nurse is extremely tired, it could lead them to mess up the medications prescribed for the patient or to overlook reactions that the patient may experience from the medications. The nurse is also responsible for focusing on the care provided to the patient. A fatigued nurse could be too tired to notice crucial changes in the patient. The fatigued nurse will be affected in his or her performance. Nurse fatigue could also result in the nurses injuring themselves. Nurse fatigue could influence a nurse to make shortcuts and that can also endanger the nurse. For example, if a nurse has to lift a patient using a hoyer lift, but misjudges the situation because of lack of energy, the nurse could end up lifting the patient by herself and hurting her back. This is how nurse fatigue relates to the safety of the practicing nurse and patient

When nurses experience fatigue due to excessive overtime, effects that can occur are reduced decision making ability, reduced communication skills, increased forgetfulness, increased tendency of risk taking, reduced ability to handle stress on the job, decreased ability to do complex planning, and inability to recall details which can all danger patients wellbeing. Unfortunately even with all the

Horkan, A. M. (2014). Exploring the Evidence Alarm Fatigue and Patient Safety. Nephrology Nursing Journal, 41(1), 83-85.

The continued shortage of registered nurses will be a catalyst for the increasing stress placed upon practicing nurses now and in the future. Mandatory overtime has been an incessant problem within the nursing profession. When lives are at risk, alertness is a critical part of a nurse’s job performance. Fatigue impairs one’s judgement directly affecting patient and nursing safety or outcomes. This author’s typical six week work schedule consists of eighteen-twelve hour shifts, nine “required” twelve hour call shifts, and three-four hour back-up shifts. A nurse that accepts a patient assignment in the operating room cannot legally or ethically leave when their shift has ended without proper relief. Inevitably, without proper staffing departure is not an

Within the recent years, hospitals and medical facilities have been experiencing nursing shortages that necessitate more nurses to be present to compensate for the care needed to be given. This requires nurses to be dealt with imperative extended work hours along with their normal shifts with no denial or excuse accepted. Working extra hours are accompanied with negative effects that have an impact on the nurse, coworkers, and patients. A major concern that occurs with overtime is that nurses become fatigued or burnout. Fatigue that is experienced is a result of sleep deprivation from working overtime that is associated with arduousness neurobehavioral functioning

According to Pennsylvania Patient Safety Reporting System (PA-PSRS), nurses stated fatigue as a contributing factor to errors related to procedures, treatments, tests, and medication administrations (Gardner, Dubeck, 2016). Many "near" errors, or “close-calls” were also attributed to mental fatigue and lack of recovery time between shifts (Maust Martin, 2015). It is reported that errors and "near" errors are related to factors, such as, lapses in attention, reduced motivation, compromised problem solving, and diminished reaction time. The Joint Commission believes that fatigue is a factor that greatly contributes to the increased number of sentinel events among patients (Gardner, Dubeck, 2016).

After exposure to repetitive and continuous alarms, nurses may become desensitized or overwhelmed with the number of alarms to respond to; this phenomenon is known as alarm fatigue (Graham & Cvach, 2010). Alarm fatigue can lead to dangerous practices such as turning off alarms, silencing alarms without evaluating or troubleshooting this issue, changing the alarm parameter to unreasonably broad settings, or complete disregard of the alarm (Ulrich, 2013). A significant contributing factor is the number of duplicate or false positive alarms nurses experience each shift, with studies showing that anywhere from 72-99 percent of alarms in the clinical setting are false or non-emergent (Graham & Cvach, 2010). Although alarm fatigue is commonly associated with critical care areas, it may occur in any patient care area with frequent or repetitive alarms (Gross, Dahl & Nielsen, 2011). In addition to causing a permanent harm or death, clinical alarms also contribute to noise levels in patient care areas, which in turn can cause insomnia or delirium.

Deaths from alarm signals can occur for countless reasons: staff not responding to alarms, resulting from alarm fatigue, improperly placed sensors, default settings instead of patient-specific settings, depleted batteries, and many other mechanical issues that occur (Cvach, 2013). Alarm fatigue is an individual experiencing a bombardment of frequent, recurrent alarm pollution,

Stressful work environments, long work hours and inadequate sleep all contribute to an increase in physical and mental exhaustion amongst nurses. Typically, people choose nursing as a career to help others and to make a difference in their lives, without realizing the number of duties this career demands. Nurses may suffer in silence when they are experiencing stress. The effects can impact safe and reliable care by decreasing job satisfaction, decreasing productivity, causing poor personal health, and compromising patient care. Many facilities would benefit from implementing evidence-based strategies to address nurse fatigue and burnout.

The risks of making an error were significantly increased when work shifts were longer than twelve hours, when nurses worked overtime, or when they worked more than forty hours per week. (Trossman, 2009). Working longer hours in a high stress area will always increase the error rate. Designating an adequate number of RN positions to ensure nurses work an appropriate schedule without overtime and that their workload allows for breaks. Managerial staff must work to develop specific policies about the length of work times based on the setting, patient and provider needs. Those policies should limit nurses from working more than 12.5 consecutive hours. Provide education for all care providers on the hazards and causes of fatigue. Continue to document unsafe staffing conditions and work with others to change the current work culture so that it recognizes the effects of fatigue on patient safety, as well as the nurse. (Berger, et al. 2006)

The fatigue associated with working the night shift was brought into the spotlight after an aircraft incident that occurred on June 10, 1990. British Airways flight 5390 had just departed from Birmingham International Airport when the aircraft experienced a rapid pressure loss due to the pilot’s windshield blowing out of the aircraft. This resulted in the pilot being sucked halfway out of the aircraft and another flight crew member grabbing the pilots belt and holding him from being sucked completely out while the copilot to take control of the aircraft and land it safely at a nearby airport. The official findings of the accident investigation linked the windshield blowout to the wrong size bolts being installed. The bolts were installed early in the morning hours and the fatigued shift maintenance manager who installed them didn’t recognize that they were the wrong bolts. He thought that the countersinking on the window was unusually large (Baron, 2009). This is just one example of mistakes made on night shift due to fatigue. Fatigue is a dangerous human factor that is present in the aircraft maintenance community.