Alarm fatigue

Originally posted 8-4-2010:
It is always interesting to find parallels between a significant current event and the healthcare world.  We have all seen the sad devastation from the oil spill in the Gulf of Mexico.  What makes it difficult for me to comprehend was it could have been prevented.  Apparently an alarm that could have warned of the explosion was turned off.  According to this interesting article I ran across recently, turning off alarms occurs quite often as people get desensitized to them.  The article went on to say that instead of instilling a sense of urgency, obnoxious false alarms would cause a "cry wolf" response.

This "alarm fatigue" happens often in healthcare.  The article highlights a study with healthcare professionals in which three-quarters admitted to becoming desensitized to important alarms.  How can it not happen?  An American Medical News brief today highlighted a 2005 study where over 16,000 alarms sounded in an 18 day period.  With that many alarms it can be pretty easy to start tuning the noise out.

I used to do a lot of work around the Operating Room and Intensive Care Unit environments.  These are environments with all sorts of medical devices that will start beeping and squawking.  When I used to interview anesthesiologists, one of the first things they would ask is "Can you reduce the amount of alarms?"  Because of medical device standards, the number of alarms would usually increase instead of decreasing. During ventilator usability studies, I would consistently observe the participant pressing the alarm silence button immediately after the first alarm sounded.  In fact, when I was a participant trying to run an infusion pump I had the same reaction...I just wanted to shut the thing up. It sometimes made me wonder why bother with the alarms if they were going to be blindly silenced right away.  I have even seen this in an actual clinical setting.  During her stay in an ICU, I saw nurses ignoring a high lung pressure ventilator alarm whenever my grandmother coughed.  She was coughing so often, they assumed it was a false alarm.

So what if one of those false alarms was signaling a critical problem that needed immediate attention?  That is what alarm fatigue does.  Alarms get turned off or ignored, which can lead to potentially dangerous and sometimes fatal situations.

It is a difficult problem to solve. You can't just get rid of the alarms.  The American Medical News article did show that a Johns Hopkins iniative reduced the amount of critical alarms by 43%.  Looking at setting appropriate default alarm levels and alarm management training seemed to have a positive effect.  I would also think making appropriate alarm level settings on a patient by patient basis would reduce the amount of false alarms as well.  An appropriate level of training on new medical devices should also combat any confusion or improper alarm settings.  Finally, device manufacturers should continue to study and understand user tasks and workflows to help evaluate which alarms are necessary.