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Alarm fatigue: When nurses do not respond to alarms

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Alarm fatigue: When nurses do not respond to alarms

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The nursing standard of care involves correctly applying, programming and responding to critical alarms on medical equipment. An article by the Boston Globe highlights one of the dangers of high-intensity nursing today – not responding to alarms. Alarms create a constant din in the background. On a 15-bed unit at Johns Hopkins Hospital in Baltimore, staff documented an average of 942 alarms per day — about 1 critical alarm every 90 seconds.

I recall when my father was in ICU nearly 33 years ago, he thought the alarms represented fire trucks, and could not understand why there were so many fires in the blocks around the hospital.

Alarm fatigue can be deadly

Alarm fatigue refers to a situation that occurs when staff become too overloaded to hear and respond to clinical alarms. Now that is a frightening thought. The kinds of alarms we are talking about warn of occluded IV lines, of obstructed airways, of empty IV bottles, of a patient trying to climb out of bed, or of life-threatening cardiac arrhythmias. Increasingly, technology has resulted in improved ways to monitor patients, and manufacturers have built in alarms to warn the staff of a problem.

But technology relies on humans to hear, interpret, and respond to alarms. Sometimes alarms are false alarms and do not signify anything. Sometimes alarms are annoying; the nurses turn them off. Sometimes the alarm is turned off because the patient is being taken off the equipment temporarily and the nurse forgets to turn it back on. Sometimes the nurse mis-programs a complicated piece of medical equipment. And sometimes the volume is turned down, or the nurse is at a point on the nursing unit where she cannot hear the alarm.

The Boston Globe provided a special report on this subject. It offers the perspectives of the healthcare providers and the manufacturers. When an investigation of a patient death associated with an alarm failure occurs, it is often not the equipment at fault, but the staff who did not respond to the alarm. Healthcare professionals and manufacturers are trying to create safety solutions, for example, by creating more technology, like signs in the hallways to warn staff of an alarm.

Investigating a claim

1. The biomedical department is typically asked to look at a piece of equipment associated with an untoward outcome. The hospital may generate a report that details their findings. This may or may not be discoverable.
2. The manufacturer may be asked to examine the equipment, and they also generate a report.
3. The hospital will have discoverable policies on setting and checking alarms.
4. The medical record may incorporate flow sheets with boxes to check off that alarms were set.
5. Cardiac monitors that detect arrhythmias may spit out the paper that is time stamped. These times should be compared with the medical record.
6. Nurse defendants and fact witnesses should be asked about the healthcare environment, the frequency of alarms, the responses, and the nursing practices associated with alarms.

Med League is a legal nurse consulting firm that assists attorneys handling cases involving medical negligence, personal injury and other litigation with medical issues at stake. Med League provides expert witnesses with expertise in evaluating nursing cases. Call us for assistance.

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