Alarming Problem of Noisy Patient Monitors Triggers NHLBI-Funded Study

If you ever have visited a hospitalized patient, you probably heard a symphony of blips, chirps, and buzzes emanating from a variety of monitors. In fact, hundreds of alarms signal for every critically ill patient each day, but research shows that 85 percent to 99 percent of alarms do not require clinical intervention. For clinicians and nurses who must distinguish these simultaneous alarms— usually while performing other high-risk tasks —the symphony often becomes white noise.

Hospital administrators, prominent healthcare organizations, and researchers have begun to sit up and listen: The barrage of unnecessary alarms could threaten the safety of the 60,000 Americans who are treated in intensive care units each day.

The ECRI Institute, an independent nonprofit that researches the best approaches to improving patient care, named clinical alarms the No. 1 health technology hazard for 2014. In addition, the Joint Commission announced alarm management as a 2014 National Patient Safety Goal. This followed an April 2013 Sentinel Event Alert in which the Joint Commission reported 80 alarm-related deaths from 2009 to 2012 and blamed alarm fatigue as the “most common contributing factor.”

Alarm fatigue is when caregivers become desensitized because too many previous alarms were insignificant, putting them at risk for missing an important alarm. While alarm fatigue is not a new problem, the number of patients connected to alarm-based physiologic monitors has increased as medical technology has advanced, multiplying the sounds that these devices generate.

Recognizing that alarm management has become a high-priority patient safety issue, Christopher Bonafide, MD, MSCE, an attending physician at The Children’s Hospital of Philadelphia wants to lead the way in alarm fatigue research nationally, with the support of a five-year career development award he recently received from the National Heart, Lung, and Blood Institute.

“No one has actually quantified alarm fatigue in the hospital before,” Dr. Bonafide said. “We want to evaluate the relationship between the number of false alarms that nurses are exposed to and their response time to critical alarms. In doing this, we hope to learn more about the science behind alarm fatigue and discover new ways to combat it.”

Dr. Bonafide has created a video research lab that uses small GoPro cameras temporarily mounted in patients’ rooms, with families’ and nurses’ permission. Every time an alarm goes off, the research team can see exactly what happens next from multiple camera angles. They synchronize the video with monitor data to allow for objective review by experts to determine the validity of alarms and measure response time.

Dr. Bonafide hypothesizes that, “Experiencing lots of false alarms leads to alarm fatigue, and this can delay responses to alarms that might represent true signs of impending cardiac or respiratory arrest. Alarms also interrupt high-risk tasks, and that can lead to dangerous medical errors. We need to do everything we can to ensure that alarms help patients, not harm them.”

Dr. Bonafide plans to use the findings of his video analysis to support future research to evaluate interventions aimed at making alarm management safer.