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Alarm Fatigue May Be Putting Hospital Patients in Danger

Can hospitals alarms really be harmful? According to a recent study by the Boston Globe, the answer is yes.

The article and the study behind it claim that patient alarms are so frequent in hospitals that nurses and other health professionals begin to tune them out. This phenomenon is referred to as “alarm fatigue.”

As detailed in the story, over the course of a shift, nurses respond to more than a dozen types of alarms that can sound hundreds of times a day, and many of those calls turn out to be false alarms. Over time, nurses can become desensitized and fail to react quickly, or at all, during a real emergency.

As explained by Liz Kowalczyk, the reporter who co-wrote the story, “We wanted to see if we could find out how many patients are actually harmed by alarm fatigue. So we analyzed reports that hospitals made to the U.S. Food and Drug Administration over the last five years, as well as to two states that track these types of incidents, Massachusetts and Pennsylvania. We also talked to dozens of nurses, doctors who oversee patient safety in hospitals, monitor makers, FDA officials, and also families.”

The Danger of Alarm Fatigue

The results were alarming—the newspaper says more than 200 deaths nationwide over the past five years have been associated with problems with patient monitor alarms, many of which involved suspected cases of alarm fatigue.

The most widely publicized case occurred in January 2010 at Massachusetts General Hospital. An elderly man suffering a fatal heart attack was left untreated because the crisis alarm on his cardiac monitor was turned off and numerous lower-level alarms warning of a low heart rate were unanswered.

In the resulting investigation, the ten nurses on duty stated that they did not recall hearing the alarms at the central nurses’ station or seeing scrolling messages on three hallway signs.

What Can Patients and Their Families Do to Prevent Alarm Fatigue?

Unfortunately, there is little that can be done to prevent alarm fatigue; the problem is in the hands of hospitals, nurses, medical device companies, and regulatory authorities.

However, there are steps that you can take if you or a loved one is admitted to the hospital.

  • Never turn off an alarm. If an alarm is sounding, wait for a nurse to evaluate the situation. If no one comes in a short amount of time, go seek help.
  • Pay attention for signs that something might be wrong such as changes in color, pain, or breathing.
  • Ask questions: Don’t be afraid to ask nurses what the different alarms mean, particularly which ones are most important.

Updated July 2016

As San Diego medical malpractice lawyers, we are pleased that the Joint Commission, a non-profit organization tasked with accrediting and certifying more than 19,000 health care organizations and programs in the United States, has made alarm management one of its key safety goals for 2016. Starting this year, hospitals must also establish new clinical alarm guidelines aimed to make certain that alarms on medical equipment are heard and responded to on time.

As noted by the Joint Commission, “Alarms are intended to alert caregivers of potential patient problems, but if they are not properly managed, they can compromise patient safety. There is general agreement that this is an important safety issue.”

Under the new guidelines, health care facilities must establish alarm management as a priority, create a formal policy, and provide training for staff. Hospitals are also required to identify the most important alarm signals by assessing the risk to patients if staff members don’t respond to an alarm right away, or if the alarm malfunctions.