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Drawing Up a New Game Plan to Reduce Alarm Fatigue.

CenturyLink Field, home of the Seattle Seahawks football team, is famous for being one of the noisiest venues in sports. The Guinness Book of World Records certified the stadium, which is nicknamed “The Clink,” as hosting the loudest crowd roar ever recorded— 136.6 decibels—during a Dec. 2, 2013, football game versus the New Orleans Saints.1 Probably more than a few nurses or respiratory therapists would say that the noise levels in their care units could give the The Clink a run for its money. Clinical alarm signals are intended to alert caregivers that a patient requires intervention. But 85% to 95% of alarms amount to little more than anxiety-inducing wild goose chases.2 They send direct-care clinical staff scrambling and disrupt the recovery of patients. The average number of alarms signals generated per bed can approach 200 per day.3 The Seahawks at least have a Vince Lombardi Trophy to show for all the racket. Direct-care staff are instead rewarded with alarm fatigue— a condition where they are overwhelmed or desensitized by alarm information—and increased threats to the safety and well-being of their patients. Healthcare associations and governing agencies, including the ECRI Institute and The Joint Commission (TJC), have documented the patient safety dangers inherent in alarm proliferation. Direct-care staff often respond to alarm fatigue by arbitrarily adjusting threshold settings on devices or shutting them off completely—actions that increase the chance of a sentinel event. TJC reported 80 alarm-related patient deaths and 13 serious alarm-related injuries from 2009 to 2012.4 The problem is exacerbated by an increase in the number of medical devices that can generate alarms, including bedside physiologic monitors, pulse oximetry machines, bedside telemetry, infusion pumps, and ventilators. These devices also lack standards to specify the proper configuration of alarm parameters. TJC recognized the adverse effects of these constantly blaring, mostly nonactionable alarms on patient safety and clinical workflow by making clinical alarm management a priority by approving its National Patient Safety Goal (NPSG) on Alarm Management (NPSG.06.01.01) in 2013. NPSG.06.01.01 mandates that hospitals take definitive steps to implement policies and procedures to safely reduce and prioritize clinical alarms.5 Although solutions and strategies abound for returning meaning and action to clinical alarms, hospitals must first understand their opponent.