By Laura Landro

When patients’ monitors beep falsely, nurses and doctors can get ‘alarm fatigue’ and miss real warnings

In hospitals, alarms on patient-monitoring devices create a cacophony of noise day and night—beeping, pinging and ringing so often that doctors and nurses ignore them, turn them off or just stop hearing them.

Now, hospitals are adopting solutions to silence or eliminate unnecessary alarms, while ensuring that staffers don’t miss alerts that could signal a life-threatening crisis. Smarter technology and more-precise monitoring practices are helping prevent false alarms, alert nurses to true emergencies, and identify deteriorating patients before an alarm signals a crisis.

As many as 90% of alarms are false or don’t require any immediate action, studies show. But when staffers become desensitized—a syndrome known as “alarm fatigue”—they often overlook the signals that are critical, leading to deadly mistakes.

There were 138 reported deaths from 2010 through June 2015 related to alarm system failures, such as a nurse turning off an alarm on one patient while caring for another, according to the Joint Commission, a nonprofit that accredits hospitals, which often helps determine a hospital’s eligibility for Medicare and private health plans.

“This is a preventable issue that is killing people, and every year we see the numbers go up because of something related to alarm management,” says Ronald M. Wyatt, the Joint Commission’s medical director for health-care improvement. Dr. Wyatt says patients and families can play an important role by familiarizing themselves with the monitors in use and asking which alarms are of highest concern versus those that aren’t important.

Following some highly publicized deaths linked to alarm issues, the Joint Commission set alarm safety as a national patient safety goal in June 2013 and gave hospitals until January 2014 to establish alarm safety as a priority and identify the most important alarms to manage. It has set January 2016 as the deadline for hospitals to have safety policies and procedures in place, along with programs to educate staff about issues such as when alarm signals can be disabled, when settings on monitors can be changed and who has the authority to set alarm parameters to “off.”

Hospitals are scrambling to meet some of the new requirements and to get staffers to comply. “Culture is probably the hardest part of alarm management because staffers are used to doing things their own way,” says Rikin Shah, a senior consultant at the ECRI Institute, a nonprofit patient-safety research group that works with hospitals on improving alarm management.

ECRI provides guidelines for hospitals on solutions that include customizing monitors for different patients. For example, Mr. Shah says, a marathon runner with a typically low heart rate might set off constant alarms unless the settings on a heart-rate monitor were adjusted. ECRI also suggests hospitals do frequent audits and random spot checks of their alarm systems. In one hospital he visited, alarm speakers at a central nursing station were unplugged because staffers were fed up with noise.

Barbara J. Drew, a professor of medicine with a Ph.D in nursing at the University of California San Francisco, says hospitals and device makers err on the side of recording every potentially relevant type of data. Monitors are so sensitive that they can sound an alarm when a patient moves in bed, for example. A study of more than 2 million alarms in five UCSF adult intensive care units over a one-month period, published in 2014 in the journal Plos One, included 12,671 alarms for heart arrhythmias serious enough to require nurses to drop everything and run to the bedside. But 88.8% of those were false alarms, and only 17 patients had a true cardiac arrest, Dr. Drew says.

False alarms also often occur with the finger-clip monitors used to measure oxygen saturation, which is the amount of oxygen in the blood. While a falling rate can signal serious breathing issues, alarms often go off if a patient makes a sudden move. UCSF also tested a program to add a 20-second delay to the monitor, so an alarm would go off only if the change in oxygen saturation persists for 20 seconds. After a month, there was a significant reduction in the number of alarms compared with a similar unit with no delay, and no adverse outcomes after the delay was implemented. UCSF has now made the change in the five intensive-care units, Dr. Drew says.

In a 2014 study, researchers at Boston Medical Center reduced the number of audible alarms in a cardiac unit by 89%, with no adverse events, by converting warning alarms for nonserious changes in heart rate to visual messages sent to nurses and allowing nurses to tailor alarms to individual patients.

Serious alarms were raised to “crisis” level and sounded in real time, requiring an immediate staff response. Deborah Whalen, co-author and clinical service manager of cardiology, says the approach has been rolled out to the rest of the hospital, where fewer heart-related alarms have reduced overall alarms by 60%.

Pediatric hospitals are taking steps to improve alarm management. For a study published last June, researchers at Children’s Hospital of Philadelphia mounted cameras in a pediatric unit to better understand the causes and effects of alarm fatigue. The study found 99% of the alarms had no impact on the patient’s care, and thetime it took nurses to respond rose in tandem with an increasing number of alarms in the previous two hours.

Study co-author Christopher P. Bonafide, assistant professor of pediatrics at Children’s and the University of Pennsylvania’s medical school, says invalid alarms can be triggered by babies’ frequent movements or by their heart rates, which go up when they cry. One technology the hospital uses is a secondary notification system that filters out lower priority and redundant alarms requiring no immediate action and automatically passes more serious alarms to a nurse’s mobile device. The system is also capable of escalating alarms to another clinician if the nurses don’t respond.

Children’s Hospital also is using technology on oxygen-measurement devices so alarms sound immediately for a major drop in oxygen, while delaying for less-significant drops. It holds “safety huddles,” where staffers review patients who have had the most alarms in the previous four hours, to make sure a problem isn’t being overlooked and to review settings on their monitors so they can reduce unnecessary alarms “and still be in a safe position,” Dr. Bonafide says.

The University of Pittsburgh Medical Center’s children’s hospital is using a software program known as the Rothman Index, which gathers data continuously from electronic medical records and produces a score, typically from 1 to 100. Lower scores indicate that closer monitoring or immediate help is needed. It creates visual graphs on a central nursing station screen, and triggers mobile phone alerts to doctors and nurses when a patient’s condition warrants attention. Unlike alarms, which can be heard only by those nearby, the Rothman program can be used to alert others out of earshot, including emergency response teams that quickly muster in a crisis, according to pediatric critical-care physician Christopher Horvat.

Karen Kern, a pediatric oncology nurse at Children’s Hospital of UPMC, says nurses try to deter doctors from automatically ordering monitoring devices with alarms for patients who don’t need specific types of monitoring. As a result, she says, “we don’t have a ton of alarm fatigue.”