Capstone Project for Undergraduate BSN

1. Running head: ALARM FATIGUE 1
Alarm Fatigue and Its Effects on Patient Quality and Safety
Evidence-Based Practice Project Phases 1, 2, and 3
Creighton University School of Nursing
Stephanie Anne Bax
April 28th
, 2014

2. ALARM FATIGUE 2
Alarm Fatigue and Its Effects on Patient Quality and Safety
Alarm hazards made it to the top of the list as the number one health technology hazard of 2013
(Emergency Care Research Institute [ECRI],2012). In addition, The Joint Commission has issued a
Sentinel Event Alert as of April 8th
, 2013, to warn hospitals of medical alarm safety issues (The Joint
Commission [JCAHO],2013a). Improvement of clinical safety alarm systems is number six on the
National Patient Safety Goals (NSPG) for 2014 (The Joint Commission [JCAHO],2013b). With this
NSPG, a performance plan has been established for July 1st
, 2014 to January 1st
, 2016 to identify and
improve safety systems and hazards surrounding the issues of alarm fatigue and alarm safety in hospitals
(JCAHO,2013b). This trend is being recognized as a top priority for hospitals nationwide and will
continue to persist as technology continues to rapidly advance.
Nurses are tasked with the daunting ability to monitor, manage, and respond appropriately to
multiple critical patients during immediate changes of status in addition to scheduled medications,
assessments,and charting. However,with these multiple patients and tasks, it is simply impossible to
spend every moment monitoring each patient carefully. Thus, the use of medical device alarms allow
caregivers to safely leave the room and be notified when a patient’s change of status occurs. For the
safety and quality of the patient, the nurse must respond to the alarm appropriately before the patient
suffers a detrimental or sentinel event. And, in order for the nurse to do so, it is imperative that these
alarms perform properly and to their highest function.
However,with the multitude of alarms, it becomes difficult for nurses to respond in a timely
manner (JCAHO,2013b). According to JCAHO (2013a), “the number of alarm signals per patient per day
can reach severalhundred depending on the unit within the hospital”. These alarms can come from a
multitude of physiologic monitors such as infusion pumps, continuous oxygen saturation monitoring,
cardiac monitors, bed and chair alarms, and patient call systems (Cvach, Dang, Foster, & Irechukwu,
2009). Nurses experience “alarm fatigue” when they are overwhelmed with the number of alarms and
adversely become desensitized to them. Nurses may turn down, silence, or adjust alarm settings outside of

3. ALARM FATIGUE 3
patient limits so that these alarms are not as bothersome, thus potentially causing harm, sometimes fatal
effects,to the patient (JCAHO,2013a).
Healthcare Environment and Reason for Alarm Fatigue
The reason for nurse “alarm fatigue” is due to a multitude of issues surrounding the healthcare
environment. False-positive alarms, lack of alarm audibility, pitch and type of alarm are some of the
reasons for staff to miss an alarm (Cvach et al., 2009 and AACE Healthcare Technology Foundation
[AHTF],2006). These false alarms are reported as a huge factor for nurses turning down or off the alarm
because they take time away from the necessary and urgent tasks during the day. Such false alarms may
be due to a multitude of factors (e.g.,oxygen saturation dropping due to the patient talking on the phone,
a patient shifting his weight and setting off the bed alarm, or a patient bending their arm at an intravenous
site causing the pump to respond with an occlusion). Such events are not detrimental to the patient but set
off the alarm, causing the need for staff to take time away from tasks to address the sound. According to
Azetema,Schull, Borgundvaag, Slaughter, and Lee (2006), out of the 1,726 recorded alarms, the false-
positive alarm rate was stated to be 99.4% with only 0.64% of the alarms resulting in a true critical event
(as cited in Cvach et al., 2009).
This multitude of false alarms and nurse alarm fatigue contributes to the lack of alarm audibility.
Unit layout, general unit noise, several alarming machines, and multiple toned alarms also contributes to
low audibility of one particular alarm, oftentimes making it difficult to pinpoint the source. Long
hallways and closed patient doors may compromise the audibility of alarms (AHTF, 2006). Patients may
desire closed doors for family and patient privacy. However,according to Sobieraj et al. (2006), the
audibility of an alarm is heard at only half the distance away when the doors are closed as opposed to
open (as cited in Cvach et al., 2009). In addition, these different medical devices sound at different levels
and tones to alert the nurse’s response. Nurses may find it difficult to memorize each audible alarm tone
and associate it with a meaning in order to create the correct response. McNeer,Bohorquez, Ozdamar,
Varon, and Barach (2007) determined that humans can normally distinguish between five to seven

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different categorical alarms (as cited in Cvach, 2012). In order to prevent an adverse or sentinel event,
nurses must audibly hear the alarm, recognize its source and severity, and respond accordingly.
Incidence and Prevalence of Alarm Fatigue
Although alarms intend to alert the caregiver of a necessary response,they can sometimes be
detrimental. This problem continues to persist nationwide, through a multitude of hospital settings,
particularly critical care settings where patient monitoring is key for safety. According to JCAHO
(2013a), their database confirms 80 deaths, 13 with permanent loss of function, and 5 with extended stay
events related to the 98 alarm reported events during 2009 to 2012. This, however, is only what has been
recorded and reported. Many events related to alarm mishaps go underreported (JCAHO, 2013a). Other
sources,such as the Food and Drug Administration (FDA) have reported alarm deaths through their
Manufacture and User Facility Device Experience (MAUDE) database. This database revealed 237 deaths
from 2002 to 2004 and 566 deaths from 2005 to 2010 related to alarm hazards (Cvach et al., 2009;
JCAHO,2013a). Of the alarm related deaths reported between 2002 to 2004, “58 were… operator error
due to poor education and training; 67 were related to operator distraction and 14 were due to other causes
such as… device failure” (Cvach et al., 2009). Due to the statistics regarding potential for harm,
frequency, breadth, insidiousness, and high-profile, ECRI (2012) has determined alarm hazards as their
number one priority problem to be addressed for 2013 and the coming years to 2016.
In speaking with the Operations Director (OD),Cynthia Lesch-Busse,of the Immanuel Medical
Center (IMC) Post-Intensive/Telemetry (PINS/Tele) unit of Omaha,Nebraska,there is a plan in place
which will involve gathering quantitative and qualitative data for their hospital. Quantative data will
include charting, monitoring, and observing the number of alarms that occur during a certain time period
of the day with their reason for the trigger and response of the staff (personal communication, February
17, 2014). In addition, an anonymous questionnaire or survey will be asked of the nursing staff to include
their perceptions of alarm fatigue, understanding of the alarm system, and their ability to change alarm
parameters to fit the needs of the patient (personal communication, February 17, 2014). In doing this, the
IMC PINS/Tele unit hopes to gain useful qualitative information on staff understanding and perceptions

5. ALARM FATIGUE 5
as well as quantative data regarding responsiveness to alarms. This data will assist the OD, Quality and
Safety team, as well as the Educational team in preventing alarm hazards in this PINS/Tele unit.
Cost Associated with Alarm Fatigue
Cost related quality performance improvement has been a high initiative since the Patient
Protection and Affordable Care Act was signed into law on March 2010 (Studer, Robinson, & Cook,
2010). This new pay per performance method includes both core measure percentile weight plus Hospital
Consumer Assessment of Healthcare Providers and Systems (HCAHPS) percentile weight indicators to
equal a set threshold or higher in order for hospitals to receive reimbursement from Centers for Medicare
and Medicaid Services (CMS) (Studer, Robinson, & Cook, 2010). A correspondence with the OD
indicated two HCAHPS percentiles significant for improving alarm fatigue and hazards: responsiveness
of hospital staff and quietness of hospital environment (personal communication, February 17, 2014).
This meeting acknowledged the need to improve scores in order to meet and maintain the threshold
requirements. According to the OD, the IMC PINS/Tele unit was given a quietness rating of 61.7% for
the month of January 2014, with a needed threshold of 60% per CMS. In addition, the score for
responsiveness of hospital staff was ranked at 58% for IMC with a needed 66% for CMS. Improvement is
needed in both scores to receive and continue the needed reimbursement from CMS (personal
communication, February 17, 2014). In order to do so, quality improvement teams are given tasks to
research and develop quality care systems within this hospital environment, including the improvement of
alarm hazards.
Additional communication with the OD,indicated potential for costly improvement plans
regarding alarm safety. Some likely plans would involve a needed 50 minute session to educate staff on
alarm systems and settings, time set aside to put together strategies for improvement, cost regarding
possible litigation or death in the event of an adverse impact to the patient, and the need to update or
change equipment if necessary (personalcommunication, February 17, 2014). In order to keep costs at a
minimum, they must also keep in mind the CMS threshold requirements in order to receive increased
compensation from their HCAHPS scores.

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Quality Effects of Alarm Fatigue
Patient satisfaction reports address two indicators: responsiveness of hospital staff and quietness
of hospital environment which relate directly to alarm fatigue hazards and contribute to the HCAHPS
scores. Patients expect quality care when they first arrive at the hospital and relate this to responsiveness
and politeness from healthcare staff (Studer, Robinson, & Cook, 2010). When alarms go off, patients
become alert to the sounds, unsure of their reason or understanding. If nurses do not respond to these
alarms in a timely manner, patients become agitated, press their call button, and await for staff to arrive.
The increased and prolonged noise levels in the patient’s room, which nurses have grown accustomed to,
are bothersome to patients. A quiet environment promotes a healing environment, as it is often difficult
for patient’s to sleep at night (Studer, Robinson, & Cook, 2010). It is important to understand that when
nurses ignore, silence, or become desensitized with alarm fatigue, they are demonstrating to patient’s that
their care is not a priority (Studer, Robinson, & Cook, 2010). A noisy environment and a decreased
responsiveness from staff lowers the quality of care received. In making alarm fatigue a priority goal for
the coming years of 2014 to 2016, patient quality and safety measures surrounding alarm hazards will
greatly improve.
Clinical Resources on Alarm Fatigue
Alarm fatigue has drawn attention to hospitals nationwide. The IMC PINS/Tele unit wishes to
address quality and safety measures surrounding alarm fatigue and to prevent any future sentinel related
events. This unit is a 21-bed unit that utilizes cardiac monitors, pulse oximetry, blood pressure and pulse
monitors, capinography, infusion pumps, bed and chair alarms, feeding tubes, as well as call light systems
and pocket phone pagers. All of these systems create unique sounds, have unique alarm parameters,and
require a quick staff response to patient’s status change. If not addressed,potential consequences may
arise that may result in a sentinel event or even patient death (JCAHO, 2013a). A multitude of research
and clinical resources are available to staff and professionals to improve and prevent such complications.

7. ALARM FATIGUE 7
ECRI’s Number One Hazard
New advances in healthcare technology create opportunities for potential harm. ECRI (2012)
placed alarm hazards as their number one concern for healthcare technology. They have selected and
ranked topics using multiple factors in which alarm hazards fit a high potential for harm, frequency,
widespread occurrence,and a reported high-profile issue that may inspire a positive change when
understood. ECRI (2012) recognizes that all units are different, such as the PINS/Tele unit at IMC, with
some using more monitors than others. However,ECRI (2012) stated alarm hazards as an ongoing
problem that needs to be addressed and has encouraged hospitals to utilize their list of Top 10 Healthcare
Technology Hazards for 2013 to set quality and safety goals for the future.
The Joint Commission Sentinel Event Alert and NSPG
In 2013, JCAHO established NPSG #6 to “reduce the harm associated with clinical alarm
systems” (JCAHO,2013b, p. 7). This goal provides an initial plan and rationale for hospital attention and
necessary protocol. Requirements include the need to initially establish alarm fatigue as a priority in
hospital safety by July 2014, differentiate between important and nuisance alarms, and establish new
policies for alarm parameters. By January 1, 2016, this goal expects hospitals to educate staff and begin
initiation (JCAHO,2013b). In addition, the Sentinel Event Alert produced by JCAHO (2013a) recognizes
the impact of alarm fatigue, identifies common causes,and provides suggestions to prevent reoccurrence
of alarm hazards. This article comprises statistics from multiple units facing the effects of alarm fatigue,
including telemetry and intensive care units such as the IMC PINS/Tele unit. JCAHO (2013a)
recommends strategies to include educating staff, adapting healthcare equipment and environment, and
providing organizational planning for continual improvement towards this goal.
Statistics and the Clinical Alarms Survey
The AHTF (2006) initiated a report which researched standards to improve clinical alarm
hazards. This report provided alarm fatigue background and statistics, incorporated research information
from a variety of reputable sources such as Advancing Safety in Medical Technology (AAMI), Food and
Drug Administration (FDA), JCAHO,and numerous nursing and professional organizations (AHTF,

8. ALARM FATIGUE 8
2006). In addition, AHTF (2006) established a clinical alarms survey to provide qualitative data. At the
IMC PINS/Tele unit, this survey was modified and provided to nurses, certified nurse assistants,
secretaries,and any respiratory, physical, and occupational therapists. Results will provide direction for
educational needs, hospital protocol and policy, and identify any necessary equipment and environmental
changes to improve quality measures regarding alarm fatigue.
Evidence-Based Practice Research
The integrative review by Cvach (2012) and a study done by Cvach et al., (2009) provided
statistical information on alarm hazards, nuisance alarms, and how alarm and environment plays a huge
part in alarm fatigue. Cvach (2012) utilized the Johns Hopkins Nursing Evidence-Based Practice model to
synthesize research and found that alarm fatigue was an effect of excessive alarms, alarm sounds, and
alarm systems. Additional recommendations based on evidence-based practice include the need for new
alarm technology, hospital education, and staff training to reduce the number of alarms (Cvach,2012).
Research from Cvach et al. (2009) supplements this by stating one study’s findings of 99.4% of alarms
being nuisance alarms, causing a decrease alarm reliability. Both Cvach (2012) and Cvach et al. (2009)
understand the impact of unit noise in competition with alarm audibility and provide hospitals with
information to understand these factors.
HCAHPS and CMS Reimbursement
To improve CMS unit standards and reimbursement costs related to alarm fatigue, The HCAHPS
Handbook has been released by Studer, Robinson, and Cook (2010). The OD of the IMC PINS/Tele unit
utilizes this book to understand HCAHPS in regards to patient satisfaction surveys and reimbursement.
This provided useful information on how to improve standardized monthly scores to meet CMS threshold
requirements to be reimbursed. Most notably, the scores related to responsiveness of staff and a quiet
hospital environment are monitored monthly to track improvements (Studer et al., 2010). The quality
improvement and education teams at IMC reference this book to continually improve their scores and
prevent alarm related hazards and fatigue.

9. ALARM FATIGUE 9
Reference Evaluation
Despite the attention of alarm fatigue, sentinel events continue to occur nationwide (AHTF, 2006;
Cvach, 2012; ECRI, 2012; JCAHO,2013). The OD, Education Director, and Quality Improvement team
at IMC have made alarm fatigue a priority quality and safety project (personal communication, February
17, 2014). The IMC PINS/Tele unit is in agreement with ECRI (2012) and recognizes this as a high
profile, high incident for harm, and widespread issue. According to the OD,their hospital has been made
aware of JCAHO’s NSPGand Sentinel Event Alert and will continue to follow the requirements to
initiate a plan by 2016, utilizing the AHTF modified Clinical Alarms Survey and by monitoring alarms.
The Operations Director also understands the negative impact of nuisance alarms, as stated in Cvach
(2012) and Cvach et al. (2012), and hopes to modify parameters to help manage alarm fatigue (personal
communication, February 26, 2014). Alarm fatigue can be a detrimental effect leading to sentinel events
in the hospital setting. The IMC PINS/Tele unit is working diligently to initiate a quality and safety plan
surrounding alarm hazards and will utilize a multitude of these clinical resources.
Best Practices Action Plan
Hospitals must understand alarm safety baseline data to direct strategies and gain unit specific
insight before beginning improvement strategies. There are multiple ways to obtain this information. Due
to the complexity of the issue, there is no singular intervention. The PINS/Tele unit has already
implemented a Clinical Alarms Survey, modified from the ECRI survey. In addition, three hours were
spent on separate days and times to monitor alarms at their centralized monitor desk. Surveys from day
and night shift staff nurses, charge nurses, unit secretaries,patient care technicians, and a nurse staff unit
manager were completed. Results demonstrated that nuisance or false alarms occur frequently, disrupt
patient care,and reduce trust in alarms which cause caregivers to turn off or disable them. Staff noted that
and the primary purpose of an alarm was to alert staff to potentially hazardous patient conditions and
must be distinct in their display notifications. Staff also agreed that that there were frequent incidences
where they had difficulty hearing alarms causing them to be missed. However,respondents believed there
was no obligation for their hospital which required documentation of alarm parameters appropriate per

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patient. This data suggests that alarm fatigue is a potential issue for this unit and is currently being
addressed but, more specific strategies for improvement for this particular unit (personal correspondence,
March 11, 2014).
On March 11th
, 2014, a correspondence with the OD indicated that the Alegent Health System has
designated one representative per hospital from their Quality and Safety Team to attend a meeting
addressing physiological monitors and to understand JCAHO’s 2014 NSPG on Alarm Safety. The OD
desires to create a team composed of a critical care educator,critical care clinician, quality and safety
team member, staff nurses,and a director to define limits on alarm parameters and how far they may be
adjusted to fit patient needs in addition to any new necessary technology (personal communication,
March 11, 2014). This will potentially provide to the development of new policies on a per unit basis and
decrease the number of nuisance alarms. This team is recognized as a “Telemetry Task Force” in many
studies and is recommended to include supply management and clinical engineers to create system wide
management standards,technology upgrades, and standard guidelines on alarms (Cvach, 2012; JCAHO,
2013; Vockley, 2012).
Establishing alarm parameter thresholds unique to each unit is recommended by a multitude of
studies as there are currently no standardized alarm parameter protocols (AHTF, (2006); Cvach, 2012;
JCAHO,2013; ECRI,2012; Vockley, 2012). Other hospitals have done similar changes in which a quick
chart was placed in each patient room to provide alarm parameters,troubleshooting tips for monitor
adjustment, and correct lead placement with reminders to change patches daily (Vockley, 2012).
Additionally, “smart alarms” have been used to decrease the number of nuisance alarms which disrupt
patient care and cause alarms to be disabled. These “smart alarms” filter out and process signals to reduce
the false positive alarms by adding short delays where the patient may be moving or off the alarm sensor
(AHTF, 2006; Cvach,2012).
In regards to alarm audibility, an evaluation was tested 3 years ago and proved efficient for
workflow on the PINS/Tele unit, when the unit was first established (personal communication, March 11,
2014). In addition, a Failure Mode Effects Analysis (FMEA) is done annually on the unit to check for

11. ALARM FATIGUE 11
proper alarm function (personal communication, March 11, 2014). However, PINS/Tele survey
respondents stated having trouble hearing alarms, causing some to be missed or go unnoticed. Long
racetrack type hallways, such as this unit, oftentimes contributes to the difficulty in hearing alarms
(AHTF, 2006). A repeat of this alarm audibility evaluation should be re-tested and become routine
whenever a new alarm device or system is implemented. Certain hospitals have elected to implement
remote speakers,scrolling marquees, and monitors on opposite ends of the hallways to aide in audibility
and visibility (Cvach 2012; Vockley, 2012). This provides additional locations to view patient conditions
and could be useful for the PINS/Tele unit.
This unit has designated a unit secretary who answers patient call lights in situations where staff
nurses are unable to attend the call. However,this does not include the answering to physiologic monitors
which cause the majority of alarm fatigue. One hospital, the Beth IsraelDeaconess MedicalCenter in
Boston, MA created short term and long term positions which aided in the reduction of alarm fatigue
(Vockley, 2012). The short term position included a primary alarm responder (PAR) which was an
assigned nurse or patient technician on every shift that was singularly responsible for attending to alarms.
This reduced the number of missed alarms or lower priority alarms that go unnoticed such as telemetry
leads off or oxygen sensor off signal which may be missed as background noise (Vockley, 2012). The
long term position is a trained personnel on the unit which responds solely to telemetry, becoming a
critical responder to code events as well as making sure leads are properly placed, batteries are charged,
and staff are consulted for abnormal rhythms and arrhythmias (Vockley, 2012). A similar position on the
PINS/Tele unit is the monitor desk technician which is located on a separate floor and able to alert staff to
potential codes, but unable to attend codes at the bedside.
Two helpful programs created by Extension Healthcare are Extension Evaluate and Extension
Engage. These are available to assess and manage alarm fatigue in hospitals and acute care facilities.
These programs were designed to aide hospitals in the adherence of JCAHO’s 2014 NSPGon Alarm
Safety (Extension Healthcare,2014a). This may be provided free of charge to hospitals, as long as the
unit meets program criteria listed on their webpage. Extension Evaluate provides a platform to collect

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baseline alarm data through a “black box data recorder” for 30 days (Extension Healthcare,2014c, p. 1).
This data will deliver information regarding number of alarms on a per-room and per-care unit, giving
details of time, type, reason, alarm priority, actual number of alarms triggered, and offer a summary of the
best practice recommendations based off collected data (Extension Healthcare,2014c). Extension Engage
provides a platform to deliver customizable alarm signals to a variety of devices including smart phones,
tablets, secure test messaging, and other cellular devices to decreases noise,interruptions, and issues
surrounding alarm fatigue. This system provides the ability to turn on or off certain alarms through their
cellular device and instantly routes alarm data to the most appropriate staff member. Stat orders,
electrocardiogram reports, critical laboratory values as well as per-room physiologic patient alarms are
routed to the cellular device along with patient’s computerized current condition and history (Extension
Healthcare,2014b). These two programs seek to evaluate and address the issue of alarm fatigue for the
specific unit and would be beneficial for all intensive care telemetry units, including the PINS/Tele unit.
Resources Needed to Implement and Sustain
Human, financial, technology and equipment resources would be needed to implement these best
practice recommendations. Hospitals, such as the PINS/Tele unit, would need to create new positions and
ongoing training, like Beth IsraelDeaconess accomplished, for a PAR,telemetry technician, and the
Telemetry Task Force. The PAR would need little to no training, but would need to understand the
appropriate person to whom data would need to be reported, whether it be the physician, charge nurse,
staff nurse, or if they can resolve the alarm themselves. For the telemetry technician, a curriculum
program includes “equipment orientation, basic arrhythmia detection, lead placement, alarm condition
response, patient care,and hand hygiene” and is recommended for all new employees (Vockley, 2012, p.
6). This position, suggests Vockley (2012), would be best suited for those who have prior understanding
of telemetry and would be very useful for a telemetry based unit such as PINS/Tele. The Telemetry Task
Force, such as the one the OD at IMC desires to establish, should include a director, staff nurse,
physician, health care quality and safety member, supply management staff, and a clinical engineer. This

13. ALARM FATIGUE 13
would be an excellent source for establishing new policies surrounding alarm protocols and parameters
(Vockley, 2012).
Technology and equipment would be needed as well. The ability to install and implement the
Extension Evaluate program would require a “black box data recorder” to gain baseline data (Extension
Healthcare,2014c). The Extension Engage program would require hospitals to implement the platform
from which data may be received and managed between critical interdisciplinary team members. This
would also include any mobile devices used strictly for clinical purposes of secure text messaging, stat
physician orders, patient data,and critical results from laboratory values or patient scans (Extension
Healthcare,2014b). Implementation of “smart alarms” would be necessary to decrease the number of
nuisance alarms (AHTF,2006; Cvach 2012). Additional remote monitors, scrolling marquees,and
speakers are suggested to be installed for long hallways such as this unit to ensure increased alarm
audibility and visibility (AHTF,2006; Cvach 2012; Vockley, 2012). The new technology required to
implement this best practice recommendation would both assist in gaining needed baseline information as
well as correct the problem of decreased audibility and visibility, increase interdisciplinary
communication surrounding alarms, and reduce nuisance alarms.
With the need for these new resources,a needed financial resource must to be available to
sufficiently implement these recommendations. Hospitals should consider the cost of training a Telemetry
Task Force and address necessary time for meetings regarding frontline alarm safety research as wellas
the development of alarm parameter policies. They must also utilize cost resources in the hiring, training,
and new employee program of the telemetry technician as well as designate a PAR to manage background
noise floor alarms. Lastly, any cost associated new equipment, such as “smart alarms”, speakers,
monitors, and scrolling marquees must also be considered in the financial resource budget. The Extension
Healthcare programs may be provided to hospitals free of cost if the unit meets specific criteria as
specified on their webpage (Extension Healthcare, 2014c). If they do not, hospitals must take into
consideration the needed financial resources for this as well.

14. ALARM FATIGUE 14
Evaluation of Effectiveness
Evaluation of these strategies are necessary to ensure adequate effectiveness related to problem
assessment and improvement. The re-collection of data from the Extension Evaluate program post
implementation of the Extension Evolve program could be useful, if possible (Extension Healthcare,
2014c). This way, after the program has been in place, a secondary assessment may be valued to show
improvements. Additionally, a re-test of alarm audibility and FMEA testing after any new equipment or
technology implementation would assess the need for alarm adjustment for best acoustical and visual
placements of remote speakers,monitors, and scrolling marquees. Lastly, the unit may send out the initial
modified Clinical Alarms Survey to evaluate staff responses for qualitative information.
Barriers and Solutions
Barriers might arise during the addition of new technology. When increasing the audibility of
alarms through the installation of remote speakers,there becomes a potential for disruption of patient
privacy and the healing process (Cvach et al., 2009; Studer, Robinson, & Cook, 2010). To overcome this,
alarm audibility checks should be done with each new technology and adjusted to fit both staff and
patients, keeping in mind patient satisfaction scores related to a quiet hospital stay (Cvach et al., 2009).
Any new technology installed into the hospital system would need to be integrated with resources to
educate necessary personneland with minimal disruption to patient quality and safety.
Because of this complex issue, there is not a single improvement strategy. Many people, as
described in the Telemetry Task Force,are involved with the development and implementation of
effective solutions to decrease alarm fatigue. Thus, finding a strategy will take time, effort, research,and
resources to make changes on each individual unit. As evidenced by PINS/Tele staff responses and
responses from previous study surveys, nursing staff seem to lack understanding of their vital role in
adjusting alarm parameters and thus deemphasized the need for education while underlining the issue of
nuisance alarms (AHTF, 2006). Understanding by all directors and staff that this is an ongoing effort to
maximize alarm effectiveness and reduce alarm fatigue is vital.

15. ALARM FATIGUE 15
References
AACE Healthcare Technology Foundation [AHTF]. (2006). Impact of clinical alarms on patient safety.
Retrieved from: http://thehtf.org/documents/White%20Paper.pdf
Cvach, M. (2012). Monitor alarm fatigue: An integrative review. Biomedical Instrumentation &
Technology,46(4),268-277. doi: http://dx.doi.org/10.2345/0899-8205-46.4.268
Cvach, M., Dang, D., Foster, J.,Irechukwu, J. (2009). Clinical alarms and the impact on patient care.
Initiatives in Safe Patient Care. Saxe Healthcare Communications. Retrieved from:
www.initiatives-patientsafety.org/Initiatives2%20.pdf
Extension Healthcare. (2014a). About Extension Healthcare. About. Retrieved from:
http://www.extensionhealthcare.com/about-us/
Extension Healthcare. (2014b). Extension Engage. Solutions. Retrieved from:
http://www.extensionhealthcare.com/extension-engage/
Extension Healthcare. (2014c). Extension Evaluate. Solutions. Retrieved from:
http://www.extensionhealthcare.com/evaluate/
The Emergency Care Research Institute [ECRI]. (2012). Health devices. Top 10 Health Technology
Hazards of 2013,41(11),1-6. Retrieved from www.ecri.org/2013hazards
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(50). Retrieved from:
http://www.jointcommission.org/assets/1/18/sea_50_alarms_4_5_13_final1.pdf
The Joint Commission [JCAHO]. (2013b). NSPG.06: Reduce the harmassociated with clinical alarm
systems. Retrieved from:
http://www.jointcommission.org/assets/1/6/HAP_NPSG_Chapter_2014.pdf
Studer, Q.,Robinson, B., & Cook, K. (2010). The HCAHPS handbook.Gulf Breeze,FL: Fire Started
Publishing Company.
Vockley, M. (2012). Plan, do, check, act: Using action research to manage alarm systems, signals, and
responses. Safety Innovations.