The document discusses strategies for reducing alarm fatigue in healthcare facilities. It notes that the large number of medical devices with alarms can lead to clinicians becoming desensitized to alarms. This is a patient safety issue, as alarms are sometimes ignored as a result. The document recommends several approaches facilities can take to reduce nuisance alarms and distinguish important alarms, such as using silent alarms, adjusting alarm settings, and integrating bed alarms with nurse call systems. The goal is to improve patient safety and care by reducing unnecessary alarms while still using alarms as important safety alerts.

1. Fall Management Best Practices
Strategies for Reducing Alarm Fatigue
Lange Medical,LLC428 Alta Loma DriveThiensville, WI 53092
(800) 278-4293dlange@langemed.com
Fall Practices
The number of medical devices with alarm systems is overwhelming: ECG
(electrocardiograms), ventilators, blood pressure monitors, infusion pumps,
pulse oximeters, central station monitors, bedside telemetry, are only a few of
such devices.
While these alarm-equipped devices are essential to providing safe care to
patients and residents, they create both opportunities and hazards in the
healthcare environment. With similar alarms sounds or false alarms, unintended
consequences including alarm fatigue poses a problem in facilities as the sheer
number of technological devices available increases every year.
Technology – Friendor Foe?
The two main purposes of alarms for medical devices is to alert caregivers about
a possible unsafe situation for their patient or to remind them some type of care
was required. With the flood of these types of products in the market,
caretakers are now inundated with hearing and responding to hundreds of
alarms from just one patient/resident’s room each day. Multiply that by caring
for multiple patients/ residents, and that can equal thousands of different alarm
sounds per day. This can result in clinicians becoming desensitized to the
offending alarms and consequently ignoring them, known as alarm fatigue.
Alarm fatigue is a persistent problem that is predominantly affecting Directors
of Nursing and their staff, including anyone who directly interacts with
patients/ residents. The issue is further complicated when alarms sound alike,
adding to a confusing situation. Various estimates show that more than 85% of
the time the indicated alarm does not require a response from a caretaker, but
they do not know this until after they have responded.

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White Paper, By David Lange 2
Fall Management Best Practices – Strategies for Reducing Alarm Fatigue (cont’d)
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A secondary problem is the challenge in creating a home-like setting, which
would help a patient/resident with their recovery. The concept of creating a
home setting would include eliminating the constant barrage of noise, much of
that caused by alarm signals. The design of the physical environment also has a
substantial impact on the caregivers through creating more efficient and
productive work areas and the proper design of settings to mitigate medical
error.
Technology and its ever-changing advancements, is considered a natural part of
the acute and critical care environment. Physiologic monitoring is standard
practice in telemetry, acute, critical, and long-term care settings. The reality is
that technology and physiologic monitors are only as reliable as the clinicians
who use them. Thus, alarms are inherent in the work of caregivers, and are
intended to alert clinicians to deviations from a predetermined “normal”
status. Alarms are important and sometimes life-saving, and can compromise
patient/ resident safety if ignored.
A common goal of patient/resident safety and security providers is to utilize
technology so it allows caregivers and clinicians the ability to efficiently perform
their jobs, to enhance their roles with critical medical device alarms, not hinder.
The ultimate goal is providing the highest level of care.
An Urgent Safety Concern
According to a Boston Globe article, a 60-year old man died in the intensive care unit of a
hospital from a system failure as a result from a delayed response to an alarm signal, and
not from the injuries he sustained to his head from an accident. It took the staff one hour to
respond to a device alarm. As a result, his heart rate increased while his blood oxygen levels
fell to a level where he suffered irreversible brain damageand was eventually removed
from life support. His unanticipated death was a result of the failure to respond to
appropriate alarm signals in a timely manner.
The Joint Commission’s (a national quality control group) Sentinel Event database includes
reports between January 2009 and June 2012 indicating 98 alarm-relatedevents occurred.
Of those events, 80 resulted in death and 13 in permanent loss of function and 5 in
unexpected, additional stay. These injuries resulted from medication errors, ventilator use,
delays in treatment, and falls.1

3. Lange Medical,LLC428 Alta Loma DriveThiensville, WI 530092
(800) 278-4293dlange@langemed.com
White Paper, By David Lange 3
Fall Management Best Practices – Strategies for Reducing Alarm Fatigue (cont’d)
Bed and Chair Alarm Effective Practices
Bed and chair alarms may add to alarm fatigue by possibly desensitizing staff to
general alarm sounds, but this is a very small part of the overall problem. Proper
monitoring of bed and chair alarms is vital for a more home-like environment.
By using the most technologically current products, a facility can improve the
overall environment, leading to improved patient/resident care and recovery.
Many bed and chair devices now allow facilities to control and change the
device settings for the best configuration for each patient/resident. The
following can assist with eliminating alarm fatigue:
1. Silent alarms: eliminating audible alarms and utilizing silent, local alarms
can have many benefits. Silent alarms will signal through the system, for
example at a nurse’s station, and will eliminate the need to be within
earshot of the patient/resident. Unnecessary interaction is reduced. Time
saved can be used for actual care work and active interactions with
patients/residents. Silent alarms can also improve environment and
occupant’s satisfaction. Noisy environments add to patients’/residents’
anxiety and make rest and healing more difficult. The use of silent alarms
can greatly improve these conditions, and with satisfied customers and
relatives, the working atmosphere improves.
2. Delay setting: most basic devices are created to alert staff immediately
when the sensor pad detects an absence of weight. In some cases, this can
create nuisance alarms if a patient is simply shifting his/her weight
without actually leaving the bed or chair. By changing a delay setting
(generally anywhere from one to four seconds), the number of nuisance
alarms can be dramatically reduced. Of course, this is totally dependent
on the patient/resident and is not appropriate for all patients/residents.
3. Alarm tone setting: there are two main advantages of changing the actual
sound the control unit makes when egress is detected. The first is to
create a tone that does not sound the same as another medical device in
use. Different devices have different levels of urgency and can create a
difficult situation for staff if they sound alike. By changing the sound of the

4. Lange Medical,LLC428 Alta Loma DriveThiensville, WI 530092
(800) 278-4293dlange@langemed.com
White Paper, By David Lange 4
Fall Management Best Practices – Strategies for Reducing Alarm Fatigue (cont’d)
bed alarm they can make it distinctive from other products. The second
possibility is to vary tones for different patients/residents. That way, staff
will know which patient/resident is leaving their bed or chair the instant
they hear the alarm rather than waiting until they begin their search. This
feature does require more diligence on the part of the staff to learn the
corresponding tones.
4. Nurse call integration: facilities can also consider connecting the product
with an existing nurse call systemto create more safeguards for the
patient/resident. This will allow more people to be notified when a
patient/ resident has left their bed or chair without the need for any
audible alarm.
5. Recorded voice message: there are also two main advantages for using
the recorded voice option. The first: it is often more pleasant than the
alarm sounds, which can create a more home-like environment for
everyone. The second: recording a familiar voice – such as a spouse, child
or sibling – can be helpful to a patient/resident who experiences
confusion. Again, this is also to be used on a case-by-case basis since some
people can be so confused by hearing their spouse’s voice that they begin
to look for them in the room and become agitated. Used in the correct
manner, however, it can be a very effective tool.
6. Integrated floor mats: using a floor mat in combination with a bed or
chair alarm, the system now becomes more like an individualized
wandering systemrather than a simple egress system. This can be another
effective way to eliminate alarm fatigue.
Overall, there are key advantages to understanding the features of any alarm
unit in place and how to configure it to best work for the facility,
patients/residents, families, and visitors. Staff should be aware of what the
visual and audible indicators mean during some type of qualitative in-servicing.
Proper usage depends on everyone who uses the product understanding these
signals.

5. Lange Medical,LLC428 Alta Loma DriveThiensville, WI 530092
(800) 278-4293dlange@langemed.com
White Paper, By David Lange 5
Fall Management Best Practices – Strategies for Reducing Alarm Fatigue (cont’d)
Alarm Improvement Initiatives Your Facility Can
Institute
Some facilities concerned about alarm fatigue simply remove as many alarms as
possible, but how will a patient be better served by removing some of the safety
nets currently used? Will a patient’s welfare be improved with fewer safeguards
to help the staff? While addressing alarmfatigue, it’s important to keep the
patient’s safety at the forefront. ECRI has compiled a handbook of suggestions
and recommendations about managing the many alarms that are currently
utilized in today’s healthcare environment.2
Have a process in place for safe alarm management and response
Establish guidelines for alarm settings on alarm-equipped medical
devices used in high-risk areas and high-risk clinical conditions Create
guidelines for customizing alarm settings and limits for each patient or
resident Inventory all alarm-equipped medical devices and identify
default alarm settings and limits Inspect and maintain alarm-equipped
devices to provide for accurate and appropriate alarm settings,
detectability, and proper operation Provide ongoing training and
education of the clinical care team Form a cross-disciplinary team to
address alarm safety and the potential impact of alarm fatigue in all
patient and resident care areas Share your experiences and
information about your organization’s alarm-related incidents, lessons
learned and prevention strategies with appropriate organizations, such as
The Joint Commission and the FDA
Prepare, Plan and Prevent
Medical products with alarms started as simple devices intended for people to
“hear and respond,” but more analytic opportunities continue to be developed.
Key aspects to consider when assessing your alarm management practices:
When are these devices alarming? How long are they alarming?
How is my facility doing compared to an industry average? Are there
patterns that can be learned about the patient/ resident as a result of this

6. Lange Medical,LLC428 Alta Loma DriveThiensville, WI 530092
(800) 278-4293dlange@langemed.com
White Paper, By David Lange 6
Fall Management Best Practices – Strategies for Reducing Alarm Fatigue (cont’d)
information? Is there proper training at your facility? Are
communication channels clearly defined?
Are responses to alarm events selective? Or does everyone react?
Are there metrics in place to track response time?
These questions will help the facilities shift their thinking from a “hear and

7. Fall Management Best Practices
Strategies for Reducing Alarm Fatigue
respond” to a “prepare, plan and prevent” methodology. The information can now
become part of a patient’s/resident’s overall careplan and not only keep them safer
but possibly help their overall recovery and healing. This type of methodology will
also allow staff to be more proactive with fall management protocols rather than
simply reacting to alarms. Also, putting metrics in place for tracking response times
will improve trends and issue areas.
An organizational focus on moving to this type of methodology is likely to yield positive
improvements in critical areas, such as patient/resident safety and satisfaction; clinical
outcomes; relevancy of clinical documentation; effectiveness of the careteam; and
staff morale.
Ironically, alarm systems were created to enhance patient and resident safety yet
have become an urgent patient/resident safety concern. We need to manage our
alarm systems to achieve the highest levels of both sensitivity and specificity. The
goal is to eliminate alarm fatigue and provide a safer health careenvironment.
References
1. Medical Alarm System Information, MedicalAlarmSystem.org, http://www.medicalalarmsystem.org /medical-alert-
alarmsystems.html
2. “Medical device alarm safety in hospitals,” The Joint Commission Sentinel Event Alert – Issue 50,
http://www.jointcommission.org/assets/1/18/SEA_50_alarms_4 _5_13_FINAL1.PDF
3.“ECRI Institute’s Alarm Safety Handbook Helps Hospitals Minimize a Top Threat to Patient Safety,” ECRI Institute, https://
www.ecri.org/press/Pages/Alarm-Safety-Handbook-Minimize-Threat-Patient-Safety.aspx

8. Fall Management Best Practices
Strategies for Reducing Alarm Fatigue