Welcome! Thanks for stopping by. If you found your way here through a share or just by accident, you can subscribe for free and get your own issues! If you are a free subscriber, please consider upgrading to paid. Just go into your subscriptions and you can do it from there.
Anyone who has spent some time in a hospital, especially in a specialized unit like an ICU, knows that there is little silence. Bells and whistles may mean something good in everyday life – not so much in a healthcare facility.
Those bells, alarms, and other sounds are very disruptive to patients who are trying to rest and concerning for their loved ones who have no idea what they mean and don’t understand why a staff member isn’t rushing to check on the patient. But they can also be dangerous because of alarm fatigue for the staff.
Alarm fatigue occurs when nurses and other staff are exposed to constant alarms and safety alerts and they don’t hear them with the urgency that the alarms may deserve. I know from experience that it’s frustrating to have machines beeping for seemingly no reason. Some are so sensitive that if a patient moves, they go off. To go into a room again and again to find out it's just the machine is annoying and time consuming. When I worked in an ICU, it seemed that all the alarms went off at the same time too. We could have beeps or noises from the ventilator, the blood pressure machine, the cardiac monitor and others – and sometimes for no serious reason. Add to that the call bells, the phones ringing, and everything else, the noise can be incredible.
(Interesting aside: I worked in a 7-bed ICU, which was right next to a 6-bed cardiac care unit, or CCU. Whenever we needed to borrow something from the CCU, we would barge through the door to be hit with a wall of silence. We often spoke too loudly and had to be shushed by the CCU nurses, who were quiet and deliberate in their movements. It’s not to say that they didn’t have machines with alarms, but they didn’t have the massive amount of machinery we had, like the ventilators, so they were able to lower the volume on the machines they did have.)
Heart monitors, a common alarm source
Most people know about the heart monitors that many patients are attached to. If they’ve not seen them in a hospital, they’ve surely seen them on TV. The information from the monitors goes directly to a central location, usually the nursing station. When an alarm goes off, the nurses decide whether they need to check the patient or silence the alarm because it is just feeding them information, like a pulse rate rising or dipping.
…the vulnerable, sick part of me felt abandoned and wondered if anyone was really looking at the monitors.
But I remember being that patient on a heart monitor a couple of times. And even though I’m a nurse, I still felt very stressed when my alarm beeped and no one came to see how I was. The nurse part of me knew why. But the vulnerable, sick part of me felt abandoned and wondered if anyone was really looking at the monitors. “What if something important was happening but no one saw it,” was a constant thought in my head.
It’s the same thing with IV pumps. Intravenous pumps have several alarms to alert the staff if there’s a blockage, air in the tubing, or the IV bag is empty. I remember being hooked up to an IV and the machine beeping because the bag was empty. I knew that if the IV stopped for too long because of an empty bag, I may have to get a new line inserted, which meant an extra poke and more discomfort (pain!). I rang my call bell and eventually, someone arrived to change the IV bag. But even my call bell was one extra alarm the nurses had to deal with. The nurse told me that they couldn’t hear the IV machines beeping at the nurses’ station.
The nurse told me that they couldn’t hear the IV machines beeping at the nurses’ station.
Again, I get it. But then what was the alarm for? I was very stressed about having an empty IV bag. I didn’t want to have to go through having someone else start another IV line.
Studies looking at alarm effects
One study published in 2015 reported that there were over 500 alarm-related deaths in the U.S. over five years. The researchers also noted that healthcare professionals could hear up to 1,000 alarms per shift. A newer study said that it could be as high as 300 times per day per patient.
An older study, one from 2010, found that of almost 6,000 alarms noted by the researchers, “About 40% of all alarms did not correctly describe the patient condition and were classified as technically false; 68% of those were caused by manipulation.” This meant that the wires or machine had been moved in some way. “Only 885 (15%) of all alarms were considered clinically relevant. Most of the generated alarms were threshold alarms (70%) and were related to arterial blood pressure (45%).” Threshold alarms are those that tell the staff if someone has reached the upper or lower limits of what is being monitored, much like a blood pressure cuff that is set to tell the nurses if the pressure has risen above or dropped below a certain set reading.
Improvements coming?
Last year, researchers from McMaster University in Canada published an article on reducing the perceived annoyance of alarms. They wanted to know if the sounds of the alarms could be changed so they could be less annoying and therefore, the staff would respond to them instead of tuning them out. The researchers looked at the timbre of the alarms, the tone quality.
They compared the standard sounds with enhanced sounds with different sounding two-step ones, like from a xylophone. The researchers found that “…musical sounding alarms are comparably recognizable, yet significantly less annoying than alarm signals common in medical environments. These outcomes provide a promising first step to improving patient care through musically informed alarm design.”
So it’s nice to see that people acknowledge this is a problem that could have a solution. Of course, we’ll never get rid of alarms in the hospital setting. But if we can lessen them and make them more bearable, that would be great.
What do you think? Leave your comment below. Let’s get a conversation started.