Assignment: Alarm-generating Devices
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Adult ICU and NICU nurses did not offer as many suggestions to remedy the conditions cre- ated by exposure to multiple clinical alarms as did labor nurses. The ICU nurses’ comments re- flected their resignation of working with alarms as part of their routine. One aspect of alarms that NICU nurses would like to improve is sys- tem algorithms to triage clinical alarms. They de- scribed the system being overloaded with mul- tiple abnormal parameters and not being able to appropriately prioritize alarms that may be more concerning. They recommended the sys- tem send the most clinically important alarms first before what they considered to be nuisance alarms.
DISCUSSION Staff nurses bear the majority of the alarm bur- den, as they are the direct patient caregivers and interface with alarm-generating devices at the bedside, at the nurses’ station, and via hospital- issued smartphones. In this study, nurses de- scribed being continuously bombarded with the sights and sounds of numerous clinical alerts and alarms. They discussed sounds from nonclinical devices such as phones, the call light system, and the tube station as adding to the ongoing noise in their work environment. Audible alarms seemed to be less appreciated than visual data.
Proliferation of medical devices with alerts and alarms in the clinical setting, even for pa- tients who are low risk and likely need minimal to no monitoring, sets the stage for generation of
excessive notification data, which leads to alarm desensitization, alarm fatigue, and challenges for clinicians to distinguish what is clinically relevant, what is actionable, and what requires an immediate response. In this context, an alarm of clinical importance can be missed and patient safety is at risk.12 Nurses in this study noted that, as their day went on, they became less attentive to the numerous alarms, consistent with results of a recent study of pediatric ICU nurses in which every subsequent hour of the nurses’ shift was associated with a 15% longer response time (6.1 minutes during the second hour compared with 14.1 minutes in the eighth hour).7
Overmonitoring
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