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April 25, 2015

Medical Alarm Fatigue

Alarms are an important part of clinical care as it serves as a warning to a possible medical error or an impending medical emergency. But when they occur frequently, most of which end up being "false-alarms," they become worse than useless and actually contributes to an unsafe patient environment because a life-threatening event may be missed due to such sensory overload.

In one fascinating research article performed in an intensive care unit (ICU) where the sickest of the sick are cared for in a hospital, they documented 2.6 million unique alarms in a 31 day period of time. There were 381,560 audible alarms for an audible alarm burden of 187/bed/day. Of cardiac arrhythmias actually annotated, 88.8% of the alarms ended up being totally wrong.

Remember the tale of the boy who cried wolf too many times?

Imagine that tale, but magnified a thousand-fold and you have some idea of what it is like to work in an ICU.

But it's not just in the ICU... in any clinic setting where electronic medical records are being used, ask any doctor, nurse, or pharmacist how many times a medical error message pops up in a typical day.

If my experience is any example, I probably get prompted by such an alarm about 6x per hour or about 240 alarms in a typical 40 hour work week, typically in e-prescribing situations. How many end up being legitimate alarms? Probably about one a week.

Only ONE legitimate alarm out of 240 alarms a week.

You can see how this alarm fatigue may become a problem where being bombarded by so many alarms may cause the one real alarm to be accidentally dismissed out of habit.

References:
Insights into the Problem of Alarm Fatigue with Physiologic Monitor Devices: A Comprehensive Observational Study of Consecutive Intensive Care Unit Patients. PLOS One October 22, 2014DOI: 10.1371/journal.pone.0110274

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Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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