The Dangers of Missed Bedside Alarms

Unfortunately, the dangers of missed bedside alarms are common and serious. Hospitals and other in-patient facilities use bedside alarms to alert medical staff when a patient issue develops.

Alarms sound when the patient’s condition deteriorates and needs attention, such as when there is a drastic change in blood pressure or respiration rates. Alarms also alert staff to a a failure of life saving mechanical equipment such as ventilators. Sounds like a great system, right?

Of course, these alarms only work if a nurse (or other staff) respond in a timely, appropriate manner. When nurses and other medical staff do not recognize and respond to bedside alarms, the consequences for patients can be serious, including patient harm or death.

How big a problem is this?

This issue is so prevalent, the ECRI Institute, a nonprofit organization focused on improving medical care, has placed alarm hazards on their Top 10 Health Technology Hazards every year since the list’s inception in 2007.

A Boston Globe investigation found that between January 2005 and June 2010 more than 200 hospital patients in the US died because of issues with patient monitors that track heart function, breathing, and other vital signs.

It’s not just death you have to worry about. Missing alarms can cause a worsening of the patient’s condition.  A recent study found that almost 50% of patients who were unexpectedly transferred from a general ward to the ICU were moved due to declining health issues caused mostly by monitoring failures.

Why is this happening so often?

The numbers of alarms ringing on monitoring equipment is mind boggling.

• Studies have shown the devices used on a single patient can produce hundreds of alarms every day.
• For an entire unit, the number of daily alarms can skyrocket into thousands, even tens of thousands, of alarms each day.
• The typical ICU bedside has devices that together produce more than 40 different alarms and information signals.
• One hospital reported an average of 1 million alarms going off in a single week!

What about false alarms?

False alarms occur when an alarm sounds even though the patient’s health does not warrant the alarm. Unfortunately, false alarms in hospitals are pretty common. Importantly, research indicates that 85 – 99% of device alarms do not require clinical intervention. For instance, alarms can sound when the settings are incorrect, of if the sensors are placed incorrectly.

Of course, this high number of false alarms can easily contribute to a dulled sense of urgency among staff.

What is alarm fatigue?

Alarm fatigue occurs when staff hear a large number of alarms throughout the day, causing desensitization. Desensitization can lead to not only delayed responses, but can cause staff to miss or ignore important alarms.

Moreover, to cope with the constant alarm noises, nurses may turn the volume down, turn the alarm off, or adjust the alarm thresholds beyond what is safe. All of these actions, and inactions, can have serious, often fatal, consequences.

Why do nurses and other staff miss alarms:

With thousands of alarms ringing each day, it is no wonder that nurses and other staff miss many alarms. In addition to alarm fatigue, other reasons for missed alarms includes:

• Alarms are temporarily silenced and staff forgets to turn them back on.
• Alarm volumes are set too low: by mistake, or on purpose by nurses and/or patients who tire of hearing the constant noise of alarms.
• Devices are not working properly.
• Devices are not programmed correctly.
• Staff forgets to turn them on.
• Inadequate staff training on monitors and alarms.
• Alarms not properly adjusted to an individual patient.

Is anyone trying to eliminate the dangers of missed bedside alarms?

Hospitals, regulatory agencies and equipment manufacturers are all evaluating solutions. Remedies cannot come soon enough.

Hospitals can take steps to reduce alarm overload and false alarms, including:

• Establishing a process for safe alarm management and response.
• Identifying the default settings and appropriate limits for each device.
• Establishing use guidelines, including identifying when alarm signals are not clinically needed.
• Setting guidelines for tailoring alarm settings for individual patients.
• Adequately inspecting, checking, and maintaining devices with alarms.
• Properly training all team members.

Additionally, advances in technology have increased the use of visual and/or vibrating alarms which can reduce overall alarm noise.

A few success stories.

Hospitals throughout the country have been able to successfully combat alarm fatigue.

The Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio specifically focused on reducing the number of alarms in the bone marrow transplantation unit. A multi-disciplinary team including nurses, physicians, nursing assistants, medical engineers, and family representatives met to devise a plan to reduce the number of alarms in the unit on a daily basis.

After making a variety of changes, the unit was able to drastically reduce the number of alarms from 180 to 40 per patient per day, and the number of false alarms fell from 95% to 50%.

Additionally, Boston Medical Center was able to reduce the number of alarms by 60% by altering the default heart rate settings based on each patient’s condition. They also implemented the following mnemonic to help prevent alarm fatigue and increase patient satisfaction and outcomes:

• Alarm sensitivity.
• Sounding notification.
• Significant need to monitor.
• Evaluate the situation.
• Timely response/technology training.

What can you do about the dangers of missed bedside alarms?

Until the situation significantly improves, if it ever does, it’s wise for patients and families to intervene.

If at all possible, I strongly recommend that a family member or other attentive adult stay with a patient in the hospital at all times. This is particularly important when patients are too ill to speak up or call for a nurse themselves .

In order to minimize the risk of missed alarms, patients and families — especially families of critically ill patients — speak with the medical staff to learn the following:

• What monitors are in use and why
• What the different alarms sound like for each piece of equipment
• Which alarms are urgent and demand immediate attention

If an urgent alarm sounds, a family member should seek help from the nurses on duty immediately by finding a nurse in the hall or at the nurse’s station.

Learn more…

All hospital stays involve risk, therefore I suggest you read these blog posts:

• Germs in Hospitals and Doctor Offices – Watch Out!
• The Benefits of Participating in Hospital Rounds.
• Hospital Fall Prevention Programs – Helpful or Harmful?
• How Does Nurse Burnout Affect Patients?
• How Hospital Patients Can Resolve Problems.
• What’s Your Hospital’s Safety Record? Is Your Hospital Safe?
• Is Your Hospital Safe? Are Programs in Place to Avoid Dangerous “Never Events”?

NOTE: I updated this post on 12-29-21.