Hospital alarms a disturbance, technological hazard

Overuse of alarms makes staff less likely to respond

When Kea Turner’s 74-year-old grandmother checked into Virginia’s Sentara Virginia Beach General Hospital with advanced lung cancer, she landed in the oncology unit where every patient was monitored by a bed alarm.

“Even if she would slightly roll over, it would go off,” Turner said. Small movements — such as reaching for a tissue — would set off the alarm, as well. The beeping would go on for up to 10 minutes, Turner said, until a nurse arrived to shut it off.

Tens of thousands of alarms shriek, beep and buzz every day in every U.S. hospital. All sound urgent, but few require immediate attention or get it.

Intended to keep patients safe alerting nurses to potential problems, they also create a riot of disturbances for patients trying to heal and get some rest.

Nearly every machine in a hospital is now outfitted with an alarm — infusion pumps, ventilators, bedside monitors tracking blood pressure, heart activity and a drop in oxygen in the blood. Even beds are alarmed to detect movement that might portend a fall. The glut of noise means that the medical staff is less likely to respond.

Alarms have ranked as one of the top 10 health technological hazards every year since 2007, according to the research firm ECRI Institute.

That could mean staffs were too swamped with alarms to notice a patient in distress, or that the alarms were misconfigured.

The Joint Commission, which accredits hospitals, warned the nation about the “frequent and persistent” problem of alarm safety in 2013.

It now requires hospitals to create formal processes to tackle alarm system safety, but there is no national data on whether progress has been made in reducing the prevalence of false and unnecessary alarms.

The commission has estimated that of the thousands of alarms going off throughout a hospital every day, an estimated 85% to 99% do not require clinical intervention. Staff, facing widespread “alarm fatigue,” can miss critical alerts, leading to patient deaths. Patients may get anxious about fluctuations in heart rate or blood pressure that are perfectly normal, the commission said.

And bed alarms, a recent arrival, can lead to immobility and dangerous loss of muscle mass when patients are terrified that any movement will set off the bleeps.

In the past 30 years, the number of medical devices that generate alarms has risen from about 10 to nearly 40, said Priyanka Shah, a senior project engineer at ECRI Institute. A breathing ventilator alone can emit 30 to 40 different noises, she said.

In addition to triggering bed alarms, patients who move in bed may set off false alarms from pulse oximeters, which measure the oxygen in a patient’s blood, or carbon dioxide monitors, which measure the level of the gas in someone’s breath, she said.

Shah said she has seen hospitals reduce unneeded alarms, but doing so is “a constant

work in progress.”

Maria Cvach, an alarm expert and director of policy management and integration for Johns Hopkins Health System, found that on one step-down unit (a level below intensive care) in the hospital in 2006, an average of 350 alarms went off per patient per day, from the cardiac monitor alone.

She said no international standard exists for what these alarms sound like, so they vary by manufacturer and device. “It’s really impossible for the staff to identify by sound everything that they hear,” she said.

The flood of alarms creates a “cry wolf phenomenon,” Cvach said. The alarms are “constantly calling for help. The staff look at them. They say that’s just a false alarm — they may ignore the real alarm.”

Barbara King, an associate professor at the University of Wisconsin at Madison School of Nursing, who has interviewed patients about their experience with bed alarms, said patients find them “very restrictive.”

“They’re loud. For some patients, it’s frightening. They don’t know where it’s coming from. It’s a source of irritation,” she said. “For some patients, they won’t move.”