The Helpful or Hindering Effects of In-Hospital Patient Monitor Alarms on Nurses

Abstract

Patient monitors generate alarms to signal changes in vital signs. Some research suggests these alarms can improve patient safety. Other reports caution that these systems generate false alarms and create nursing workflow interruptions. These findings require contextualization by qualitatively investigating the lived experiences of nurses working with these monitors. Research into the dynamics involved in nursing responses to alarms can provide insights for monitor development and implementation. This study's purposes were (1) to describe the frequency of alarms generated by patient monitors and nursing responses and (2) to report nurses' explanations of the impact of alarms on workflow and strategies for responding to alarms. Forty-nine hours of observations and 14 interviews were conducted at a Canadian medical center. Four hundred forty-six monitor alarms (1 every 6.59 minutes) were observed. Of these, 70% had no immediate response from nurses. Furthermore, 34 red alarms (potential life-threatening) were observed, with 41% having no immediate response. Nurses reported feeling overloaded by alarm frequency. They described learning to interpret alarm data and developing workaround strategies (eg, ignoring alarms). Paradoxically, alarms prompted nurses to regularly consider and interpret patient information. We suggest the interpretive work associated with workarounds may hold benefits mitigating the potential harms of ignoring alarms.

Understanding Clinical Alarm Safety

“…Given the frequency of critical tasks, alarms, and alerts, nurses must resist abandoning tasks to accomplish safe, quality care and, in fact, they develop skills to interpret and decide on "appropriate" responses to alarms. 27 …”

“…Units with incessant alarms have been described as "hostile" to patients, clinicians, and nonclinical workers alike. 51 Any environment with frequent, persistent alarms generates frustration, irritation, and other distressing feelings, 27 which can lead to burnout. 12,51,52 In response to distress, humans take actions (consciously or unconsciously) to reduce or eliminate their negative feelings.…”

“…Because of inherent (human) cognitive traits, nurses may delay response to unexpected events (eg, alarms) if it hampers work flow or interrupts tasks. 27,56 Persons performing critical tasks (eg, sterile placement of a urinary catheter) or tasks with high entry demand (eg, tasks requiring full isolation precautions) are particularly prone to resisting or delaying response. Given the frequency of critical tasks, alarms, and alerts, nurses must resist abandoning tasks to accomplish safe, quality care and, in fact, they develop skills to interpret and decide on "appropriate" responses to alarms.…”

“…Waiting for self-correction is a response based on the inherent tendency of humans to limit extraneous and unnecessary expenditure of cognitive or physical energy. 27 Because of the high prevalence of false and clinically insignificant alarms in many settings, waiting for self-correction is subconsciously perceived as an efficient way to prevent task interruption.…”

“…13,27 There are 2 main types of clinical alarms (device alarms and physiological alarms). Alerts, which differ from alarms, also contribute to noise in clinical settings.…”