Boston Medical Center Tackles Alarm Fatigue and Noise

Hospitals around the country are grappling with the issue of alarm fatigue. The concern is that the constant noise of equipment alarms on hospital inpatient floors is so overwhelming that nurses can become desensitized, thereby creating potential patient safety risks. This issue is so pervasive that the Joint Commission--the accrediting body for hospitals nationwide--is implementing a new national standard aimed at reducing alarm fatigue.

BMC is tackling the issue head on, where a multidisciplinary team of BMC physicians, nurses and clinical engineers has designed a new approach to increase patient safety by reducing the number of clinically insignificant alarms. Their work is already getting national attention.

The approach was piloted on a unit that cares for cardiac patients and uses telemetry equipment to monitor heart rate, blood pressure, oxygen level and other vital signs. The alarm noise on the unit was constant. Many of the alarms indicated clinically insignificant events that required no action by staff, yet they competed with alarms indicating life-threatening conditions like critical heart rhythms.

"The warning alarms for clinically insignificant events were constantly going off and creating unnecessary background noise, causing us to struggle with alarm fatigue," says Deborah Whalen, NP, BMC Clinical Service Manager, Cardiology.
The team reviewed alarm data and developed a list of safe changes that would decrease the total number of alarms, while still ensuring that alarms continued for all events that required immediate attention.

During the six-week pilot, the number of alarms dropped from 87,823 to 9,967 per week - a stunning 89 percent decrease in audible alarms. Patient satisfaction rose. Staff satisfaction increased, too, with many nurses remarking on the quietness of the unit and noting that they could spend more time caring for patients than answering clinically insignificant alarms. Physicians indicated that patient alarm histories now were more meaningful and there was unanimous agreement that care was safer and better. The results were so successful that the program has been implemented in all inpatient adult general medical surgical units at BMC.

"We observed that while the number of alerts dropped drastically, we also had greater response to alerts because those that sounded were all actionable, and now the staff were keenly listening for alarms," says James Piepenbrink, director of the department of clinical Engineering at BMC.

Meanwhile, the novel approach of the pilot and the significant improvement in both patient care and patient and staff satisfaction is proving of interest to care providers nationwide, and in May, the BMC team presented their work in a Joint Commission webinar viewed by more than 1,000 health care institutions with more than 5,000 participants.