What Is Alarm Fatigue For Nurses
In healthcare, we talk about the dangers of alarm fatigue and its consequences: It presents a threat to patients when an alarm is overlooked, and unrelenting alarms and alerts exact a toll on clinicians.
Not unlike the boy who cried wolf, as Nadine Salmon wrote on rn.com, the constant drone of beeps and buzzes, not to mention false alarms in between, can leave todays healthcare provider desensitized and in danger of missing the next alarm.
Shes right. Ive been there.
All clinicians struggle with alarm fatigue, but in this article, I address it from a nurses perspective. I’ve worked with alarms and alerts within acute settings as a caregiverand as part of a team that comes in to provide solutions to reduce the number of alarms and alerts directed at clinicians.
Understanding And Fighting Alert Fatigue
In 2013, a 16-year-old boy at one of the USs top hospitals was given a 3800% overdose of his medication.
The hospitals built-in alert system noticed the overdose order and sent alerts to a doctor and a pharmacist. And yet, a short time later, the overdose was administered and the seizures, full-body numbness, and struggle for the boys life began.
How could this happenespecially when the safety system caught the problem before the medication arrived at the boys bedside?
The answer is alert fatigue.
Both the doctor and the pharmacist ignored the systems alert because that same system generates alerts for about 50% of the hundreds of prescriptions they deal with each day. Theyd learned that most of those alerts were false alarms, and, as a coping mechanism, theyd started giving them a cursory glance at best.
And so a boy who should have taken a single pill took 38. And while he ultimately survived, the consequences to his health were significant.
Stories like these are commonand too often fatalin hospitals and the aviation industry. In fact, a 2013 survey found that 19 out of 20 hospitals rank alert fatigue as their number one safety concern.
And while the risks are different, alert fatigue is also common for IT and DevOps teams as they monitor the always-on technology that drives our businesses.
Set Tiered Alert Priorities
If not all alerts are created equal, they shouldnt show up equally in a physicians approval form, a developers inbox, or a pilots dashboard. Setting alert priorities and using visual, audible, and sensory cues to indicate importance can reduce alert fatigue by a large margin.
In the case of the 3800% overdose, a big part of the problem was that the system had very low alert thresholds and every alert was given equal priority. A .1% overdose alert looked the same as a 3800% overdose alert. And with 50% of the medication requests generating these alerts, clinicians had learned to ignore them all.
Again, the aviation industry sets a good example of not only aggressively setting tiers for their priorities, but also clearly indicating priority with a variety of visual and sensory cues. The only time a red alertwith red lights, a red text message, a voice warning, and a vibration in the steering mechanismcomes up on a pilots dashboard is if the plane is in immediate danger of a stall and the pilot must take action right away. No one wants these alerts ignored and so they get their own special category.
Other alertseven alerts that sound alarming to those of us who fly often, like an engine fire or loss of cabin pressureare downgraded to warnings , cautions , and advisories .
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How To Avoid Alert Fatigue And Burnout With Healthcare Technology
These studies may paint a grim picture around alert fatigue and clinician burnout, but theres reason to be optimistic. Healthcare technology, including informatics platforms such as Phrase Healths Interventions and Outcomes products, offer health systems tools to assess their current alerting and suggest changes to improve efficiency and patient outcomes.
With the use of clinical informatics principles and advanced data analysis, here are some recommended steps you can take right now:
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Prioritize Continuous Review And Improvement
There is no one-time, one-size-fits-all fix to alert fatigue and the dangers that come with it. Its essential to review your processes, alerts, and systems regularly to make sure youre striking the right balance.
Are alerts getting missed? If so, why? Have you set your thresholds too high or too low? Are visual cues not working? Have workers normalized the alertsand would changing their design increase attention? These questionsand others like themshould be regularly revisited.
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Cds Acceptance By Feature
For the analysis of feature acceptance, we included the 22 studies that used event analysis. Of those studies, 15 were based on CDS systems that interrupted prescribers with modal dialogs. Among the 7 alternatives, 4 presented alerts pertaining to areas such as antimicrobial stewardship or renal dosing to pharmacists, 2 delivered fax or mail alerts to prescribers,, and 1 depended on the prescriber to manually trigger a review process.
We compared those interventions that interrupted prescribers with modal dialogs with all other interventions. The group of alternative interventions included any alerts that were sent to the pharmacist instead of the prescriber, as well as any alerts that were sent to the prescriber but were not modal dialogs. Using a t test, we found that prescriber-interrupting modals were accepted significantly less often, as predicted . The acceptance rate distributions are shown in .
Boxplot comparing how often prescribers accepted advice directly from interruptive modal dialogs vs alternatives.
Our plot of acceptance rates by CDS feature is shown in . In that figure, CDSs with multiple features appear on multiple lines. For example, a CDS that interrupted prescribers with tiered modal dialogs will appear twice in the figure, once on the Modals Interrupted Prescribers line, and once on the Alerts Tiered to Convey Risk line.
What Is Alert Fatigue In Healthcare
Clinicians receive many notifications from a variety of devices, such as phones, pagers or machine-specific alerts. Machine-specific alerts come from monitors, beds, bathroom alerts, ventilators, telemetry monitors, infusion pumps, pulse oximeters and feeding pumps. Generally, a nurse may have to oversee a minimum of around 12 different alarms — and the number of alarms will only increase the sicker a single patient is. Nurses and doctors also have to care for multiple patients, meaning the number of alerts to manage can increase quickly.
A number of these alerts may be unimportant, meaning they can be ignored. However, clinicians may accidentally ignore a critical alarm that could cause harm if not properly heeded. The burnout from dealing with so many alerts could lead to mismanagement of a situation like this, which how alert fatigue shows up in healthcare.
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Reducing Alert Fatigue By Sharing Low
1Department of Manufacturing and Civil Engineering, Norwegian University of Science and Technology, Gjøvik, Norway
2Department of Computer Science, Norwegian University of Science and Technology, Gjøvik, Norway
3Department of Industrial Economics and Technology Management, Norwegian University of Science and Technology, Gjøvik, Norway
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What Is Alert Fatigue And How Can It Undermine Your Insider Risk Management Efforts
Alert fatigue is a serious threat that can derail your efforts to secure your sensitive data from insider threats.
Alerts are fundamentally important tools in security operations. They deliver important information to you and your team about events happening within your network and can help prevent major breaches from developing out of seemingly minor occurrences. However, alerts can also overwhelm your team, making it very hard to cut through the noise and find the real threats that need to be acted upon. Alert fatigue is the term we use to describe this state of mind within an insider risk management team. Here are some of the ways alert fatigue can undermine your efforts to secure your sensitive data from insider threats.
Optimizing Or Eradicating Low
Clinician burnout and EHR fatigue caused by alerts have been an issue for clinicians struggling with EHR usability overload.
Although EHR alerts can offer providers practical suggestions and updates, EHR alert fatigue has been an issue for clinicians already struggling with EHR usability problems. Low-value EHR alerts can disrupt patient care and contribute to clinician burnout.
At Brigham and Womens Hospital, clinicians were getting roughly one alert for every two medication orders, and clinicians were overriding an astounding 98 percent of the alerts.
One of the big issues is that many of the clinical systems that are in routine use today, alert too frequently, David Bates, MD, chief of the Division of General Internal Medicine at Brigham and Womens Hospital, said in an interview with EHRIntelligence. When clinicians are overriding that high a proportion of alerts, clinicians get very used to closing the alert, and sometimes they arent fully processing what the alerts are saying and they tend to stop paying attention to the important alerts.
Unsatisfied with how their EHR vendor fired off alerts, Bates and his health IT team tapped Seegnal eHealth to leverage its EHR alert solution and conduct an EHR alert study at the hospital.
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Why Does Alert Fatigue Matter To Process Manufacturing Plants
Alert fatigue can result in:
- Stressed-out employees, due to high adrenaline levels which cause them to feel overwhelmed.
- High burnout and churn rates as employees feel unable to cope with the stress.
- Real part, process, and/or safety issues going undetected when employees turn off alerts to reduce being overwhelmed with alerts.
- Employees using arbitrary means to decide which alerts to respond to, since they cant deal with them all.
- Workers becoming desensitized to alerts, causing them to fade into the background noise and no longer produce any response at all.
Once employees are unable to respond appropriately to alerts, theres a high risk that problems go overlooked and develop into serious incidents which can threaten employee safety, cause significant environmental harm, and/or result in costly damage to the plant.
The Real Challenge Is Maintained And Updated Content
The panellists emphasised that, where information has been too sparse, or unreliable and in too great a volume it can hinder, rather than help an already overstretched healthcare team.
The content thats needed for the workflow is whats generally missing from organisations, said Elseviers Nieves. So, when designing systems, the real challenge is making sure that you have content thats maintained and updated readily and quickly within the workflows, together at the right time, right place and in the right context.
We have to think holistically – not only of physician workflow, nursing workflow and the allied health workflow, but also patient education and patient needs, as well as that of the caregivers. All these elements have to line up and this will lead to an efficient system.
While the information challenge during the COVID-19 pandemic is huge, Dr Chagla also sees opportunity to get prepared now for future crises.
Necessity being, of course, the mother of invention, the pandemic has been a catalyst for a much-needed transformation within our industry, said Dr Chagla. It has allowed us to grow as an industry. It has made us think outside the box on different things and as we go on, we learn, and we will improve.
Data Extraction And Analysis
Results will be taken from the included papers, including appendices where appropriate, and will be imported into analysis software . Inductive thematic analysis will then be performed to form overarching third order themes. To enable this, we will use the three stages described by Thomas and Harden in the thematic synthesis of qualitative research. The first is the coding of the findings of the primary studies. The second is the categorisation of these codes into descriptive themes. The third is development of analytical themes to describe the themes that have emerged in the second phase. The approach we adopt will be inductive, i.e. themes emerge from the data through repeated examination and comparison. The emerging descriptive themes will be analysed in consideration of the contextual factors, i.e. healthcare context, setting and reminder usage within clinical decision systems to assess if these contextual factors have any impact upon the ensuing analytical themes. The findings will be verified by utilising independent coding by two reviewers, the triangulation of these codes and iterative discussions amongst all reviewers of the coding framework at each of the three phases of the analysis.
The Downside Of Ehr Alerts
Not all clinicians agree EHR alerts increase productivity and efficiency. Theyre often overwhelmed by the sheer number of alerts, many of which do not provide clinically significant information. This 2019 study showed three main findings in regards to EHR alerts:
- They may be ineffective if they are inappropriately deployed
- Alert fatigue is common clinicians override the vast majority of EHR alerts
- As EHR alert volume increases, so does alert fatigue – and thats just one of many factors causing clinician burnout.
In fact, were in the midst of an epidemic of burnout among healthcare professionals, and its no wonder why. The COVID-19 pandemic has only compounded the issues clinicians were already facing, adding mental health challenges to a growing list of burnout factors, including:
- Frustration with EHR system design, cost, and maintenance
- Less time for 1-on-1 patient interaction
- Longer workdays
- Demands of meeting clinical quality measures
Even worse, alert fatigue doesnt just affect clinicians. The downstream effects are vast, impacting numerous stakeholders within each health system, including anyone who participates in clinical workflows like medical assistants, unit secretaries, and more. This systemic numbness to alerting means that the next important alert that the user actually needs to pay attention to may go unheeded when their mental model for alerts summarizes simply: this is noise.
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Recommendations For Future Work
Given the preceding discussion, we propose the following 3 recommendations for future CDS research:
First, we recommend that researchers consider alternatives to prescriber-interruptive modal dialogs, since there is evidence that the latter suffers from relatively lower acceptance. Role-based tailoring appeared to improve acceptance rates, and further work is needed in this area. Ideally, those who will receive the alerts should be involved in role-tailoring decisions. Alternatives to modal dialogs should also be explored.
Second, recommend measuring acceptance rates using event analysis, rather than in-dialog action analysis. Because event analysis is more widely applicable, using it will enable meta-analyses that accommodate varied CDS interventions.
Last, we recommend reporting both acceptance rates and patient outcomes. Much of the literature that we saw in our review reported one or the other few reported both. This has made it difficult to analyze patient outcomes as a function of CDS design and role-tailoring, mediated by acceptance.
Reducing Alert Fatigue: A Labor & Delivery Clinicians Perspective
Hospitals place patient safety at the top of their strategic initiatives. This has resulted in the development of medical devices and surveillance systems that emit visual and auditory warnings to alert clinicians to potentially unsafe conditions. However, when too many happen during a clinicians shift, they can develop alert fatigue and become desensitized to them. This compromises patient safety.
Alert fatigue is a hospital buzzword and has become an industry problem. In an OB unit, a steady stream of alerts emitted from IV controllers, epidural pumps, blood pressure cuffs, fetal monitors, pre- and post-op leg compression devices, and central surveillance monitors create a constant barrage of noise. All of this, coupled with day-to-day activities on the unit, can consume a clinicians time and mental energy. Door alarms, pagers and overhead announcements add to the chaos.
These items are typically produced by multiple companies, so they arent designed to integrate with one another. This results in a barrage of alerts sounding simultaneously and competing for a clinicians attention. Compounding the problem is a lack of industry standards specifying volume and pitch. While some companies may take into consideration the desired, low noise level in a hospital, others may set the volume higher than necessary to ensure their alerts are noticed. Additionally, many of the alerts sound similar, so it can be challenging to quickly differentiate them.
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