Commentary

Silencing the Noise Without Sacrificing Safety

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The machines measure every vital sign, every drip of fluid, every drop excreted. Each has an associated noise “informing” us that the event has occurred at the appropriate time. The never-ending chimes, bells, and buzzers echo throughout the halls of hospitals where patients are supposed to be resting and recovering. As each machine announces the patients’ progress, the cacophony increases and violates the healing environment, creating anxiety for both the patients and the nursing staff.

Anyone who has spent a night in the hospital, either as a patient or at the bedside of a loved one, knows all those sounds are disturbing. They interfere with sleep, interrupt calming positive thoughts of healing, and cause worry about what is happening to other patients or what the noise from one’s own machine means.

Years ago, there were signs in the hospital reminding us “the patient must have absolute quiet.” Even then we knew, perhaps only tacitly, that undisturbed sleep of adequate duration is required to recover from illness or surgery (patients) or maintain our performance and health (hospital staff).

More recently, research has shown that the most powerful disruptors of sleep are automatic noises designed, intentionally, to alert, even when the signaling devices are on a quiet setting.1,2 The hospital, once considered a quiet zone, is now a chaotic riot of distracting noise. Clearly, one would not describe this scenario as conducive to healing.

Alarm systems, designed to alert caregivers to potential problems with a patient, have increased over time—and with them, the noise level. There are now so many different alarms that we have become inured to them. This desensitization, known as alarm fatigue, can lead to inappropriate responses to the alarms. In some cases, this has included decreasing the alarm volume, disabling the alarm, or setting the alarm beyond safety limits.3

As a result, the problem is far more serious than the distraction or disruption the noises cause. Between 2005 and 2008, the FDA received 566 reports of patient deaths related to the alarms on monitoring devices.4 In one case highlighted by the agency, an infant died when staff overlooked the visual cues on its heart rate monitor; it turned out that the audible alarm notification had not been set up. In another, a patient on continuous cardiac monitoring experienced ventricular fibrillation and died without her monitor issuing an alert. Although the monitor had detected the problem, its dysrhythmia processing had been turned off.

The FDA and the Association for the Advancement of Medical Instrumentation jointly convened a summit to investigate this disconcerting issue in October 2011. They recognized a window of opportunity to place the hazards and frustrations of alarm fatigue on the safety agenda. The committee emphasized the need to keep the focus on patient safety first and foremost, as this will provide a sense of urgency to the issue, and outlined an ambitious goal that by 2017, “no patient will be harmed by adverse alarm events.”5

So what exactly is alarm fatigue? Continue reading to find out...

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