Alarm fatigue: 5 reasons nurses may have a delayed response to alarms

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Nurses typically respond quickly when alarms are urgent and life-threatening. But a new study finds they are slower to respond to them at the end of a long shift when they suffer from chronic alarm fatigue.

Nurses typically respond quickly when alarms are urgent and life-threatening. But a new study finds they are slower to respond to them at the end of a long shift when they suffer from chronic alarm fatigue.

The study, published this week in JAMA Pediatrics, found that nurses with the fastest response times were at the earlier part of their shifts, had less than a year’s experience, only had to care for one patient, previously had responded to an alarm that needed intervention, and were reacting to an alarm for lethal arrhythmia.

The research team, led by Christopher Bonafide, M.D., of The Children’s Hospital of Philadelphia, analyzed more than 500 hours of video of 38 nurses caring for pediatric patients at the hospital’s medical unit over a 16-month period in 2014-2015. On average, they found that nurses responded in about a minute to a lethal arrhythmia alarm. But it took them a little more than 10 minutes to respond to about half of the less critical 11,745 alarms. The factors for the delayed responses varied:

Staffing: On average, nurses caring for one patient responded to the alarms in 3.5 minutes, compared with nurses who were responsible for two or more patients (10.6 minutes).

Experience: Nurses who had less than a year of experience responded more quickly (4.4 minutes) than those who had one or more years of experience (8.8 minutes).

Severity of illness: Nurses responded more quickly to patients with complex needs (5.3 minutes) than general pediatric patients (11.1 minutes).

Previous need for intervention: If nurses had previously responded to alarms that required intervention, they were quicker to respond to alarms (5.5 minutes) compared to patients who didn’t need previous intervention (10.7 minutes).

Presence of a family member: If a family member wasn’t at the bedside, nurses reacted more quickly (6.3 minutes) than when there was a family member in the room (11.7 minutes).

"The nurses were overall doing a great job predicting which alarms were going to be important," Bonafide told HealthDay. "Their intuition was correct."

But in an accompanying commentary in JAMA Pediatrics, Azizeh Khlaed Sowan, Ph.D., R.N., of University of Texas Health at San Antonio, and Charles Calhoun Reed, Ph.D., R.N., of University Health System in San Antonio, were concerned that there was such a long response time when nurses were out of the patient’s room. They said the response times were “astonishing given that the study was conducted in the leading children’s hospital in the United States, and implies much worse safety-threatening results among facilities with fewer resources."

They called on future studies to improve response times to alarms and decrease the number of nonactionable alarms.

“Understating the causes for alarm fatigue and long response time from the perspective of nurses and soliciting their suggestions for priority-fixes are important to promote adherence to and ownership of subsequent quality improvement processes,” they wrote.

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