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 clinician’s 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 clinician’s time and mental energy. Door alarms, pagers and overhead announcements add to the chaos.
These items are typically produced by multiple companies, so they aren’t designed to integrate with one another. This results in a barrage of alerts sounding simultaneously and competing for a clinician’s 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.
Another problem might occur when an alert is too loud or irritating. A clinician may be inclined to turn it off prior to considering appropriate action. This could put a patient at risk. It can also be misconstrued as an acceptable work practice when mentoring a new or less experienced nurse.
Every alert serves a distinct purpose—to bring attention to a potential patient health issue. The challenge is to help clinicians better manage the large number of alerts they encounter every day.
The following steps can help minimize alert fatigue:
Adjust alert settings. Not all system alerts can be modified, but some customization may be possible, including the volume, frequency, and evaluation parameters based on the clinical situation of a patient.
For example, if a laboring patient arrives on unit with a fever, they may have a baby whose fetal heart rate (FHR) is running higher than normal due to the maternal fever. While the standard procedures are being followed, including notifying the physician, increasing fluids, and infusing antibiotics, experienced clinicians know it would not be unusual for the FHR to remain high.
Rather than hear the audible FHR alert sound repeatedly, the clinician may decide to “individualize” the alert parameter to a more appropriate and reasonable baseline setting for that patient. This minimizes the number of alerts regarding that patient and helps reduce alert fatigue for all of the clinicians on the unit.
Some devices can go one step further and indicate a parameter reset as well, prompting clinicians to give report or shift change notification of a personalized alert for that same patient. As always, communicating the rationale for a setting change to co-workers is necessary for continuity of care. Personalized alerts should be returned to default settings when a patient’s clinical situation returns to normal baseline parameters.
Please note that policies and procedures should be in place to support clinical judgements that lead to the adjustment of device settings. It must be stressed that the volume on patient device alerts should never be completely turned off.
Review alert indicators. Clinicians should receive high-quality training to ensure new users and those with less experience understand all medical device alert indicators and how to respond, especially following a new system installation or upgrade. A formal process in place to check for correct alert functionality is recommended.
Clinicians must fully understand all the devices that are utilized on the OB unit and what they are trying to communicate. Is it an IV close to infused? Is it a BP cuff not able to fully inflate? Is it a baby out of range of unit safety? Unit managers should also provide in-services, medical device manuals, and tutorials, so clinicians are never caught swimming in a sea of bells and whistles without understanding what they mean.
Adequately staff the unit. Make sure there are always enough clinicians to respond to alerts, or designate one clinician on each shift to primarily oversee alert conditions. This is a customary practice in ICU and telemetry units. Having a clinician who is solely responsible for responding to alerts, and then notifying the care provider assigned to the patient, can help minimize everyone’s stress level.
Following the recommended Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) guidelines for staffing the unit, based on census and acuity, is important for response time to alerts.
Make environmental changes. Noise control should be taken into consideration when making facility improvements or designing a new space. This could include the installation of absorptive ceiling tiles and walls that feature sound-deadening materials that minimize noise transfer, repositioning remote speakers within larger units, and exploring wearable alert notification devices.
Overall, medical devices and surveillance systems provide valuable assistance when caring for mothers and babies, but clinicians are ultimately responsible for patient care and safety. They determine interventions based on their critical thinking skills and experience. For that reason, soliciting their input when discussing ways to reduce alert fatigue is very valuable. When alerts are properly managed clinicians are better able to remain focused on the well-being of all their patients. Positive outcomes are always a clinician’s goal, and they can be achieved when medical device alerts are used correctly.
Co-authored by Rosanne McMahon, RN, BSN, and Patricia Sims of Clinical Computer Systems, Inc., makers of the OBIX Perinatal Data System. To learn more about OBIX, visit www.obix.com or follow us on Twitter @OBIXperinatal.