Occlusion Alarms and Alarm Fatigue in the NICU

 

Providing developmentally appropriate care to critically ill newborns is a priority in the neonatal intensive care unit, which includes a provision of quiet environment with low levels of stimulation.

But walk into any NICU in the world, and you will hear a plethora of sounds: caregivers communicating, phones ringing, equipment alarming, pagers going off, and parents speaking quietly to their premature babies.

One area in particular that presents a great challenge in is in the use of alarms and alarm fatigue.

Alarm fatigue occurs when clinicians are exposed to an overwhelming number of alarms, causing a heightened sensory impact resulting in desensitization. Talk to any nurse who has cared for a baby with bronchopulmonary dysplasia and ask her about the frequency with which the pulse oximeter alarms. Or a NICU nurse who is attending to a patient with a radial arterial line that is sensitive to movement. They can explain the challenges of alarm fatigue.

Unfortunately, with so many alarms competing for the nurse’s attention, a “cry wolf” effect, or a lowering of attention to alarms and missed alarms, can occur. Consequences of such an effect include patient injury and death.1 Patient safety and regulatory agencies have focused on the issue of alarm fatigue, and it is a 2016 Joint Commission National Patient Safety Goal to “reduce the harm associated with clinical alarm systems.”2

Many regulatory agencies and researchers have addressed the growing issue of alarm fatigue. Some of the recommendations include opportunities for improvement involving partnerships with the medical device industry.3

According to Association for the Advancement of Medical Instrumentation (AAMI): “the industry should be brought in to be a part of the alarm management work group, so that all parties understand the complexity of the work and what is needed to promote patient safety by designing safer systems.”

This is a complex issue and has potential consequences for caregivers. One culprit is often the enteral feeding pumps. When looking to incorporate new enteral syringe pumps in your unit, there are three considerations to help reduce alarm fatigue:

1. Customizable settings which can be calibrated for your NICU preferences
2. Visual lights to indicate which pump is alarming
3. Different sound levels to meet your NICU needs

These considerations can be implemented to directly reduce the repetition of alarms, which can contribute to alarm fatigue and distraction.

Alarm fatigue is a real and potentially life-threatening issue. It’s important for nurses to talk to vendors of all alarming equipment and ask what measures can be taken to continue to improve the quality and safety of patient care.

Learn more about the Medela Enteral Feeding Pump

References:

1. Sendelbach, S., & Funk, M. (2013). Alarm Fatigue A Patient Safety Concern. AACN Advanced Critical Care, 24(4), 378-386. Retrieved June 18, 2015, from PubMed.

2. https://www.jointcommission.org/hap_2016_npsgs/

3. Association for the Advancement of Medical Instrumentation. Clinical alarms: 2011 summit . http://www.aami.org/publications/summits/2011_Alarms_Summit_publication.pdf . Updated 2011. Accessed January 14, 2013.