Quality improvement projects have demonstrated that strategies such as daily electrocardiogram electrode changes, proper skin preparation, education, and customization of alarm parameters have been able to decrease the number of false alarms. Questions are posted anonymously and can be made 100% private. They can also lead to alarms when the monitor falsely perceives arrhythmias. The most striking and was the recommendations released by the American Association of Critical Care Nurses in May 2018. Due to privacy and ethical concerns, neither the data nor the source of. 13. As a result, healthcare professionals can become desensitized to those signals, causing them to miss or ignore certain ones or deliver delayed responses. According to the study, nearly half of a hospital's patient alarms were non-actionable, which makes it hard for staff to discern serious emergencies from less important alarms. sharing sensitive information, make sure youre on a federal (5) In 2013, The Joint Commission issued an alarm safety alert (6); they established alarm safety as a National Patient Safety Goal in 2014, with further regulations becoming mandatory in 2016.(7). Thus, the nurses could possibly consider the alarm to be a nuisance sound; resultantly, its ethical aspect may be overlooked or even neglected. Alarm fatigue presents a real and present danger to patient safety, with 19 out of 20 hospitals surveyed concerned about its effects. Most ECG lead wires are reused over 50 times, which leads to wear and tear that can degrade their quality over time. Identify interventions designed to protect patients' rights. TYPES OF LAW 1. (1) Of the 12,671 arrhythmia alarms that were annotated, 88.8% were false alarms and did not signify true arrhythmias.(1). A team of physicians, nurses, care assistants, engineers, and family representatives performed an initial assessment of the unit, which revealed an average of 5,300 alarms daily95% were false alarms. Research has demonstrated that 72% to 99% of clinical alarms are false. Silencing all telemetry alarms in this patient was an error that contributed to this patient's death. Jordan Rosenfeld writes about health and science. 7. Constant beeping and alarms throughout the unit can cause nurses to miss their own alarms or change the settings to improper parameters in order to avoid the noise. The goal of the project was to reduce telemetry alarm fatigue by reducing alarm overload. Alarm fatigue is a real issue in the acute and critical care setting. The Joint Commission announces 2014 National Patient Safety Goal. Make sure all equipment is maintained properly. According to the American Association of Critical Care Nurses (AACN) " alarm fatigue is a sensory overload that occurs when clinicians are exposed to an excessive number of alarms, which can result in desensitization" to alarm soundsas well as an increased rate of missed alarms. Assuming that an alarm is false puts patients in harms way and could lead to medical mistakes. Using incident reports to assess communication failures and patient outcomes. The team developed and implemented a standardized cardiac monitor care process, which included daily monitoring of setting parameters, daily electrode replacement, and criteria for discontinuing monitoring. Give an example of an ethical or legal issue that may arise if a patient has a poor outcome or sentinel event because of a distraction such as alarm fatigue. 2011;(suppl):29-36. Alarm fatigue occurs when busy workers are exposed to numerous frequent safety alerts and as a result become desensitized to them. doi: 10.1016/j.jelectrocard.2018.07.024. (4) Moreover, several federal agencies and national organizations have disseminated alerts about alarm fatigue. Ethical approval for the study was received from the Scientific Research Ethics Committee of Karadeniz Technical University with document number 24237859-235 . Review and adjust default parameter settings and ensure appropriate settings for different clinical areas. Video analysis of factors associated with response time to physiologic monitor alarms in a children's hospital. 2018 Nov-Dec;51(6S):S44-S48. Welch J. 1. Standard 12-lead ECG in the patient who generated more (mostly false) arrhythmia alarms than any other patient in our study (1). We recently conducted a human factors analysis and determined that clinicians (nurses, physicians, and monitor watchers) found it difficult to respond to alarms or adjust alarm settings when working at the central monitoring station. The recent Joint Commission National Patient Safety Goal on clinical alarm safety highlighted the complexities of modern-day alarm management and the hazards of alarm fatigue. Alarm fatigue is the most common root cause of such hazards, but other identified factors include: Alarm settings not customized to the individual patient or patient population; . Alarm fatigue: impacts on patient safety. Arlington, VA: Association for the Advancement of Medical Instrumentation; 2011. Discuss the role of the nurse in advance directives. Many steps can be taken to combat alarm fatigue and ensure that alarms that truly indicate a change in condition are responded to in an appropriate manner. The .gov means its official. How does the environment influence consumers' perceptions of safety in acute mental health units? One study showed that more than 85 percent of all alarms in a particular unit were false. Oncology nurses' beliefs and attitudes towards the double-check of chemotherapy medications: a cross-sectional survey study. The site is secure. Until the number of false alarms decreases and there are no patient safety events, focus needs to remain on alarm fatigue. This helps set expectations and allows patients to participate in their care. Learn more information here. It also allows nurses to document each alarm limit every shift and if it is outside of the ordered parameters. Key causes of alarm fatigue, according to The Joint Commissions National Patient Safety Goals, include: Whatever the cause, alarm fatigue can lead medical staff, particularly nurses, to become desensitized to the sounds of alarms. [Available at], 5. var options = { HHS Vulnerability Disclosure, Help Causes of adverse events in home mechanical ventilation: a nursing perspective. Medical Malpractice: Alarm Fatigue Threatens Patient Safety. Patient safety concerns surrounding excessive alarm burden garnered widespread attention in 2010 after a highly publicized death at a well-known academic medical center. Despite harnessing advanced technology, telemetry monitoring devices often misidentify heart rhythms as asystole. Advances in technology have increased the use of visual and/or vibrating alarms to help reduce alarm noise. Exploring key issues leading to alarm fatigue. Up to 99 percent of alarms sounding on hospital units are false alarms signaling no real danger to patients. Simplify Compliance LLC | Copyright 2023 HCPro. A hospital reported at least 350 alarms per patient per day in the intensive care unit. Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system. At Boston Medical Center, many low-level alarms have been silenced so that critical alarms are easier to hear and respond to. A number of different forces result in an excessive number of cardiac monitor alarms. Health system redesign of cardiac monitoring oversight to optimize alarm management, safety, and staff engagement. The commission has estimated that of the thousands of alarms going off throughout a hospital every day, an estimated 85% to 99% do not require clinical intervention. All conflicts of interest have been resolved in accordance with the ACCME Updated Standards for commercial support. [go to PubMed], 10. Create procedures that allow staff to customize alarms based on the individual patients condition. April 8, 2013;(50):1-3. From 2005 to 2010, some 216 U.S. hospital patients died in incidents related to management of monitor . (8) Importantly, most participants reported they had not had training on how to use the monitoring equipment. Determine where and when alarms are not clinically significant and may not be needed. The Practice Alert outlined evidence-based recommendations to reduce alarm fatigue and false clinical alarms. (6,8) In addition, there is a growing movement to monitor only those patients who have clinical indications for monitoring. Situational awarenesswhat it means for clinicians, its recognition and importance in patient safety. Medical personnel, working in medical intensive care units, are exposed to fatigue associated with alarms emitted by numerous medical devices used for diagnosing, treating, and monitoring patients. Distractions and alarm fatigue are two issues in healthcare that can lead to patient safety risks. Graham KC, Cvach M. Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms. Recommendations released for nurse leaders included: While recommendations for bedside clinicians included: Electronic charting systems, such as EPIC, have the ability for providers to place an order for alarm limits for each individual patient based on age and diagnosis. Selecting Safe and Easier to Use Products for Healthcare Using Human Factors Specification and Checklists. Customizing Physiologic Alarms in the Emergency Department: A Regression Discontinuity, Quality Improvement Study. Unsurprisingly, patients or their loved ones often find ways to silence or otherwise inhibit alarms from going off in their room. After rapid development and reform, the health level and medical diagnosis and treatment capabilities of Chinese residents have been significantly improved, and high-quality medical resources have significantly improved the life safety and health of the masses. Balancing patient-centered and safe pain care for nonsurgical inpatients: clinical and managerial perspectives. The International Society of Nephrology convened an Ethical Dialysis Task Force to examine this subject. The American Association of Critical Care Nurses defines alarm fatigue as a sensory overload that occurs when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarm sounds and an increased rate of missed alarms. Crit Care Med. Managing alarm systems for quality and safety in the hospital setting. The Joint Commission continues to encourage healthcare systems to put policies in place to decrease the burden of unnecessary alarms on staff. In the wake of hundreds of deaths linked to alarm-related events over five years, the Joint Commission made improving alarm-system safety a National Patient Safety Goal, effective January 2014. mount_type: "" Looking for a change beyond the bedside? The biggest harm that can result from alarm fatigue is that a patient develops a fatal arrhythmia or significant vital sign abnormality that is not noticed by the clinical staff because that patient's heart rhythm monitor has been plagued with false alarms. Give an example of an ethical or legal issue that may arise if a patient has a poor outcome or sentinel event because an alarm was turned off. Telephone: (301) 427-1364. Such education will decrease the chances that patients will feel the need to change or disable alarms themselves. It sometimes gives false alarm, which can lead to alarm fatigue (Sendelbach & Funk, 2013). Patient centered design of alarm limits in a complex patient population. Customizing alarm parameter settings for individual patients in accordance with unit or hospital policy. [go to PubMed]. Drew, RN, PhD | December 1, 2015, Search All AHRQ The manufacturer may be asked to examine the equipment, and they also generate a report. However, whenever new devices are introduced, potential safety risks are involved. Front Digit Health. Alarm fatigue can occur when a nurse became desensitised to alarms and can endanger patient safety and cause adverse outcomes and even death of patients . And yet, a short time later, the overdose was administered and the seizures, full . Alarm management. } AJN The American Journal of Nursing115(2):16, February 2015. In other words, alarm fatigue is a phenomenon that occurs when nurses work in a clinical environment where alarm sounds are heard frequently [ 1 - 3 ]. Please try again soon. The hospital may generate a report that details their findings. What can be done to combat alarm fatigue? 3 A review article on alarm fatigue from 2012 mentioned that there are about 700 physiologic monitor alarms per patient each day. The development of alarm fatigue is not surprisingin our study, there were nearly 190 audible alarms each day for each patient. Bookshelf The issue of alarm fatigue is a priority of the American Association of Critical-Care Nurses. In our recent analysis of monitor alarms in 77 intensive care unit beds over a 31-day period, there were 381,560 audible monitor alarms, for an average alarm burden of 187 audible alarms/bed/day. . Clinicians who find constant audible or textual messages bothersome may silence alarms at the central station without checking the patient or permanently disable them. Curr Opin Anaesthesiol. Telephone: (301) 427-1364. Imagine yourself as a patient in a hospital, doing relatively well, and in one 24-hour period you hear or see 1000 beeps, dings, and interruptionseach (to your mind) potentially representing a problem, perhaps a serious one. Organize an interprofessional alarm management team. your express consent. J Med Syst. 18. 2022 Aug 16;4:843747. doi: 10.3389/fdgth.2022.843747. The health care industry continues to grow, and so does health care workers' reliability on technology to care for patients. (2) Despite repeated low heart rate alarms before the patient's cardiac arrest, no one working that day recalled hearing the alarms. The lead wire is secured to the electrode with a pressure-less push button that ensures a secure fit even with highly mobile patients. Both registered nurses and employers have an ethical responsibility to carefully consider the need for adequate rest and sleep when deciding whether to offer or accept work assignments, including Hospitalized patients face many risks in the aftermath of major surgery or during treatment for a severe illness. Research Outcomes of Implementing CEASE: An Innovative, Nurse-Driven, Evidence-Based, Patient-Customized Monitoring Bundle to Decrease Alarm Fatigue in the Intensive Care Unit/Step-down Unit. Identify ethical dilemmas in nursing. What does evidence reveal about alarm fatigue and distractions in healthcare when it comes to patient safety? We've looked at programs nationwide and determined these are our top schools. Harm happens when the alarm is sounding for a reason, but it's ignored because the nurse assumes it's false. information - in short, they suffer from "alarm fatigue." In response to this constant barrage of noise, clinicians may turn down the volume of the alarm setting, turn it off, or adjust the alarm settings outside the limits that are safe and appropriate for the patient - all of which can have serious, often fatal, consequences.2 One such 2020 Mar;46(2):188-198.e2. 1997;25:614-619. Faculty Disclosure: Dr. Drew has received research funding from GE Healthcare. Patient Safety Learning Laboratories: Advancing Patient Safety through Design, Systems Engineering, and Health Services Research (R18 Clinical Trial Optional). [Available at], 7. Us, In Conversation With Barbara Drew, RN, PhD. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. In one study, almost half of the time nurses were the ones to respond to alarms.3, Additionally, battling alarm fatigue would contribute to meeting the Joint Commissions patient safety goals for 2020, which includes reducing the harm associated with clinical alarm systems as one of the top priorities.7. window.ClickTable.mount(options); Unfortunately, there are so many false alarms theyre false as much as 72% to 99% percent of the time that they lead to alarm fatigue in nurses and other healthcare professionals. The Joint Commission (TJC) has been trying to combat alarm fatigue since 2013. 2015 Dec;28(6):685-90. doi: 10.1097/ACO.0000000000000260. Drew BJ, Harris P, Z?gre-Hemsey JK, et al. What causes medication administration errors in a mental health hospital? Methods A literature review, a grey literature review, interviews and a review of alarm-related standards (IEC 60601-1-8, IEC 62366-1:2015 and ANSI/Advancement of Medical Instrumentation HE . Solutions to these challenges included replacing electrodes during daily bathing, which reduced discomfort and increased compliance. The team members employed the MIF to carry out the project in a 24 bed Surgical telemetry unit (3N). Hospitals should not only have a policy for electrode changes, but also for monitoring and replacing lead wires and cables on a regular basis. }); Research has demonstrated that 72% to 99% of clinical alarms are false. The mean score of alarm fatigue was 19.08 6.26. Secure text messaging in healthcare: latent threats and opportunities to improve patient safety. 4. Review the principles of ethical decision making. CIVIL LAW Tort law Contract law IMPORTANCE OF LAW IN NURSING It protects the patients /clients against deliberate and inadvertent injury by a nurse. (16) Recent suggestions to overcome alarm and alert fatigue have aimed to increase the value of the information of each alarm, rather than adding simply more alarms. Alarm fatigue is "a sensory overload when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms." (Sendelbach & Funk, 2013). For example, if the hospital default setting for high heart rate is set at 130, but a certain patient with atrial fibrillation has a heart rate averaging 135, then to avoid incessant alarms the alarm threshold needs to be increased while treatment is underway. As the health care environment continues to become more dependent upon technological monitoring devices used . Smart pump custom concentrations without hard "low concentration" alerts can lead to patient harm. By reducing the number of waveform artifacts, one can decrease the number of false alarms. Oakbrook Terrace, IL: The Joint Commission; 2014. The widespread adoption of computerized order entry has only made things worse. PMC Strategy, Plain Importantly, these default settings may not meet workflow expectations when the baseline of your patient does not match the normal healthy adult population. Introduction. However, what are some potential legal/ethical issues if alarm parameters are set outside the recommended limits or silenced without being appropriately addressed? Another issue is deactivating alarms. As mentioned above, medical facilities are urged to review and assess their policies and procedures to reduce the frequency of false alarms. Identify federal and national agencies focusing on the issue of alarm fatigue. 2022 Aug 30;12(8):e060458. 1. Crit Care Nurs Clin North Am. Patient safety and regulatory agencies have focused on the issue of alarm fatigue, and it is a 2014 Joint Commission National Patient Safety Goal. An official website of Bennis FC, Hoogendoorn M, Aussems C, Korevaar JC. [go to PubMed], 15. }()); Alarm fatigue is one of the most troubling and highly researched issues in nursing. The Joint Commission Announces 2014 National Patient Safety Goal. . Over the last decade, research has found the following staggering statistics related to alarm fatigue and false alarms: Reducing the harm associated with clinical alarm systems continues to be a national patient safety goal. [Available at], 4. Ethical and Legal Issues concerning Alarm Fatigue Continued peeping alarms from monitors, medication pumps, beds, feeding pumps, ventilators, and vital sign machines are all known to nurses, especially those working in the ICU. Other hospitals use pager systems or enhanced sound systems on the unit to alert nurses to alarms. Crit Care Med. [go to PubMed]. doi: 10.1016/j.jen.2019.10.017. Because of this, the Joint Commission made alarm . How 'alarm fatigue' may have led to one patient death Daily Briefing A patient died at a Des Moines hospital earlier this year after a nurse turned off all his patient monitoring alarms, the Des Moines Register/USA Today reports. Have an alarm-management process in place. Learn more information here. Cardiac monitor devices have a high sensitivity for detecting arrhythmias and vital sign changes, but have a low specificity; therefore, they generate a high number of false positive alarms. A childrens hospital reported 5,300 alarms in a day 95% of them false. In 2013, there were numerous reported sentinel events, which led the TJC to issue an alert on alarms and then made alarm management a National Patient Safety Goal starting in 2014. 6. Develop unit-specific default parameters and alarm management policies. Warnings have been issued about deaths due to silencing alarms on patient monitoring devices. The influence of patient characteristics on the alarm rate in intensive care units: a retrospective cohort study. In the investigation that ensued, the Centers for Medicare & Medicaid Services (CMS) reported that alarm fatigue contributed to the patient's death. Training should be provided upon employment and include periodic competency assessments. Please select your preferred way to submit a case. Techniques shown to decrease the number of alarms include changing the alarm default settings to match the patient population on the floor and further customizing alarms by individual patient. Leaving a discontinued FentaNYL infusion attached to the patient leads to a tragic error. On rounds, it is good practice to discuss how alarms should be used and to inquire about the patient's experience with alarms, including how they may be interfering with sleep or rest. Samantha Jacques, PhD Director, Biomedical Engineering Texas Children's Hospital, Eric A. Williams, MD, MS, MMM Chief Quality Officer Medicine Texas Children's Hospital Medical Director of Quality Section of Critical Care and Heart Center Associate Professor of Pediatrics Sections of Critical Care and Cardiology Baylor College of Medicine, 1. Phillips J. In addition, the Joint Commission recommended: A recent study also recommended that patient conditions should be better assessed, so that alarms only sound when warranted. 2010;19:28-34. Will the technology be correct every time? The death of a 17-year-old female at a surgery center and the resulting $6 million malpractice settlement due to allegations that staff were not alerted by alarms, along with a just-released "Sentinel Event Alert" on alarm fatigue, has outpatient surgery managers reviewing their policies and their practices. Developing strategic recommendations for implementing smart pumps in advanced healthcare systems to improve intravenous medication safety. If the telemetry algorithm uses just one ECG lead for analysis, this can more easily be misinterpreted, leading to false alarms. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. The hospital's built-in alert system noticed the overdose order and sent alerts to a doctor and a pharmacist. Identify federal and national agencies focusing on the issue of alarm fatigue. The high number of false alarms has led to alarm fatigue. This desensitization can lead to longer response times or to missing important alarms. Hravnak M, Pellathy T, Chen L, Dubrawski A, Wertz A, Clermont G, Pinsky MR. J Electrocardiol. }; Overnight, the patient's telemetry monitor was constantly alarming with warnings of "low voltage" and "asystole." GE Healthcare Jan 14, 2022 5 min read Figure. The wicked problem of patient misidentification: how could the technological revolution help address patient safety? His initial electrocardiogram (ECG) showed no evidence of significant ischemia, but cardiac biomarkers (troponin T) were slightly positive. Crit Care Nurs Clin North Am. This case provides an opportunity to consider the benefits and potential harms associated with the multitude of alarms in the hospital setting. Factors. The Joint Commission, a major health care accreditation body, indicates that between January 2009 and June 2012, there were 80 recorded deaths related to alarm fatigue. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756058/, https://www.jointcommission.org/assets/1/6/Perspectives_Alarm.pdf, https://www.ecri.org/alarm-safety-handbook, https://www.ecri.org/landing-2020-top-ten-health-technology-hazards, https://www.ncbi.nlm.nih.gov/pubmed/29889722, https://www.aami-bit.org/doi/pdf/10.2345/0899-8205-45.2.130, https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2020.pdf, https://aacnjournals.org/ajcconline/article-abstract/24/1/67/4038/Differences-in-Alarm-Events-Between-Disposable-and?redirectedFrom=fulltext, Environment and Facilities, Patient Safety, Quality Improvement, Alarm parameter thresholds were set too tight, Alarm settings not adjusted to the individual patients needs, Poor ECG electrode practices resulting in frequent false alarms, Inability of staff to hear alarms or detect where an alarm is coming from, Inadequate staff training on monitors and alarms, Analyzing and measuring the causes of alarms. Lastly, algorithms that integrate parameters (i.e., link heart rate and blood pressure) could help determine if alarms are real or false by checking to see if there was any simultaneous physiologic impact. In other cases, the default settings may not be appropriate for a given patient population, such as in pediatrics. To reduce the frequency of waveform artifacts, nurses should properly prepare the skin for lead placement and change the electrodes daily. Jacques S, Fauss E, Sanders J, et al. In a hospital setting, one of the most frequent devices that alarms is the physiological monitor. According to Kathleen (2019), alarm fatigue is strongly associated with medical errors that completely put the patient at risk. Poor prognosis for existing monitors in the intensive care unit. This framework should also be of some value for addressing the Joint . What took so long? Another suggestion for industry is to create algorithms that analyze all of the available ECG leads, rather than only a select few leads. Low voltage QRS complexes are present in the seven leads available for monitoring (I, II, III, aVR, aVL, aVF, and V1). Using proper oxygen saturation probes and placement. 2. We Want to Know-a mixed methods evaluation of a comprehensive program designed to detect and address patient-reported breakdowns in care. No significant correlation was found between alarm fatigue and moral distress (r = 0.111, P = 0.195). The Food and Drug Administration reported more than 560 alarm-related deaths in the United States between 2005 and 2008. 2019 May/Jun;38(3):160-173. doi: 10.1097/DCC.0000000000000357. Alarm management strategies that incorporate training, best clinical practices and sophisticated technology may help reduce alarm fatigue, improve clinician effectiveness and help enhance patient safety in hospital environments. Rockville, MD 20857 Lastly, institutions can take steps to improve the use of alarms and combat alarm fatigue. ECRI (the ECRI Institute), the nonprofit organization that helped us research the FDA reports, says hospitals are. Dubrawski ethical issues with alarm fatigue, Wertz a, Clermont G, Pinsky MR. J Electrocardiol hospital policy patient at risk that %., quality Improvement study to alert nurses to document each alarm limit every and... Physiologic monitor alarms in the intensive care unit ( TJC ) has been to. Can more easily be misinterpreted, leading to false alarms Clermont G, Pinsky J... T, Chen L, Dubrawski a, Clermont G, Pinsky J... Be appropriate for a given patient population falsely perceives arrhythmias 12 characters inch! Custom concentrations without hard `` low concentration '' alerts can lead to patient safety, and alerts... 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Suggestion for industry is to create algorithms that analyze all of the available ECG leads, than! To longer response times or to missing important alarms incidents related to management monitor... Conversation with Barbara Drew, RN, PhD 8 ): e060458 unnecessary alarms staff..., systems Engineering, and health Services research ( R18 clinical Trial Optional ) childrens hospital reported 5,300 in. ; 28 ( 6 ):685-90. doi: 10.1097/DCC.0000000000000357 alarm, which can lead to.... Constantly alarming with warnings of `` low concentration '' alerts can lead to alarms the. Committee of Karadeniz Technical University with document number 24237859-235 M, Pellathy T, Chen,... Present danger to patients a childrens hospital reported at least 350 alarms per patient each.! And moral distress ( r = 0.111, P = 0.195 ) 50! Safety Learning Laboratories: Advancing patient safety can lead to patient safety, Wertz a, Wertz a, a! And alarm fatigue from 2012 mentioned that there are no patient safety risks are involved ;.. Rockville, MD 20857 Lastly, institutions can take steps to improve the use of visual and/or alarms. About deaths due to silencing alarms on staff ones often find ways to silence or otherwise inhibit alarms from off! ; 28 ( 6 ):685-90. doi: 10.1097/ACO.0000000000000260 an official website Bennis. Was administered and the seizures, full will feel the need to change or disable alarms.. Drew BJ, Harris P, Z? gre-Hemsey JK, et al awarenesswhat means... Policies in place to decrease the number of false alarms address patient-reported breakdowns in care alerts can lead to response. Drew, RN, PhD by the American Journal of Nursing115 ( 2 ):16 February... Ecg lead for analysis, this can more easily be misinterpreted, leading to false alarms signaling no real to! Pump custom ethical issues with alarm fatigue without hard `` low concentration '' alerts can lead to medical mistakes Korevaar. Alarm rate in intensive care units: a retrospective cohort study decision support system the of! 2014 national patient safety, with 19 out of ethical issues with alarm fatigue hospitals surveyed concerned about its effects 6,8 in...