For nurses, it’s a constant dash to respond to alarms
By Liz Kowalczyk
Globe Staff / February 13, 2011
Logan’s cardiac monitor flashed a red crisis alarm and broadcast a fast, high-pitched beeping, a piercing sound that reached his nurse, Tammy Dillon, in the hallway.
She hurried into Logan’s room — only to find a pink-cheeked, kicking 3-month-old, breathing well, cooing happily.
Logan was fine. His pumping legs had triggered the crisis alarm again.
The red alarm is the most urgent, meant to alert nurses to a dangerously slow or fast heart rate, abnormal heart rhythm, or low blood oxygen level. But on this morning in the 42-bed cardiac unit at Children’s Hospital Boston, infants and preschoolers activated red alarms by eating, burping, and cutting and pasting paper for an arts and crafts project.
All morning long, nurses heard — and responded to — constant beeping, dinging, and chiming; some kind of alarm sounded at least every minute.
Nurses know that a large percent of patient monitor alarms are false — triggered by movement, a poor connection, or some other factor — but they still must listen carefully to each one and react quickly in case a patient really requires immediate medical attention. Given the almost overwhelming number of alarms going off, nurses, doctors, and health care leaders are concerned about staff in hospitals across the United States becoming desensitized to the noise, a phenomenon called alarm fatigue.
“Children move a lot, and that creates lots of false alarms,’’ said Dillon, a nurse at Children’s since 1996. But “if you have an alarm that is real, a sick child goes down very fast. You never want to be the person responsible for a delay in care.’’
In the case of Logan Narolis of Williamstown, N.Y. — who had surgery at Children’s for a heart defect — the movement of his legs interrupted the oxygen level signal on his monitor.
Children’s is working with engineers at MIT to develop more sophisticated monitors that better identify true crises, with fewer false alerts.
On another morning at nearby Beth Israel Deaconess Medical Center, the 10 nurses caring for 35 patients on Clinical Center 7 responded to all manner of warnings — abnormal heart rate alarms, arrhythmia alarms, bed and chair alarms warning that fragile patients might be getting up, patient call bells, intravenous medication pump alarms, and emergency alarms in patient rooms.
Each has its own unique noise, speed, and pitch — the most urgent are, by design, the most annoying — differences barely discernible to visitors but second nature for nurses. The most serious alarms also scroll across signs in hallways or are sent to nurses’ pagers.
Nurse Sylvia LaRocca was caring for a patient whose cardiac monitor blared a low-heart-rate alarm every few minutes — each time pulling LaRocca away from other patients and into the woman’s room. In every instance, the patient was fine, alert, and breathing well. The hospital’s monitors are programmed to set off an alarm when a patient’s heart rate falls below 40 beats per minute. Doctors had lowered the limit on this patient’s monitor to 34, but her slower-than-normal heart, which dipped down to 31, was still triggering the alarm. Now doctors were debating whether to lower the parameters again.
“You have to respond to the alarm, you have to do it,’’ LaRocca said. “But there are some days when you feel you’re just running from alarm to alarm. It can be exasperating.’’
Dr. Julius Yang, medical director for the unit, said it’s a dilemma. Doctors could risk the patient’s safety if they made her monitor less sensitive, but if they don’t, they run the risk of desensitizing the nurses.
“I worry about alarm fatigue quite a bit,’’ he said. “The problem is, when is real real?’’
Yang was part of a group of Beth Israel Deaconess caregivers that met last year with Philips Healthcare, a monitor manufacturer in Andover, to discuss ways to improve the machines and reduce false alarms. Meanwhile, the hospital is taking steps on its own.
A new “we promise’’ campaign requires a nurse or technician to ask a patient every hour whether they have pain, need a drink, or require help using the bathroom — a program intended to reduce falls but that nurses on LaRocca’s floor said also has reduced bed alarms and call button alerts. The cardiac unit has hired a monitor technician who sits at the central nurses’ station to help triage the alarms.
Not all alarms are false. On that morning, a nurse found a patient unconscious on the floor of her room and pushed the emergency alarm. Nurses and doctors ran to the room, inserted a breathing tube, and transferred the patient to the intensive care unit.
Liz Kowalczyk can be reached at firstname.lastname@example.org.