One of the National Patient Safety Goals (NPSG) is reducing alarm fatigue (read about it here). Alarm fatigue is a pretty big deal; patients tend to die because of it. Phase II of The Joint Commission’s initiative to address this goal begins in January 2016 and will involve implementing the changes that facilities have identified to reduce the problem.
I have been consciously keeping alarms on my radar, and it’s really annoying because I have successfully learned to tune just about anything out—hence the problem. Patients don’t even react to alarms anymore. They used to hit the call light (also tuned out) anytime the bedside monitor blipped. Now it’s not uncommon for me to happen upon a scary alarm (the really insistent ones) that no one has told me about, and the patient will say something like “I figured if it was bad you would come in.”
So at this point I would say basically we have hobbled ourselves into making all alarms completely useless.
I have also been looking at reducing distractions in general at work. I’ve been customizing monitor alarms so that my patient in a-fib won’t have an arrhythmia alarm going off. I know she has an irregular heartbeat. I’ve been not putting patients on monitors at all if they don’t need constant monitoring or sometimes even if they aren’t going to keep the wires on, because in the former case the alarms will mean nothing and in the latter I need to be checking on them physically anyway.
But alarm fatigue is only part of the problem; I am finding that dings, blips, and bloops come not only from patient alarms, but from my work mini-cell, my personal cell phone, and coworkers. I literally cannot go to the Omnicell, get a medication, and give it to a patient without at least six interruptions in the process (a rate nearly guaranteed to cause an error at some point).
It’s no wonder that nurses tune things out; the human mind can do only so many things well at a single time. I’ve heard that humans can do only *one* thing at a time, but I don’t believe it. If that’s true, my point is even more valid, though.
The question of what I want to get my attention has been on my mind increasingly since I got my Apple Watch; I got the watch to filter out the bombardment of stuff on my phone. I quickly realized I had too many notifications on the watch, similar to the alarms at work; the signal to nose ratio was grim. I turned everything off and started adding things back, and after a week or so now I get tapped on the wrist only for stuff I really want to know about.
It makes me wonder whether using a similar approach in the work setting would be fruitful. Just shut everything off and start adding it back when we realize we really wanted to know about that thing that happened. I know: we would miss stuff! But we’re missing stuff now.