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Alarm fatigue

From Wikipedia, the free encyclopedia
(Redirected from Alert fatigue)

Alarm fatigue or alert fatigue describes how busy workers (in the case of health care, clinicians) become desensitized to safety alerts, and as a result ignore or fail to respond appropriately to such warnings.[1] Alarm fatigue occurs in many fields, including construction[2] and mining[3] (where vehicle back-up alarms sound so frequently that they often become senseless background noise), healthcare[4] (where electronic monitors tracking clinical information such as vital signs and blood glucose sound alarms so frequently, and often for such minor reasons, that they lose the urgency and attention-grabbing power which they are intended to have), and the nuclear power field. Like crying wolf, such false alarms rob the critical alarms of the importance they deserve. Alarm management and policy are critical to prevent alarm fatigue.

Healthcare

[edit]

The constant sounds of alarms and noises from blood pressure machines, ventilators and heart monitors causes a "tuning out" of the sounds due to the brain adjusting to stimulation. This issue is present in hospitals, in home care providers, nursing homes and other medical facilities alike. The US Food and Drug Administration cataloged 566 deaths from ignored alarms in the period 2005 to 2008.[5] The United States-based Joint Commission's sentinel event reports 80 alarm-related deaths and 13 alarm-related serious injuries over the course of a few years. On 18 April 2013, the Joint Commission issued a sentinel event alert that highlighted the widespread problem of alarm fatigue in hospitals. Their recommendations included establishing guidelines to tailor alarm settings, training all members of the clinical team on safe use of alarms, and sharing information about alarm-related incidents.[4] This alert resulted in designation in 2014 of clinical alarm system safety as a National Patient Safety Goal and it remains a goal in 2017.[6] This Goal will force hospitals to establish alarm safety as a priority, identify the most important alarms, and establish policies to manage alarms by January 2016.[7][8] ECRI Institute has listed alarms on its "Top Ten Hazards List"[9] since 2007; in 2014, alarms were listed as the number one hazard.

Unintended outcomes of alarms

[edit]

The large number of alarms, especially of false alarms, has led to several unintended outcomes. Some consequences are disruption in patient care,[10] desensitization to alarms,[11] anxiety in hospital staff and patients,[11] sleep deprivation and depressed immune systems,[11] misuse of monitor equipment including "work-arounds" such as turning down alarm volumes or adjusting device settings,[12][13] and missed critical events.[14] Some additional outcomes include workload increase,[11] interference with communication,[14] wasted time, patient dissatisfaction,[14] and unnecessary investigations, referrals, or treatments.[14]

Child abduction

[edit]

The Amber alert system used in countries such as the United States and Canada to notify the public of a child abduction has been theorized as being susceptible to alarm fatigue.[15][16] A 2018 abduction in Thunder Bay resulted in an amber alert being sent to cell phones as far away as Ottawa, some 15 hours' drive from Thunder Bay, followed one hour later by a second alert which notified individuals that the first alert had been resolved.[17] A similar double alert occurred on a single night in February 2019, leading to concerns over alert fatigue.[18]

Public transport

[edit]

In the New York City Subway, the Metropolitan Transportation Authority installed sirens in 2006 to discourage subway users from using emergency exits to evade fares; the sirens had little effect other than irritating passengers and were removed in 2015.[19]

Alarm fatigue has sometimes contributed to public transport disasters such as the 2009 train collision in Washington, DC, caused by a faulty track circuit which failed to detect the presence of a stopped train. Though the automatic train control system generated alerts notifying train dispatchers to the presence of such faulty circuits, the rate of such alerts was about 8,000 per week. An investigation by the US National Transportation Safety Board concluded that "the extremely high incidence of track-circuit alarms would have thoroughly desensitized [the dispatchers]".[20]

Weather

[edit]

Researchers think the large number of deaths from Hurricane Ida in the US states of New York and New Jersey may have been the result of too many warnings. Since 2012, weather alerts have been sent out to cell phones, but in 2020, federal officials set up a three-tier system so people would get this warning for the most serious situations.[21]

Smoke alarms

[edit]

The 2023 Loafers Lodge fire in Wellington, New Zealand, killed 5 people. A contributing factor was a slow initial response caused by frequent false alarms from the building's smoke alarm system. A survivor stated "The smoke alarm did go off, but it often went off and people didn't realise at first it meant there was a fire ...[t]he alarm they keep going every week, two times, three times, there's no good management there."[22]

Warning labels

[edit]

A law passed by referendum in the US state of California in 1986, Proposition 65, requires corporations to place a warning label on products containing certain chemicals that could cause cancer or birth defects. Many companies now routinely attach such warning labels to any product that might possibly contain one of the 900 listed chemicals without testing to see whether the chemical is really present in their product and without reformulating their product, because it is cheaper to do so than to run the risk of being sued by Proposition 65 enforcers.[23] The law has been criticized for causing "over-warning"[24] due to encouraging "meaningless warnings."[25][26][27] There is no penalty for posting an unnecessary warning sign,[28] and to the extent that warnings are vague or overused, they may not communicate much information to the end user.[24]

See also

[edit]

References

[edit]
  1. ↑ "Alert Fatigue". psnet.ahrq.gov. 7 September 2019. Archived from the original on 14 October 2019. Retrieved 26 July 2026.
  2. ↑ Blackmon, R.B.; A. K. Gramopadhye (1 June 1995). "Improving Construction Safety by Providing Positive Feedback on Backup Alarms". Journal of Construction Engineering and Management. 121 (2): 166–171. doi:10.1061/(asce)0733-9364(1995)121:2(166). ISSN 1943-7862.
  3. ↑ Bliss, JP; Gilson, RD; Deaton, JE (November 1995). "Human probability matching behaviour in response to alarms of varying reliability". Ergonomics. 38 (11): 2300–12. doi:10.1080/00140139508925269. PMID 7498189.
  4. 1 2 "The Joint Commission Sentinel Event Alert" (PDF). Medical device alarm safety in hospitals. The Patient Safety Advisory Group. Archived from the original (PDF) on 5 January 2019. Retrieved 21 October 2013.
  5. ↑ Schutz, Michael (16 June 2022). "Medical devices that are music to our ears could save lives". The Boston Globe. ISSN 0743-1791. Archived from the original on 16 June 2022. Retrieved 26 July 2026.
  6. ↑ "2017 Hospital National Patient Safety Goals" (PDF). The Joint Commission. Archived from the original (PDF) on 20 April 2017. Retrieved 26 July 2026.
  7. ↑ The Joint Commission (July 2013). "The Joint Commission Announces 2014 National Patient Safety Goal" (PDF). Joint Commission Perspectives. 33 (7). Archived (PDF) from the original on 3 February 2023. Retrieved 21 October 2013.
  8. ↑ Monegain, Bernie (9 April 2013), "'Alarm Fatigue' Endangers Patients", Healthcare IT News, HIMSS Media Web. 24 January 2014
  9. ↑ "ECRI Institute Releases Top 10 Health Technology Hazards Report for 2014". Archived from the original on 5 March 2016. Retrieved 10 September 2015.
  10. ↑ Healthcare Technology Foundation. "2011 National Clinical Alarms Survey: Perceptions, Issues, Improvements, and Priorities of Healthcare Professionals" (PDF). Archived from the original (PDF) on 12 August 2022. Retrieved 21 October 2013.
  11. 1 2 3 4 Borowski, M; Görges, M; Fried, R; Such, O; Wrede, C; Imhoff, M (April 2011). "Medical device alarms". Biomedizinische Technik/Biomedical Engineering. 56 (2): 73–83. doi:10.1515/bmt.2011.005. PMID 21366502. S2CID 17511189.
  12. ↑ Meade, Karen; Catania, Kimberly; Lopez, Ben; Connell, Ryan (1 April 2019). "Air-in-Line Alarms: Decreasing Alarms Through Antisiphon Valve Implementation". Clinical Journal of Oncology Nursing. 23 (2): 209–211. doi:10.1188/19.CJON.209-211. PMID 30880809. S2CID 81977608.
  13. ↑ Medical device alarm safety in hospitals, The Joint Commision, 2013, Sentinel Event Alert, 50, 1–3
  14. 1 2 3 4 Graham, KC; Cvach, M (January 2010). "Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms". American Journal of Critical Care. 19 (1): 28–34, quiz 35. doi:10.4037/ajcc2010651. PMID 20045845.
  15. ↑ Snow, Robert L. (2008). Child Abduction: Prevention, Investigation, and Recovery: Prevention. Greenwood Publishing Group. ISBN 9780313347870.
  16. ↑ Wood, Daniel B. (7 August 2017). "Amber alert fatigue? Alerts on cell phones set Californians buzzing".
  17. ↑ "Mobile users warn of 'apathy' after alerts ring out for Thunder Bay abduction". CBC News. 14 May 2018.
  18. ↑ "More research needed to determine if alert fatigue is true, says prof". CBC News. 16 February 2019.
  19. ↑ Flegenheimer, Matt (1 January 2015). "Exit Alarms in the Subways Are Silenced by the M.T.A." The New York Times. ISSN 0362-4331. Retrieved 26 July 2026.
  20. ↑ "July 27, 2010 Railroad Accident Report – Collision of Two Washington Metropolitan Area Transit Authority Metrorail Trains Near Fort Totten Station Washington, D.C. June 22, 2009". NTSB. 27 July 2010. Retrieved 10 April 2012.
  21. ↑ Calvan, Bobby Caina (5 September 2021). "As flood alerts lit up phones, did 'warning fatigue' set in?". WHYY. Retrieved 5 September 2021 – via Associated Press.
  22. ↑ Stuff reporters (16 May 2023). "'I knew I had to jump': What it was like inside Loafers Lodge when fire broke out". Stuff. Retrieved 9 June 2026.
  23. ↑ "Title 27, California Code of Regulations - Article 6 Clear & Reasonable Warnings: Side-by-Side Comparison" (PDF). December 2017. Archived from the original (PDF) on 24 July 2019. Retrieved 24 July 2019. Companies in every sector of the consumer economy now routinely attach warnings for any of the more than 900 chemicals and elements covered by Proposition 65, without testing for them or attempting to reformulate products. They fear citizen-enforcer lawsuits more than they fear freaking out customers. That profusion of warnings has subverted Proposition 65 and left Californians, and increasingly anyone who shops online, overwarned, underinformed and potentially unprotected, a Times investigation has found. And it has funneled hundreds of millions of dollars to a handful of attorneys and their repeat clients.
  24. 1 2 "California Hotel & Lodging Association Helps Lodging Guests Understand Proposition 65; Court Approval Obtained for Comprehensive Compliance Procedure" (Press release). California Hotel & Lodging Association. 7 July 2004. Archived from the original on 24 August 2005. Retrieved 22 July 2008. "Unfortunately, the 'safe harbor' warning-sign language specified under Proposition 65 is designed to be so all-encompassing that it is vague and typically doesn't provide much useful information," said Jim Abrams, president and CEO of CH&LA. "People see Prop. 65 warning signs nearly every place they go – grocery and hardware stores, restaurants, commercial buildings, car show rooms, hotels and inns, pretty much everywhere...
  25. ↑ Written Testimony of Jeffrey B. Margulies. Proposition 65's Effect on Small Businesses. In the United States House of Representatives, Committee on Small Business. 28 October 1999. "Implications for consumers. While the intent of Prop 65 was to 'inform' consumers, the impact of warnings under the Act has been a proliferation of meaningless warnings. Virtually every business has some sort of Prop 65 warning sign posted, and innumerable products are labeled with the warning. From gas stations to hotels, from grocery stores to hardware stores, consumers are deluged with warnings that they are being exposed to unnamed carcinogens and reproductive toxins. They are not told either the degree of exposure or the likelihood that they may actually be impacted by it. Moreover, because the risks to business of not providing a warning, many provide a warning even though they don't actually know whether an exposure is occurring, or even if the exposure is trivial, further diluting the meaning of warnings to consumers."
  26. ↑ Indira Nair and Detlof von Winterfeldt. "Equity and Environmental Justice Considerations in Electromagnetic Field (EMF) Policy" (PDF). Archived from the original (PDF) on 26 July 2011. Retrieved 22 July 2008. This is to be contrasted with Prop. 65 warning experience where the public received meaningless warnings filled with disclaimers, information that trivializes risk, and fails to put it into context.
  27. ↑ Consumer Defense Group v. Rental Housing Industry Members, 40 Cal Rptr 3d 832 (Cal. Ct. App. 4th Dist. Div. 3 24 March 2006) ("Given the ease with which it was brought, and the absolute lack of any real public benefit from telling people that things like dried paint may be slowly emitting lead molecules or that parking lots are places where there might be auto exhaust, instead of $540,000, this legal work merited an award closer to a dollar ninety-eight."), archived from the original on 11 April 2019.
  28. ↑ "Proposition 65 Safe Drinking Water and Toxic Enforcement Act of 1986". State of California. 1986. Retrieved 22 July 2008.
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