Impact of Alarm Fatigue on ICU Nurses at John Hopkins Aramco Healthcare, Dhahran

Introduction

The John Hopkins Aramco Healthcare (JHAH) is among the first health organizations set up in Saudi Arabia, offering a wide variety of primary care health services to the citizens in Dhahran and across the country. JHAH is a collaborative healthcare organization arising from the partnership between Aramco, an energy and petroleum company, and John Hopkins, a medical services and training center. With the critical organizational goal of using the latest technological innovations that are safe for patients, JHAH staff deliver safe and quality healthcare to patients in Saudi Arabia, including emergency services and the Intensive Care Unit services (McMacken, 2022). Alarms in ICUs alert nurses and medical professionals on critical conditions or machine failures for immediate response and correction. Slow or lack of response to these alarms could result in the affected patient's death since they are already in critical condition before consideration of joining the ICU. These alarms may, however, be false alarms from machine dysfunctions, which are not a direct representation of the patient's change in vital organs and medical variables. ICU nurses consistently interact with patients to read and gauge their vital conditions. The alarm response rate is 150-400 times, accounting for 35 percent of a nurse's workload (Lewandowska et al., 2020). Such a consistent checkup results in fatigue and, in most cases, ignoring the alarms.

Problem Statement

New technologies may over-predict the healthcare conditions of patients in Intensive Care Units. Staff motivation at JHAH may affect their response willingness to such alarms, primarily if they result from incorrectly set machinery or minor variations in patients' wellbeing. An evaluation of the influence of alarms on staff motivation and the subsequent response, which influences the general wellbeing of patients, is necessary. Through the evaluation's results, interventions that influence the general wellbeing of nurses and patients can be developed to improve healthcare at JHAH and, therefore, its popularity in Saudi Arabia's population. Through this study, nurses' views and current patients' health reports will be used as metrics of the intensity and severity of alarm fatigue to influence the development of relevant propositions.

Objectives

General Objective

To evaluate the influence of ICU alarms on ICU nurses’ alarm fatigue and their general work output at JHAH.

Specific Objectives

1.    To identify alarm fatigue metrics as understood by nurses in the ICUs at JHAH.

2.    To explore management influence on factors reported by ICU nurses.

3.    To evaluate management policies in place to reduce alarm fatigue.

4.    To predict the rate of alarm exhaustion in JHAH in the future, make recommendations to manage alarm fatigue.

Significance of the Study

1.    Studying alarm response management may correct reported issues of alarm desensitization resulting from high exposure to alarms, reducing the urgency to respond.

2.     Study results can influence recommendations to the JHAH management that can influence finances allocated to staff training and increase of staff, in case overworking is an influencing factor of alarm fatigue.

3.    Interventions can prompt the government to allocate funds to increase the training programs of nurses that work in the ICUs to increase the workforce that can manage alarm fatigue.

4.    Areas of machine modification can be noted, improving the efficiency of alarm management training since training will be focused on specific significant symptom changes made on new machinery.

Literature Review

Alarm response in ICUs results in adverse health effects on healthcare providers. The rate of alarm response has increased with the adoption of modern technology in health institutions, from an average of fewer than six alarms to more than 40 alarms per patient (Lewandowska et al., 2020). Modern technology incorporates minor details of a patient's health which is essential but may raise a false alarm when there is a shift in normal conditions. The result is a false alarm and illusions for patients and healthcare providers instead of being a cautionary development to assist healthcare providers in detecting any harm to the patients. In addition, consistent response to alarms causes fatigue which could range from acute fatigue to chronic fatigue (Lewandowska et al., 2020). Acute fatigue could be resolved by taking mental breaks and resting, contrary to chronic fatigue, which affects the cognitive wellbeing of nurses, resulting in irreversible damage to the nurses’ systems (Lewandowska et al., 2020). In hospitals where alarm fatigue was prominent, nurses reported cognitive and physical exhaustion. Cognitive exhaustion affects the response stimulus of a human being. Since these alarms are signals of system dysfunctionality, nurses are supposed to respond with a sense of urgency. Their stimulus system is therefore raised since they are used to responding to emergencies. Physical exhaustion is evident because, running on regular schedules, nurses are already overworked. The addition of consistent response to alarms causes physical exhaustion that affects the work culture of ICU nurses. Therefore, alarm fatigue common for ICU nurses causes adverse health implications such as fatigue and damage to the cognitive systems of healthcare workers, which is irreversible.

Alarm fatigue affects patients' health in ICUs and could result in death. Some machines that detect changes in a patient's vitals could be incorrectly set, which may cause adverse effects when they incorrectly raise the alarm or fail to raise it when they should. In some cases, nurses reported having missed low heart rate alarms, which could signify alarm fatigue (Lewandowska et al., 2020). Additionally, incorrect machine settings causing alarm fatigue may have influenced ICU nurses to mute them, which may have caused adverse patient effects, including death. While knowing the effects of ignoring ICU alarms, some nurses reported that alarms may have influenced their absence beside a patient's bedside and their decision to mute these alarms. Alarm fatigue is, therefore, not a result of a lack of knowledge of the implication of not responding to these alarms but a reflection of the urgency to respond to these alarms. Nurses already responsible for consistent checkups of patients may find the consistent alarms a disturbance of their duty. Between 2012 and 2014, alarms were observed to be a significant hazard to patients' health by the Emergency Care Research Institute (Gunnerson et al., 2019). Hospitals have a minimum allowable noise policy that is not observed if there are consistent alarm sounds, affecting the hospital environment, which should facilitate the patients' wellbeing and create a conducive environment for healthcare workers to care for their patients (Oliveira et al., 2018). Therefore, alarm fatigue influences nurses' response to their patients, which may cause adverse health effects.

The development of new machinery alarming healthcare nurses on essential changes in patients' vitals, an increase in the ICU workforce, and education can resolve alarm fatigue. The false alarm has been observed since machines in place detect even the slightest changes in the patient's vitals, which has influenced the response rate and urgency of healthcare workers. Some of these changes do not affect the general wellbeing of patients and are no cause for alarm. With new technology, healthcare departments can model machinery that only tracks the significant and extreme changes which may put the patient's health at risk, reducing machinery errors and observing improvement of alarm fatigue, as recommended by healthcare workers (Oliveira et al., 2018). Additionally, alarm fatigue reflects current work overload issues in healthcare institutions, which can be resolved if more funds were allocated to training nurses, making the license acuity process less strenuous to increase the number of healthcare workers (Oliveira et al., 2018). This would resolve issues of physical and cognitive exhaustion. Exhaustion is common among nurses since they are emotionally and physically overwhelmed. In the ICUs, alarms prompt nurses to make prompt decisions since machinery signals may indicate severe changes in the patient's wellbeing. An increase in the number of admitted patients that is not matched by an increased workforce causes burnout since nurses attend to more patients, work overtime and respond to emergencies that are difficult to foresee and adequately plan for (Khammar et al., 2018). The American Association of Critical-Nurse Care developed a system that ensures induction and continual training on the usage of alarms in the ICUs since some of the technology may be complicated and, with subsequent developments, will demand the consistent equipping of the workforce (Lewandowska et al., 2020). Alarm management training equips a workforce to track oximeter changes and patient changes with clinical recommendations, increasing the efficacy of systems built to correct health conditions (Lewandowska et al., 2020). In a case-control study, alarm management training was applied in the case group, and the control group was left to respond to alarms with only the induction training they had received (Bi et al., 2020). The results proved that alarm management training influenced planned behavior among ICU healthcare providers, reducing false alarm responses and may have managed adverse effects of cognitive alarm fatigue (Bi et al., 2020). Therefore, some interventions, such as using new technology with accurate alarms, increasing healthcare workers, and adequate training, could resolve ICU nurses' fatigue issues.

References

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