Alarm Saturation

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Alarm fatigue has become such a popular phrase in our industry that organizations are trying to create designations within it to categorize the types of fatigue that are occurring.   This activity has created phrases such as Alert Fatigue and Notification Fatigue. At first I thought this was a simple practice of categorization to better diagnosis and enable a focused fix.   My fear is that nothing is really new under the sun and that the focus is more about defining their products capabilities than about identifying ways to actually fix the problem.

JHACO defines Alarm Fatigue as “when hospital staff becomes desensitized to patient notifications.”   Alarm Fatigue, as phrase, is defined as the result…it is the end point when someone has become desensitized. But what actually leads to alarm fatigue? When is the moment that we are no longer able to handle the load? Instead of looking for fatigue or looking for when the error occurs we recommend that we begin to define the factors that lead to alarm fatigue – the point at which saturation occurs.

Several summers ago I learned about growing tomatoes. These finicky little plants like soil consistently moist but not wet. Inconsistency can cause the tomatoes to split or the roots can rot.   It’s an unforgiving process that requires consistent (not constant) interaction.   I learned this the hard way – I thought if a little water is good then a lot is better. With my travel schedule I was not consistently watering or recognizing when it had rained previously.   When faced with a sick plant – I grew frustrated. I had done what I was supposed to do – I watered – I gave it sunlight – I provided it good miracle grow soil – I did the things that should have produced at least one healthy tomato….but unfortunately the thing I should have been managing I was not. I did not understand the signs. I didn’t know that too much water would be a bad thing – it seemed as though water should be a no brainer – more should be better.

This is my perception of how the authorities having jurisdiction around alarms are thinking – we should enable technology sensitivities to produce more and people who are experiencing more are crying out for a throttle to allow less. We are living in an overstimulated environment and some are trying to send notifications informing that there are too many notifications…does anyone else see the illogical nature of that statement.

The signs I missed on the tomato plant was simple – at a glance (had I known what to look for) I could have identified what was going on….the leaves curl in when they get too much water….the leaves turn yellow when they have a lack of nutrients….watering is based on the amount of fruit on the vine and the environment of the moment.   When you are able to interpret the information in front of you then you can solve the problem before it becomes a problem.

In the same way, we need to read the signs on our clinical units that indicate we are moving to an environment ripe for alarm fatigue – the tomato will split soon. This only comes with being able to see the signs….hospital leader you can’t fix what you can’t see to fix. A report won’t fix it because you are seeing a split tomato and then assessing the soil – the tomato split because the soil was wet earlier in the week! If you could see the information and learn to identify the signs – whether it’s technology, process, policy or behavior you can intervene effectively and efficiently.

We are working on a white paper on the concept of Alarm Saturation which will help to identify the signs in real time that all hospitals should look for and create engagement/ correction strategies. We are always looking for hospitals willing to put this information in the hands of their clinical leadership – hospitals that are willing to learn to read the signs.   Is that your hospital?

By the way….I don’t grow a lot of tomatoes anymore because they need a lot of attention. I will invest in one or two plants at the beginning of the season and manage as best I can – the rain this year has been my vice. I have accomplished 4 cherry tomatoes so far from my mother’s day plant……which were sweet success.

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