Abundance of Medical Device Alarms Leads to Patient Harm

There are times when too much technology can be counter-productive. Case in point: a new study that shows an abundance of medical monitoring devices – or more specifically their alarms – can lead to fatal medical errors.

The daily, ongoing beeping of alarms of medical devices, including ventilators, EEG machines and blood pressure monitors, tend to become white noise and medical professionals may ignore them, putting patients at risk. The Joint Commission, an independent, not-for-profit organization that accredits and certifies more than 19,000 health care organizations and programs in the United States, recently issued and distributed a warning about this so-called “alarm fatigue.” In its report, it noted that, depending upon the hospital unit, a patient may experience hundreds of alarm sounds each day.

The organization cited a U.S. Food and Drug Administration database that revealed 560 patient deaths related to alarm fatigue between 2009 and 2001, and its own records uncovered 80 such deaths in the same timeframe. Ninety four percent of these fatal events occurred in hospitals.

Types of Patient Deaths Cause by Medical Device Alarm Fatigue

According to the Joint Commission, ignoring alarms resulted in patient deaths from:

• Patient falls

Medication errors

• Delays in treatment

In response, the organization recommended that healthcare organizations and providers take several actions, including:

• Inventory the alarm-equipped medical devices in the Intensive Care unit and other high-risk areas, and identify the default alarm settings for each

• Set guidelines for customizing alarm sound settings for each patient in order to safely minimize them; even deciding when they aren’t necessary

• Inspect and properly maintain the devices to make sure that the alarms are in good working order and are kept at proper settings

• Training for clinical care providers for safe alarm management and appropriate response

It would be easy to overlook how alarms could actually contribute to fatal medical errors. This issue simply illustrates that, in questions of medical malpractice, many factors and details – no matter how minute – must be independently explored by knowledgeable professionals.