Definition of alarm fatigue and its influence on staff performance
An alarm is a warning of an approaching situation which requires a response. This study considered the influences of alarms in the clinical health environment. The Emergency Care Research Institute considered alarm hazard as the number one health technology hazard for the years 2012 through 2014. The Joint Commission set a standard for all hospitals in the US to assess alarm fatigue in their monitoring process and to develop a systematic, coordinated approach to clinical alarm system management. In order to comply with this requirement, a working definition of alarm fatigue is necessary. To the very best of our knowledge, there have been no studies proposing a quantitative definition of alarm fatigue, a way to measure it, or exploring the influence of alarm fatigue on performance deterioration. This observational study undertook the objective of defining alarm fatigue and its role on performance deterioration in a quantitative way. A survey using a questionnaire proposed by the American College of Clinical Engineering Healthcare Technology Foundation was conducted before the observations to assess the attitude of nurses toward the existing alarm monitoring system at the hospital where the research took place. An extensive literature review and Hierarchical Task Analyses were conducted in order to reveal all the possible influencing factors behind alarm fatigue. From these, alarm fatigue was defined and measured in terms of mental workload and three types of affect: boredom, apathy, and distrust. A conceptual model was developed considering the significance of working conditions and staff individuality on alarm fatigue and, consequently, alarm fatigue on staff performance. Staff performance was measured in terms of response (yes/no), response time and number of ignored alarms. Several analytical approaches were performed to find association between alarm fatigue and staff performance. The results show that, in general, performance deterioration is actually influenced by a combination of alarm fatigue with working conditions and staff individuality. In the case of nurses and response time, alarm fatigue plays no role, only working conditions and staff individuality. These findings suggest that the role of alarm fatigue as a health hazard in the clinical environment should be reevaluated.