Intensive care unit alarmshow many do we need? In 2020, alarm, alert, and notification overload ranked sixth in hazard status.4, To help tackle the issue, The Joint Commissions National Patient Safety Goals in 2013 provided recommendations to help medical institutions reduce the number of false alarms.2. Unsurprisingly, patients or their loved ones often find ways to silence or otherwise inhibit alarms from going off in their room. Importantly, these default settings may not meet workflow expectations when the baseline of your patient does not match the normal healthy adult population. What types and numbers of alarms occur with hospital monitor devices and how accurate are they? The resident physician responsible for the patient overnight was also paged about the alarms. TYPES OF LAW 1. This adverse event reveals a clear hazard associated with hospital alarms. The mean score of moral distress was 33.80 11.60. In January 2020, only 5.7% of employees worked exclusively at home; by April that figure rose eight-fold to 43.1%. Methods A literature review, a grey literature review, interviews and a review of alarm-related standards (IEC 60601-1-8, IEC 62366-1:2015 and ANSI/Advancement of Medical Instrumentation HE . Another suggestion for industry is to create algorithms that analyze all of the available ECG leads, rather than only a select few leads. [Available at], 7. Plymouth Meeting, PA: ECRI Institute; November 25, 2014. The International Society of Nephrology convened an Ethical Dialysis Task Force to examine this subject. Reprinted with permission from (1). The Joint Commission stresses in the 2019 National Patient Safety Goals that there needs to be standardization but can be customized for specific clinical units, groups of patients, or individual patients. They found a number of common errors: monitors weren't set with age-appropriate parameters, electrodes were placed incorrectly and replaced too infrequently, and there were no standard processes for ordering patient-specific parameters. Michele M. Pelter, RN, PhD, and Barbara J. }; Figure. The bedside nurse initially responded to these alarms, checking on him several times and each time finding him to be well. Learn more information here. The goal of the project was to reduce telemetry alarm fatigue by reducing alarm overload. According to the American Association of Critical Care Nurses (AACN) " alarm fatigue is a sensory overload that occurs when clinicians are exposed to an excessive number of alarms, which can result in desensitization" to alarm soundsas well as an increased rate of missed alarms. 1. PUBLIC LAW Constitutional law Administrative law Criminal law 2. Alarm fatigue occurs when busy workers are exposed to numerous frequent safety alerts and as a result become desensitized to them. 2015;48:982-987. 3 A review article on alarm fatigue from 2012 mentioned that there are about 700 physiologic monitor alarms per patient each day. 2022 Aug 16;4:843747. doi: 10.3389/fdgth.2022.843747. [go to PubMed]. The influence of patient characteristics on the alarm rate in intensive care units: a retrospective cohort study. Factors. In a hospital setting, one of the most frequent devices that alarms is the physiological monitor. Patient d In 2013, a 16-year-old boy at one of the US's top hospitals was given a 3800% overdose of his medication. Crit Care Nurs Clin North Am. Similar to the case described here, under-counting of heart rate due to low-voltage QRS complexes led to repetitive false asystole alarms in our patient. A hospital reported at least 350 alarms per patient per day in the intensive care unit. The most striking and was the recommendations released by the American Association of Critical Care Nurses in May 2018. The health care industry continues to grow, and so does health care workers' reliability on technology to care for patients. Such education will decrease the chances that patients will feel the need to change or disable alarms themselves. Boston Medical Center switched cardiac monitor thresholds from warning to crisis and as a result reduced the noise levels from 92 dB to 70 dB. [Available at], 4. (6,13) For example, for a patient with COPD whose normal baseline SpO2 is 88%, a clinician may decide to reduce her SpO2 low alarm to 80%, if at the level he will intervene to get the patient's SpO2 level back to her baseline. In one study, almost half of the time nurses were the ones to respond to alarms.3, Additionally, battling alarm fatigue would contribute to meeting the Joint Commissions patient safety goals for 2020, which includes reducing the harm associated with clinical alarm systems as one of the top priorities.7. The Joint Commission advocated for convening a multidisciplinary team to review trends and develop protocols to make clear whose role it is to address and respond to alarms. Curr Opin Anaesthesiol. Imagine a neighbor who has a hair trigger car alarm that goes off all the time. While most educational interventions to date have focused on nurses, one hospital found that a team-based approach, combined with a formal alarm management committee structure and broad-based education, led to a 43% reduction in critical alarms.(15). Psychology Today: Health, Help, Happiness + Find a Therapist After rapid development and reform, the health level and medical diagnosis and treatment capabilities of Chinese residents have been significantly improved, and high-quality medical resources have significantly improved the life safety and health of the masses. Patient centered design of alarm limits in a complex patient population. As soon as technologies and monitors entered the world of clinical medicine, it seemed logical to build in alarms and alerts to let clinicians know when something isor might bewrong. It would follow that significantly decreasing the number of alarms on a unitparticularly false alarmswould translate into a decrease in alarm fatigue, and although that wasn't one of the study measures, 95% of patient families thought alarms had been responded to in a timely manner.Maria Nix, MSN, RN. The cause of death was unclear, but providers felt the patient likely had a fatal arrhythmia related to his NSTEMI. Researchers found that use of the new process successfully reduced the number of alarms from 180 to 40 per patient day, and the proportion that were false fell from 95% to 50%. Alarm fatigue is "a sensory overload when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms." (Sendelbach & Funk, 2013). The Emergency Care Research Institute (ECRI) defines alarm fatigue as the emotional pressure care-providers experience when they are exposed to too many alarm sounds. Prediction of heart failure 1 year before diagnosis in general practitioner patients using machine learning algorithms: a retrospective case-control study. The lead wire is secured to the electrode with a pressure-less push button that ensures a secure fit even with highly mobile patients. Identify federal and national agencies focusing on the issue of alarm fatigue. These artifacts can cause alarms highlighting system malfunctions (called technical alarms; an example is a "leads off" alarm). The Joint Commission, recognizing the clinical significance of alarm fatigue, has made clinical alarm management a National Patient Safety Goal. An official website of 8600 Rockville Pike The high number of false alarms has led to alarm fatigue. That is, arrhythmia alarms are programmed to never miss true arrhythmias, but as a consequence they trigger alarms for many tracings that are not true arrhythmias, such as when a low-voltage QRS complex triggers an "asystole" alarm. [go to PubMed], 4. 3. Medical Malpractice: Alarm Fatigue Threatens Patient Safety. All rights reserved. Samantha Jacques, PhD Director, Biomedical Engineering Texas Children's Hospital, Eric A. Williams, MD, MS, MMM Chief Quality Officer Medicine Texas Children's Hospital Medical Director of Quality Section of Critical Care and Heart Center Associate Professor of Pediatrics Sections of Critical Care and Cardiology Baylor College of Medicine, 1. (1) Research has shown that 80%99% of ECG monitor alarms are false or clinically insignificant. Bonafide CP, Zander M, Graham CS, Weirich Paine CM, Rock W, Rich A, Roberts KE, Fortino M, Nadkarni VM, Lin R, Keren R. Biomed Instrum Technol. Biomed Instrum Technol. Nurs Manage. What took so long? What can be done to combat alarm fatigue? (1) Of the 12,671 arrhythmia alarms that were annotated, 88.8% were false alarms and did not signify true arrhythmias.(1). Over the last decade, research has found the following staggering statistics related to alarm fatigue and false alarms: Reducing the harm associated with clinical alarm systems continues to be a national patient safety goal. Nurses' perceptions and practices toward clinical alarms in a transplant cardiac intensive care unit: exploring key issues leading to alarm fatigue; JMIR. The root of the problem, of course, is nurses' exposure to too many alarms due to the . Equipment such as infusion pumps and mechanical ventilators also have alarms to notify issues with the patient or with the device. Accessibility eCollection 2022. First, nurses and providers can review their hospital alarm default settings to determine whether some audible alarms that do not warrant treatment can be changed to inaudible text message alerts. 2014;9:e110274. Have an alarm-management process in place. Determine where and when alarms are not clinically significant and may not be needed. The World Health Organization recommends noise levels of 35 decibels (dB) during the day and 30 dB during the night. Identify interventions designed to protect patients' rights. Writing Act, Privacy And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. For example, a patient with chronic obstructive pulmonary disease (COPD) may have a baseline SpO2 that is not within the normal range for healthy adult patients. Promoting civility in the OR: an ethical imperative. On rounds, it is good practice to discuss how alarms should be used and to inquire about the patient's experience with alarms, including how they may be interfering with sleep or rest. Disclaimer. Identify federal and national agencies focusing on the issue of alarm fatigue. Alarm Fatigue Defined. CIVIL LAW Tort law Contract law IMPORTANCE OF LAW IN NURSING It protects the patients /clients against deliberate and inadvertent injury by a nurse. (2) Despite repeated low heart rate alarms before the patient's cardiac arrest, no one working that day recalled hearing the alarms. Both registered nurses and employers have an ethical responsibility to carefully consider the need for adequate rest and sleep when deciding whether to offer or accept work assignments, including Hospitals throughout the country have been able to successfully combat alarm fatigue. (16) Increasing the value of the information requires a decrease in the number of false and clinically insignificant alarms. Unlike bedside ECG monitors in the intensive care unit where data is displayed in the patient's room, telemetry ECG systems transmit the ECG signal wirelessly to a central monitoring station where data for all of the patients is displayed. Please select your preferred way to submit a case. Customizing Physiologic Alarms in the Emergency Department: A Regression Discontinuity, Quality Improvement Study. Alarm management strategies that incorporate training, best clinical practices and sophisticated technology may help reduce alarm fatigue, improve clinician effectiveness and help enhance patient safety in hospital environments. Us, In Conversation With Barbara Drew, RN, PhD. Boston Globe. [go to PubMed], 11. Specifically, research suggests that Kendall DL, a single-patient-use lead wire system, may reduce the rates of false alarms, which ultimately may result in improved patient safety and care delivery. To sign up for updates or to access your subscriber preferences, please enter your email address The increased dependency on alarm-enabled equipment can place patients at risk. 4 A study from Johns Hopkins found that over a 12-day period, one ICU had an average . The issue of alarm fatigue is a priority of the American Association of Critical-Care Nurses. Pediatrics. Jordan Rosenfeld writes about health and science. Alarm fatigue occurs when clinicians become desensitized by countless alarms, many of which are false or clinically irrelevant. Selecting Safe and Easier to Use Products for Healthcare Using Human Factors Specification and Checklists. Although this type of unit-based defaulting does reduce alarms, it is not as effective as adding in some consideration of individual patient characteristics. Not responding to alarms can lead to critical patient safety issues, including medical mistakes and even death. [go to PubMed], 16. Research indicates that 72% to 99% of all alarms are false which has led to alarm fatigue. A call to alarms: Current state and future directions in the battle against alarm fatigue. (6) In addition, proper care and maintenance of lead wires and cables can improve signal-to-noise ratios. Bookshelf Assuming that an alarm is false puts patients in harms way and could lead to medical mistakes. Writing Act, Privacy Alarm fatigue is a lack of response to alarms due to their high frequency. 1. Exploring key issues leading to alarm fatigue. Managing alarm systems for quality and safety in the hospital setting. The commission has estimated that of the thousands of alarms going off throughout a hospital every day, an estimated 85% to 99% do not require clinical intervention. Despite harnessing advanced technology, telemetry monitoring devices often misidentify heart rhythms as asystole. Trigger alerts associated with laboratory abnormalities on identifying potentially preventable adverse drug events in the intensive care unit and general ward. Arlington, VA: Association for the Advancement of Medical Instrumentation; 2011. your express consent. Patients Placed in Danger as a Result of Alarm Fatigue The term "alarm fatigue," which is generally attributed to the increased use of monitors, is distracting and numbing hospital personnel with deadly outcomes. [go to PubMed], 15. Burdick KJ, Gupta M, Sangari A, Schlesinger JJ. As the most concentrated area of medical equipment in the hospital, the intensive care unit produces the most alarms during the . It also allows nurses to document each alarm limit every shift and if it is outside of the ordered parameters. A recent initiative at Cincinnati Children's Hospital Medical Center, in Cincinnati, Ohio, sought to reduce the number of cardiac monitor alarms on the facility's bone marrow transplantation unit while not missing signs of patient decompensation. Please select your preferred way to submit a case. Leaving a discontinued FentaNYL infusion attached to the patient leads to a tragic error. Research has demonstrated that 72% to 99% of clinical alarms are false. Set up an inspection, cleaning and maintenance program for alarm-equipped medical devices, and test them regularly. Please enable scripts and reload this page. The biggest harm that can result from alarm fatigue is that a patient develops a fatal arrhythmia or significant vital sign abnormality that is not noticed by the clinical staff because that patient's heart rhythm monitor has been plagued with false alarms. A pilot study. Silencing all telemetry alarms in this patient was an error that contributed to this patient's death. Atzema C, Schull MJ, Borgundvaag B, Slaughter GR, Lee CK. J Emerg Nurs. 2011;(suppl):29-36. The bed alarm system is reported to cause another problem to nursesalarm fatigue. Training should be provided upon employment and include periodic competency assessments. reduce risks from nurse fatigue and to create and sustain a culture of safety, a healthy work environment, and a work-life balance. News and Education Editor, MSN, RN, BA, CBC, ACNP- American College of Nurse Practitioners, Advanced Practice Nurses of the Permian Basin. Finally, successful changes require education of both staff and patients. Am J Crit Care. Applying human factors engineering to address the telemetry alarm problem in a large medical center. In 2013, there were numerous reported sentinel events, which led the TJC to issue an alert on alarms and then made alarm management a National Patient Safety Goal starting in 2014. Oakbrook Terrace, IL: The Joint Commission; July 2013. No, most alarms are false and not emergent in nature. Some error has occurred while processing your request. Ethical Issues in Patient Care Chapter Objectives 1. [go to PubMed]. These included: While there is no universal solution to alarm fatigue, hospitals are taking individual approaches to combat it. 2015, 2, e3. So that the ventilator device of alarm fatigue in nurses is moderate. FOIA Alarm fatigue is a real issue in the acute and critical care setting. IV push medications survey resultspart 1 and part 2. Alarms should never be completely silenced; rather, clinical staff should problem-solve why an alarm condition is occurring and work to resolve it. 6 A false alarm is an alarm which occurs in the absence of an intended, valid patient or alarm Human factors approach to evaluate the user interface of physiologic monitoring. AJN The American Journal of Nursing115(2):16, February 2015. This could minimize the number of false alarms for asystole, pause, bradycardia, and transient myocardial ischemia. ECRI Institute Announces Top 10 Health Technology Hazards for 2015. These and other strategies need to be tested in rigorous clinical trials to determine whether they reduce alarm burden without compromising patient safety. It's easy to see that this is far from a healing environment; in fact, it is likely to be terribly anxiety provoking to patients or family members. Improved Patient Monitoring with a Novel Multisensory Smartwatch Application. Looking for a change beyond the bedside? These three pillars of alarm notification provide a simple framework for tackling the problem of chronic alarm fatigue. We recently conducted a human factors analysis and determined that clinicians (nurses, physicians, and monitor watchers) found it difficult to respond to alarms or adjust alarm settings when working at the central monitoring station. You may be trying to access this site from a secured browser on the server. The Joint Commission, a major health care accreditation body, indicates that between January 2009 and June 2012, there were 80 recorded deaths related to alarm fatigue. "If you have. Hospitals can implement functions on their monitors to pause alarms for short periods when providing patient care, turning a patient, and/or suctioning. In our recent analysis of monitor alarms in 77 intensive care unit beds over a 31-day period, there were 381,560 audible monitor alarms, for an average alarm burden of 187 audible alarms/bed/day. However, the cause of overexuberant alerts and alarms is multifactorial and therefore difficult to address. The scenario described in this case is commonskilled and well-intentioned health care providers diligently respond to repeated false alarms. Providing proper skin preparation for and placement of ECG electrodes. Drew, RN, PhD Emeritus Professor Founder and Former Director, ECG Monitoring Research Lab Department of Physiological Nursing University of California, San Francisco (UCSF). The overload of cardiac monitor alarms can lead to desensitization, or alarm fatigue, which may lead to providers turning down or turning off alarms, adjusting alarm settings, or simply failing to hear alarms. The Joint Commission (TJC) has been trying to combat alarm fatigue since 2013. Policy, U.S. Department of Health & Human Services. The issue of alarm fatigue has been reported to be a major healthcare concern due to its negative effects on patient safety. This desensitization can lead to longer response times or to missing important alarms. Earning an advanced degree, such as a Master of Science in . Causes of adverse events in home mechanical ventilation: a nursing perspective. below. As mentioned above, some hospitals set default parameters by overall patient populationsuch as changing the settings for a cardiac step-down unit vs. a pulmonary care unit. 7. They also implemented the following mnemonic to help prevent alarm fatigue and increase patient satisfaction and outcomes: Alarm fatigue is a serious concern in hospitals around the country and The Joint Commission will continue to address this in their annual national safety goals. [Available at], 6. Please try again soon. Hravnak M, Pellathy T, Chen L, Dubrawski A, Wertz A, Clermont G, Pinsky MR. J Electrocardiol. Customizing alarm parameter settings for individual patients in accordance with unit or hospital policy. Because of this, the Joint Commission made alarm . One reason computer algorithms from telemetry monitoring systems are less diagnostic and less accurate than computer interpretations from the standard 12-lead ECG is that a limited number of leads (typically, 12) are used for analysis. Strategy, Plain Strategy, Plain By reducing the number of waveform artifacts, one can decrease the number of false alarms. [go to PubMed], 10. Committees charged with addressing alarm management should be formed and include all levels of the organization to ensure recommendations for practice changes can be carried out. An evidence-based approach to reduce nuisance alarms and alarm fatigue. Using proper oxygen saturation probes and placement. Alarm fatigue is sensory overload caused by too many alerts, beeps, and alarms. Reducing the risk of false clinical alarms is also a key consideration when choosing ECG cable and lead wire systems. Epub 2019 Dec 19. Oncology nurses' beliefs and attitudes towards the double-check of chemotherapy medications: a cross-sectional survey study. and transmitted securely. Research has shown that educational interventions that increase clinicians' understanding of and competencies with using the monitoring systems decrease alarms. Between January 2009 and June 2012, hospitals in the United States reported 80 deaths and 13 severe injuries. 2014;134(6):e1686e1694. One peer-reviewed study found that a single-patient-use cable and lead wire system with a push button design reduced false alarms by 29% for no-telemetry, leads-off, or leads-fail alarms. An official website of This patient's telemetry device warned of this problem with "low voltage" alarms. Shes written for The Atlantic, The New York Times, and Medical Economics. In addition, individual nurses and providers at the bedside can take steps to improve the usefulness of alarms. The overload of cardiac monitor alarms can lead to desensitization, or "alarm fatigue," which may lead to providers turning down or turning off alarms, adjusting alarm settings, or simply failing to hear alarms. The mean score of alarm fatigue was 19.08 6.26. Standard 12-lead ECG in the patient who generated more (mostly false) arrhythmia alarms than any other patient in our study (1). Assessment of health information technology-related outpatient diagnostic delays in the US Veterans Affairs health care system: a qualitative study of aggregated root cause analysis data. A childrens hospital reported 5,300 alarms in a day 95% of them false. Get new journal Tables of Contents sent right to your email inbox, Articles in Google Scholar by Maria Nix, MSN, RN, Other articles in this journal by Maria Nix, MSN, RN, Evidence-Based Practice, Step by Step: Asking the Clinical Question: A Key Step in Evidence-Based Practice, Privacy Policy (Updated December 15, 2022). Patient safety and regulatory agencies have focused on the issue of alarm fatigue, and it is a 2014 Joint Commission National Patient Safety Goal. Insights into the problem of alarm fatigue with physiologic monitor devices: a comprehensive observational study of consecutive intensive care unit patients. Discussion: ethical or legal issue that may arise if a patient has a poor outcome. The study compared three brands of disposable lead wire connectors and found that the Kendall DL ECG lead wire system had greater retention forces than the other products.8, By reducing false alarms, hospitals can potentially reduce some of the costs associated with nursing care, given the time spent by nurses responding to alarms. The tradeoffs between safety and alert fatigue: data from a national evaluation of hospital medication-related clinical decision support. A team of physicians, nurses, care assistants, engineers, and family representatives performed an initial assessment of the unit, which revealed an average of 5,300 alarms daily95% were false alarms. Consequently, rather than signaling that something is wrong, the cacophony becomes "background noise" that clinicians perceive as part of their normal working environment. 18. One study found that medical staff encountered 771 patient alarms per day.. Discussion of alarm settings and changes to those settings should allow for patient feedback and include education for patients so that they understand the rationale for the adjustments and what is likely to happen. } Electronic window.ClickTable.mount(options); According to one industry review of ECG lead wires, the most common problems include broken lead wires or clips, broken connector pins, worn lead wires, and frayed cords.6. This highlights the need for education and training of all staff that interact with monitoring devices. 2006;18:145-156. Fidler R, Bond R, Finlay D, et al. Alarm fatigue in nursing is a real and serious problem. The Joint Commission Announces 2014 National Patient Safety Goal. All conflicts of interest have been resolved in accordance with the ACCME Updated Standards for commercial support. (6-11) Furthermore, combining alarm default changes with added delays between the alarm and the provider notification shows the greatest reduction in alarms. the Solutions to these challenges included replacing electrodes during daily bathing, which reduced discomfort and increased compliance. In a hospital setting, one of the most frequent devices that alarms is the physiological monitor. To avoid patient safety concerns, acknowledgement of alarm fatigue must be recognized. Warnings have been issued about deaths due to silencing alarms on patient monitoring devices. Workarounds are routinely used by nursesbut are they ethical? Introduction. The team members employed the MIF to carry out the project in a 24 bed Surgical telemetry unit (3N). Pulse oximeters and their inaccuracies will get FDA scrutiny today. The American Association of Critical Care Nurses defines alarm fatigue as a sensory overload that occurs when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarm sounds and an increased rate of missed alarms. List strategies that nurses and physicians can employ to address alarm fatigue. information - in short, they suffer from "alarm fatigue." In response to this constant barrage of noise, clinicians may turn down the volume of the alarm setting, turn it off, or adjust the alarm settings outside the limits that are safe and appropriate for the patient - all of which can have serious, often fatal, consequences.2 One such Drew, RN, PhD | December 1, 2015, Search All AHRQ Solving alarm fatigue with smartphone technology. Alarm fatigue occurs when busy workers are exposed to numerous frequent safety alerts and as a result become desensitized to them. Administering and monitoring high-alert medications in acute care. Provide details on what you need help with along with a budget and time limit. Alarm fatigue can occur when a nurse became desensitised to alarms and can endanger patient safety and cause adverse outcomes and even death of patients . The team developed and implemented a standardized cardiac monitor care process, which included daily monitoring of setting parameters, daily electrode replacement, and criteria for discontinuing monitoring. doi: 10.1016/j.jen.2019.10.017. April 8, 2013;(50):1-3. In the present study, an . [go to PubMed], 5. 8. The Association for the Advancement of Medical Instrumentation released recommendations to combat alarm fatigue including: Nursing associations have also released recommendations to combat alarm fatigue. window.addEventListener('click-table-loaded', function(){ 2010;19:28-34. We worked with CreditCards.com to help nurses find the right card to fit their lifestyle. The study was performed in the . Advancement of medical Instrumentation ; 2011. your express consent Solutions to these alarms, it is not as effective adding. Resolved in accordance with the ACCME Updated Standards for commercial support this minimize! 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Lee CK to medical mistakes and even death several times and each time finding him be. Creditcards.Com to help nurses find the right card to fit their lifestyle clinically... Concerns, acknowledgement of alarm fatigue is a `` leads off '' alarm ) a neighbor who has a trigger! Never be completely silenced ; rather, clinical staff should problem-solve why an alarm condition occurring! Their inaccuracies will get FDA scrutiny today alarms during the night rhythms as asystole technical ;! With highly mobile patients that nurses and providers at the bedside can take steps improve. Nurse fatigue and to create and sustain a culture of safety, a healthy work,..., Quality Improvement study alarms can lead to critical patient safety issues, including medical mistakes study... Infusion attached to the electrode with a Novel Multisensory Smartwatch Application 33.80.... To alarm fatigue was 19.08 6.26 Drew, RN, PhD, and Barbara.... 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That the ventilator device of alarm fatigue occurs when clinicians become desensitized to.... Of death was unclear, but providers felt the patient overnight was also paged about the alarms the team employed! Learning algorithms: a retrospective cohort study of individual patient characteristics mistakes even. Between safety and alert fatigue: data from a national patient safety concerns, acknowledgement of fatigue. A cross-sectional survey study Healthcare concern due to silencing alarms on patient monitoring devices telemetry (. Staff that interact with monitoring devices false and not emergent in nature 16. Please select your preferred way to submit a case Multisensory Smartwatch Application Lee CK hospital medication-related clinical decision....