Alarm Fatigue

Dec 2, 2012

Alarm fatigue. It’s a new phrase that is catching on in the news recently and in nursing journals. If you work in a hospital, you don’t need a definition, you are just nodding your head, Uh-huh. In the 20 years I’ve worked in hospitals alarms have taken off, so that now we are supposed to be tuned into not just cardiac monitors, but bed alarms, chair alarms, IV pump alarms, staff emergency alarms, fire alarms and the occasional, “What is that?” random alarm. Obviously some of these should have a bit more priority over others, but sometimes it becomes one long drone and we tune out.

Yesterday I worked on a cardiac floor. So the Big Memo Board in my mind that I use at work to tack dozens of tasks to, in some order of priority, had Pay Attention to Monitor at the top. The cardiac monitors are at the nurses’ station and in the hall and as I was working at a desk, I heard the alarm sound.It was loud, not the soft bing bing of minor stuff but HEY! Pay attention here!. Nurses call it “banging off.”

As I glanced up to the hall monitor I could see it was my patient, Mr. Olsen (not real name) and I quickly got up to take a closer look. His heart rate, which had been a little too high all morning to begin with, had jumped suddenly into the 140- 160 range. Not fatal, but not good. As I walked into his room, I realized he was in the bathroom. “Are you alright?” I asked as I opened the door a crack. It’s one of those odd nursing things. You want to give dignity but you also want to make sure the patient is not on the floor, so we feel we have the right to watch you as you sit on the toilet.

Jack (not his real name either) was clearly angry. Jack has COPD which is the same thing as emphysema. As I’ve cared for probably hundreds of these folks over the years I’ve observed a few things. They are scared, because it’s scary not knowing if you can keep breathing, and then they get angry because life stinks like this and often they get depressed. You will usually find them in one of these three moods.

After he finished listing all of the obstacles he had encountered in just performing a simple human function which I will spare you details of, I suggested some modifications and alternative equipment, which he declined, his voice now giving way to exhaustion.

“Jack, your heart rate is high. Can you get back in bed?”

“I will. I need a little more time.” Okay. Sometimes you have to cut a deal. He had simply walked four steps to the toilet and he felt like he was struggling. I knew he would not die and I wanted to give him a little sense of control.

A few minutes later I found him sitting on the edge of his bed, facing the window. Checking the monitor, he was coming down into the 120’s. Better but not great. Someone with lung disease will always opt for sitting up straight rather that lying down. More lung space, it’s easier. His shoulders slumped and he hung his head, depressed. It’s a rotten disease.

I went on to the next thing, making another note for the Big Board in my overcrowded brain to check back on him in a little while. The alarms had quieted, but still 120’s is not a great rate for a long period of time. The monitors were alarming for a couple of other cardiac miscreants so it kept me turning to the screens, checking on Jack. About a half hour later I noticed his rate had dropped into the 70’s and 80’s, a perfect rate, and lower than he had been all morning. Must be napping, I thought, free from worry and discouragement.

I decided to peek in on him and see if I was right, but as I passed his door I saw that his wife had slipped in and she was sitting next to him on the bed. She had her head on his shoulder, which seemed less stooped now, and she was gently rubbing his back. They were saying nothing but everything in the language that only years of marriage can create. Jack’s heart hummed away. Nice.

Would CVS shut down if more people took the time to touch, to love, to tell those that are sick and frightened, You’re not alone ? Probably not. Medicine is not wrong, or not always. But I have never found a pill as powerful as the human touch. Jesus demonstrated this repeatedly… to lepers, to the blind, to the broken hearted. He touched and brought healing. For God so loved the world….

The world is busy, and at this time of year it’s easy to be overwhelmed. We have Alarm Fatigue., putting out fires as we hear them go off…finances, children, co-workers, spouses. And then there’s the news. But think about this next time you hear an alarm, about Jack, who didn’t want alternatives but just needed a touch. And an “I love you” makes it even sweeter. It may even silence some alarms. Nice.