Observing the customary cacophony at the nursing station, I’d estimate that so-called “alarm fatigue” contributes to more than a few tragedies in long-term care.
Here’s one example that resulted in a lawsuit filing after a resident died when nursing staff ignored the alarm signaling that her ventilator had become disconnected.
That’s why I was so interested in a Stat news article “Anatomy of a Beep,” which focused on collaboration between Medtronic, a medical device company, and Yoko K. Sen, an ambient electronic musician. The feature describes how medical devices came to have the sounds that they do — “alarms that are easily confused and difficult to learn and don’t really tell us what’s wrong” — and efforts to create a more helpful and appealing healthcare soundscape.
While the Medtronic project is geared toward a hospital emergency department with its plethora of health monitors, long-term care operators hoping to avoid alarm-fatigue-related medical catastrophes might take note of their efforts.
Among the many sounds typically competing for the attention of nursing home staff members are ringing telephones, television sets, conversations among staff members, overhead pages, elders calling for help, chair alarms, escalating arguments between residents, completed tube-feed nutrition cycle indicators, noisy nebulizers and oxygen concentrators, exit door and elevator warnings, and call bell signals. Specialized units such as ventilator programs will blare additional alerts.
While some employees are fortunate enough to be able to move to a quieter unit to complete their duties, most must contend with a din they have limited power to change. Researchers have found that noisy healthcare environments can significantly increase workers’ level of distress.
Residents, unless they can independently ambulate, have virtually no ability to escape the hubbub, which can border on an abusive level of noise pollution and can negatively affect their perceptions of their stays. In addition, studies have shown that noise can disrupt sleep and increase the likelihood of delirium.
Consider taking a moment to listen to the soundscape of your facility. Stand by the nursing station, close your eyes and imagine that the sounds are the backdrop for your eight-hour workdays, or your life, 24/7.
Below are some adjustments that can enhance the aural environment:
- Eliminate overhead pages in favor of systems that alert staff members individually.
- Remove chair and bed alarms, which add significantly to the clamor but not to the reduction of falls.
- Provide an adequate number of nursing staff trained to answer call bells promptly, which does reduce falls.1
- Hold interdisciplinary meetings to identify and treat disruptive residents.
- Regularly review the need for each resident’s wander guard — which sets off elevator alarms — and discontinue it if possible.
- Train staff to address resident discord before it escalates.
- Provide alternative communication systems so that team members can contact each other quickly and quietly rather than shouting down the halls.
- Educate staff to reduce loud conversations at night near sleeping residents and to lower the volume on televisions and radios during quiet hours.
- Consider acoustic ceiling tiles and sleep aids such as sound machines or an internal television station that plays the sounds of the ocean.
Evaluations of the long-term care setting often focus on safety, visual aesthetics and odors. The soundscape can have as great an impact on residents and staff and improvements in this area can enhance the experiences of those who live and work in nursing homes.
Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with over 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.