Cvach believes most nurses do an admirable job sorting out alarms by relying on critical judgments that are based on intuition, experience, and knowledge of the particular patient.
"As a clinician, it is really hard for us to sort out all the noise that is in a room and dig out the important information," she says. "The average nurse doesn't just rely on alarms. They look at the perceived urgency of the alarm and they try to decide, based on the patient, whether or not it is important. That is why you need the critical thinking piece."
But relying on critical thinking and experience in lieu of exact science and best practices also unfairly exposes nurses and other clinicians if things go awry.
"Whenever I hear ‘someone missed an alarm,' people fail to realize that there are thousands of alarms," Cvach says. "It's like Aesop's fable about crying wolf. Where do we go to prevent any kind of events happening? Because they are going to continue to happen until we have a way to predict negative outcomes as opposed to waiting for an alarm to occur."
Cvach and The Johns Hopkins Hospital have been reviewing alarm fatigue since 2006. In that time, they've reduced audio alarms dramatically. "On the unit that I staff we started at over 500 alarms per patient per day, but we were able to reduce the number to 100 alarms per patient per day. We were able to take it down to a fifth of the amount, but that is still a lot."
It's an impressive achievement considering that The Johns Hopkins Hospital team didn't have a map when it started the journey.