Alarm Fatigue and Burnout in the ICU

Abstract

Purpose: The purpose of this Doctoral of Nursing Practice (DNP) project was to collect and analyze data on alarm fatigue and nurse burnout to understand the relationship between the two and to inform efforts to minimize nurse burnout, maximize retention, and improve patient safety. Background: Burnout is a pervasive nursing problem with many factors to blame including patient acuity, patient ratios, and working environment. Alarm fatigue is a phenomenon where high rates of clinical alarms are responded to with desensitization and dismissal by staff, creating dangerous patient environments. Alarm fatigue has a logical connection to environment and burnout. However, the relationship is not well understood as there is a paucity of literature. To address this, we must study the nurse work environment for modifiable factors including noisy alarms. Methods: A descriptive study was developed by the investigator to evaluate and characterize alarm fatigue and nurse burnout via the collection of self-reported survey data. The survey consisted of a set of questions designed to measure alarm fatigue based on existing literature to develop a scoring system, and questions asking participants to rate the severity of alarm fatigue (AF_sev) and the percentage of burnout attributed to alarm fatigue (AF_Atr). Burnout was measured utilizing the Maslach Burnout Inventory (MBI). Alarm fatigue data trends were compared to burnout scores. Results: Every participant scored high in the Emotional Exhaustion burnout category, and all but one scored high in Depersonalization based on the high, moderate, and low cutoffs defined by the MBI. Alarm fatigue scores increased as burnout scores decreased. Demographic factors (i.e., age, ICU specialty, years of work as a nurse, and years worked in the ICU) were not associated with burnout. AF_sev positively correlated with two burnout domains. One-way ANOVA for AF_atr Vs. Burnout by domain did not reveal significant frequency differences between the categorical responses the of burnout percentage attributed to alarm fatigue. This was consistent for each MBI domain. However, most participants attributed 10-25% of their burnout to alarm fatigue. Conclusions: AF_sev correlated positively with burnout in two out of three domains, while the alarm fatigue score did not. This is likely because the alarm fatigue scoring in this project may not measure the construct validity of alarm fatigue, indicating the need to develop a validated tool to measure alarm fatigue as an area for future work. There may be a relationship between alarm fatigue and burnout, but more work is needed. Participant reports of attributing up to 25% of burnout to alarm fatigue indicate that alarm fatigue could be an impactful target in the effort to address nurse burnout.