Alarms Fatigue: How are you planning to meet this NPSG?

meanmaryjean, DNP, RN · Sep 27, 2013

The webinar was the first in a series of six or seven- YES it was helpful. There was NO mention of the sponsors' products.

My big takeaways were the statistics regarding how tweaking alarms can reduce the number of clinically insignificant alarms by >50%.

I am really looking forward to the subsequent webinars.

nightengalegoddess · Jan 28, 2014

Thanks for this thread, know I'm coming in late on it. This is one of my biggest stressors in the ICU. I love my co-workers; but it becomes difficult conversation at times to notify some of them that it is completely ok to customize the monitor! "Your PVC pair is driving me batty!!!! How to say this...

"Huh, may I help you customize your monitor? Well, cuz' the monitor keeps ringing for the wide ST's....uh and that might not change....oh you got some EKG's....uh, that's baseline? Can you widen the parameters then?" "BECAUSE I AM GOING INSANE responding to your monitor ALL NIGHT"

...It is hard to address this because a lot of nurses are new and paranoid as well as understandably possessive of the patient. I always come out sounding like a know it all, which I am not!!!! But do know enough to get an EKG and or compare what evidence I've got to know that I can change parameters. I am newish to ICU though, so it becomes taboo to ask a more experienced ICU nurse to change these things. I quietly customize my monitors and attempt to add less insanity to the cacophony that is critical care.

Please everyone....have courage to customize!!!!

Here.I.Stand, BSN, RN · Jan 29, 2014

We customize our alarms. Pt is a 25 y/o triathlete whose baseline HR is 50? Lower the low limit for HR. Pt has been running a high fever, we're aware of it and investigating the cause (sepsis vs. neurogenic temp, etc.)? Increase the high alarm limit for temp. Vent set to deliver 12 breaths per minute? Turn off the apnea alarm on the monitor...the leads might not be picking up the person's chest rise, but we know that their RR is 12/min at minimum, and can even verify an adequate tidal volume by looking at the vent. Plus the vent will also alarm if something is amiss...circuit is disconnected and pt hasn't been ventilated in 20 sec, for example.

Our neuro pts often have specific parameters, so we set the alarms based on those parameters. One might have a SBP goal of

Our beds have built-in bed alarms with low, mid, and large ranges. So for someone who is relatively low risk and repositions ad lib, but maybe a bit confused so we want some safety measure, we can select the large range. That way they can flip over as often as they want to in bed and the bed alarm won't alarm unless they are actually getting OOB. We save the low range for people who are very impulsive, unsteady/weak, and very high risk for injury.

It helps that as a unit though, we take alarms seriously, and we have a culture of helping each other. If a colleague is in a pt room and his other pt is alarming, those of us who are free think nothing of looking at the pt. In the case of our neuro pts that I mentioned before, we might not know everything about each pt, but if someone alarms high SBP at 125 we'll at least know that it's something that needs to be dealt with.