UCSF Alarm Fatigue Study

Alarm fatigue is a real phenomenon and very familiar to critical care nurses. What can we do?

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Specializes in Nephrology, Cardiology, ER, ICU.

Alarm fatigue is defined as sensory overload when clinicians are exposed to an excessive number of alarms, which can result in desensitization to alarms and missed alarms. The American Journal of Critical Care recently published a study by UCSF about accelerated ventricular rhythm alarms.

“UCSF researchers found that none of the 223 true AVR alarms they examined was clinically actionable and none was associated with adverse patient outcomes. The research team took a deeper dive into the results from one of the ECG Monitoring Research Lab’s earlier studies that included alarm data from all 77 bedside monitors in five adult critical care units at UCSF Medical Center during a 31-day period. The primary study showed AVR to be the most common audible ECG alarm category, accounting for one-third of the over 12,600 annotated arrhythmia alarms. Importantly nearly 95% of the AVR alarms in the study were determined to be false alarms. However, before recommending that AVR alarms be adjusted to an inaudible setting, the researchers carefully examined whether true AVR alarms were actionable.”

There was a secondary analysis too that examined the 5% that were considered “true” alarms and found that only one “true” alarm resulted in a medication change or the addition of a medication to treat the rhythm.

The conclusion of this study was:

“Accelerated ventricular rhythm alarms are common false alarms in ICUs and may contribute to alarm fatigue. In our study, the vast majority of true AVR alarms were not documented in the EHR. None of the true AVR alarms were clinically actionable, and none were associated with adverse patient outcomes. We propose that hospitals reevaluate the need for close monitoring of AVR and consider adjusting this alarm to an inaudible text message setting in an effort to reduce alarm burden and help prevent alarm fatigue.”

AACN recently released an update on the alarm practice alert which supports this study emphasizing when you have excess alarms staff get to the point of not hearing them. The accelerated ventricular rhythm alarm has been mentioned in several studies with the same conclusion: this alarm if not needed for a specific patient, it should be silenced.

However, once you set this alarm for a patient, you must, of course, be mindful that alarms are assessed. So, how do we reduce alarm fatigue? Here are some tips:

  • Set appropriate alarm settings
  • Effective notification channels such as smartphones
  • Clear and actionable alarm information
  • Clear and timely response protocols
  • Effective staff training

Technology and nursing, as well as management, must work together to reduce unactionable alarms. Alarm escalation pathways are necessary and need to consider:

  • The type, age and condition of patients in the unit
  • Clinical workflows
  • The unit’s architectural layout, which affects the proximity and visibility of room monitors
  • Staffing schedules
  • Number of patients per nurse
  • Time of day

Flexibility is key to successfully monitor patients. This should entail utilization of technology as well as nursing practice. Advocating for correct and clinically relevant alarm parameters is important for both patient care and to reduce alarm fatigue.

allnurses.com recently interviewed two nurses who are doing something about alarm fatigue. 

What are your thoughts on this very hot topic?

Resources:

AACN Issues Practice Alert on Reducing Alarm Fatigue

Alarm Fatigue: A Safety Concern

American Journal of Critical Care: Contributions of Electrocardiographic Accelerated Ventricular Rhythm Alarms to Alarm Fatigue

Five Technology Tools for Reducing Alarm Fatigue

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

I work in a smaller ICU and the biggest loss related to this issue, I think, is that they have eliminated our past monitor tech position. The techs in that role were trained to identify alarms that needed immediate action by the nurse and ensure that they were aware. Now, we have alarms that are far too sensitive, low O2, high bp, inaccurate heart rhythm alarms, etc. Some nights I think we hear it for 12 hours. Add to that the ventilator alarms that aren't always a signal of anything truly important, and you can't tell where to look or act. Sometimes it's just too much and doesn't improve the outcomes or quality of care.

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Specializes in Critical care.

Nihon Koden monitors are the definition of alarm fatigue, they should attach a picture of the monitor in the study.

Cheers

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Specializes in NICU.
2 hours ago, hawaiicarl said:

Nihon Koden monitors are the definition of alarm fatigue,

Worst system ever,ring for no reason,all the time and the set up is excessive monitor panels showing all monitors which ring also along with bedside monitors.Nurses were not allowed any input on their purchase,installation or use. This expedited my exit from the nightmare and future hearing loss.

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Specializes in Cardiology.

I work on a step-down and the tele monitors we use are so sensitive. Even with changing the parameters for each patient they still seem to ring for every little thing. You would think by now that monitors could determine what is artifact and what is real....but, that is why we are still fortunate enough to employ a monitor tech.

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Specializes in Nephrology, Cardiology, ER, ICU.
15 hours ago, JBMmom said:

I work in a smaller ICU and the biggest loss related to this issue, I think, is that they have eliminated our past monitor tech position. The techs in that role were trained to identify alarms that needed immediate action by the nurse and ensure that they were aware. Now, we have alarms that are far too sensitive, low O2, high bp, inaccurate heart rhythm alarms, etc. Some nights I think we hear it for 12 hours. Add to that the ventilator alarms that aren't always a signal of anything truly important, and you can't tell where to look or act. Sometimes it's just too much and doesn't improve the outcomes or quality of care.

Great point - monitor techs do help with the workload and help to ensure "real" alarms aren't missed.

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Specializes in Nephrology, Cardiology, ER, ICU.
15 hours ago, hawaiicarl said:

Nihon Koden monitors are the definition of alarm fatigue, they should attach a picture of the monitor in the study.

Cheers

Ugh - have you considered making a review of the product or contacting the manufacturer?

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Specializes in Nephrology, Cardiology, ER, ICU.
47 minutes ago, OUxPhys said:

I work on a step-down and the tele monitors we use are so sensitive. Even with changing the parameters for each patient they still seem to ring for every little thing. You would think by now that monitors could determine what is artifact and what is real....but, that is why we are still fortunate enough to employ a monitor tech.

Good for you - monitor techs do help

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Specializes in Nephrology, Cardiology, ER, ICU.
12 hours ago, Leader25 said:

Worst system ever,ring for no reason,all the time and the set up is excessive monitor panels showing all monitors which ring also along with bedside monitors.Nurses were not allowed any input on their purchase,installation or use. This expedited my exit from the nightmare and future hearing loss.

Yikes - bedside nurses are the ones that should be the decision makers when it comes to equipment purchases.

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Specializes in Critical care.
6 hours ago, traumaRUs said:

Yikes - bedside nurses are the ones that should be the decision makers when it comes to equipment purchases.

The only person that influences these decisions are bean counters and sales reps.

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.
On 7/13/2019 at 3:41 PM, hawaiicarl said:

The only person that influences these decisions are bean counters and sales reps.

Just like the EMRs that are designed by IT people with no real insight for what is important when charting. Some of the drop down options are ridiculous, and obvious signs/symptoms that would make sense to include are not available. Free texting everything takes so much extra time! And charting stupid stuff for the sake of completing the charting gets in the way of providing patient care.

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I work inpatient pediatrics, and alarm fatigue is SO REAL. Ya'll try keeping a pulse ox on a 12 month old with any reliability at all. It's honestly the most frustrating part of my job: The over ordering of full monitors (cardiac and respiratory) coupled with the monitors that just DON'T PICK UP CORRECTLY on a screaming infant/active toddler/busy child.

We actually had an initiative, several years ago, to curb the over ordering of these monitors.... where if a cardiac monitor was ordered on a child, the residents (or the attending) would have to come up and read strips Q4. This worked for awhile... we only got cardiac monitors on cardiac kids.... but then they went back to their old ways and the initiative went by the wayside. Now I feel like they order them because it's a box to click in the order set. I have gotten to where I will question these orders in rounds.

1/2 of my work day is spent silencing alarms and readjusting leads so that they pick up and STOP %#&^%&^%@^# BEEPING.

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