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.
I totally understand alarm fatigue! My hospital has changed the HR alarm limits to 45-130... but, I get so irritated with my coworkers who ignore the alarms, or worse... silence the alarm without checking on the pt! I work in the ICU, we only have 2 pts max! It’s not hard to check the monitor or the pt. If I have an unstable pt and am busy in my other pts room I’ll pull up the unstable pt’s monitor view so I can keep an eye on them... in case a coworker silences the monitor
This is very real. I work in outpt dialysis for most of my day and the machines alarm for so many things. However, I also tell nurses, "look at the pt" - these machines read BP and have some limited capability to be an arterial line measuring PaO2. So, pts have to be assessed.
Forest2
625 Posts
The problems with alarms will never cease till admin and management listen to the voices of bedside nurses. Don't need a study to tell us that.