Time to Battle Alarm Fatigue

Better Monitoring and Management

Laura A. Stokowski, RN, MS

Disclosures

February 20, 2014

In This Article

Alarms: Separating the Useful From the Useless

The useful -- and actionable -- alarms on medical devices are designed to let clinicians know that some attention is required, either to the device or to the patient. Clinically significant alarms are those that require intervention to avoid an adverse event. A repeated pattern of such alarms, even if the patient self-recovers, could indicate a negative trend that warrants closer observation or investigation because it might be a precursor to a critical emerging condition.

False alarms are generated by the monitor when no physiologic (valid) triggering event occurs; instead, the alarm is precipitated by such events as patient movement, electrodes connecting intermittently, poor sensor placement, or broken cables. Many false alarms are this type of technical alarm. They may require a clinician to take action to prevent them from recurring, or to make certain that the alarm is functional should a real event take place.

Nonactionable alarms are a type of true alarm triggered by intentional actions, such as suctioning or moving the patient. The alarm sounds correctly but has no clinical relevance, is typically self-correcting, and requires no clinical intervention. Because they are distracting and contribute to overall noise levels, nonactionable alarms are often grouped in the category of "false alarms." A clinically nonactionable alarm, such as a brief drop in oxygen saturation that doesn't require treatment, is another nuisance alarm; the literature frequently interchanges these terms.

According to Cvach, the perfect alarm system would have 100% sensitivity (never miss a clinically important event) and 100% specificity (never alarm in the absence of a clinically important event). However, when an alarm system has high sensitivity and low specificity -- which is usually the case with monitors today - it will have a very high false-alarm rate.

Some devices, such as physiologic monitors, pulse oximeters, and ventilators, have different levels of alerts built in to the audible pattern so that nurses can differentiate among high-, medium-, and low-priority alarm conditions and prioritize their responses accordingly. Other devices, such as infusion pumps, typically have only a single audible sound for all situations. The nurse must go to the bedside every time to investigate the cause and silence the alarm because the pump stops infusing.

How frequent are nuisance, false, and nonactionable alarms? Various studies, both observational and those involving clinician report, suggest that false-alarm rates for physiologic monitors in adult units are as high as 86%-99%.[3,11,12] If that is true, there are times, or areas, where almost every single alarm is a false alarm or a clinically insignificant alarm.

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