Time to Battle Alarm Fatigue

Better Monitoring and Management

Laura A. Stokowski, RN, MS

Disclosures

February 20, 2014

In This Article

Who's Minding the Monitors?

When alarm-generating monitors and devices were used primarily in intensive care units and smaller telemetry units, staff were trained and policies were developed to observe and manage monitor alarms, which were often centralized. The situation has changed now that the number of devices and application of physiologic monitors has expanded to lower-risk populations throughout the hospital. In some areas, notification and communication of alarms, accountability for alarm system management, and policies about the setting and changing of alarm limits may not have entirely kept pace with the increase in use of these devices.

A basic issue is how nurses even know that an alarm condition is occurring when they are not at the bedside. Must the nurses rely on hearing an audible alarm coming from a patient room, even when they are behind a closed door some distance away, in a supply room or medication room, or performing a treatment with another patient in isolation? Does the unit use centralized "monitor watchers," who then relay the information to the appropriate nurse that a device is alarming in one of her patient rooms? According to 2011 Clinical Alarms Survey conducted by the Healthcare Technology Foundation,[20] 47% of respondents said that their institutions used monitor watchers in central viewing areas to observe and communicate alarm conditions to nurses on the floor.

Another problem is accountability and back-up coverage.[21] Who ensures that alarms are responded to when the patient's nurse is already busy, or even off the floor? One of the limitations of centralized alarm management is that communication with nurses is often 1-way, with the use of standard pagers, so that the technician watching the monitors has no confirmation that the page was received or acted upon.[22]

A modern alternative to human monitor surveillance is to use a system that blends wireless devices for alarm system notification with preprogrammed delays and closed-loop communication.[23] This system links patient monitors with communication devices carried by nurses, such as mobile phones, tablets, or pagers. Such a system has many advantages, explains Cvach, because it can be configured to optimize alarm management on many levels, by incorporating alarm escalating algorithms and automatic delays in relaying actionable alarms to nurses.

Crisis alarms are immediately relayed to nurses, but less important, noncrisis alarms might be delayed for 10-60 seconds (depending on the type of alarm) to allow time for the condition to self-correct or for staff who are already in the patient's room to silence the alarm before the nurse is notified. Nurses must acknowledge receipt of alarms or escalate them to other caregivers to "close the loop" of communication. In a quality improvement project, Johns Hopkins has tested this notification and acknowledgment system and found that it improved nurse notification of high-priority alarms and reduced the average duration of alarms, although it did not completely eliminate nuisance alarms.[24]

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