Time to Battle Alarm Fatigue

Better Monitoring and Management

Laura A. Stokowski, RN, MS


February 20, 2014

In This Article

Alarm Management in Pediatric and Neonatal Intensive Care

Alarm fatigue is not a new problem in the pediatric intensive care unit or neonatal intensive care unit. Alarm fatigue is rapidly expanding to general pediatric floors as physiologic monitoring becomes the norm for hospitalized children of all ages. However, to date, few alarm studies have been conducted in pediatrics and neonatal populations. A factor that makes monitoring particularly challenging in pediatrics is that default alarm parameters established by manufacturers cannot be used, and appropriate alarms limits must be individualized for each patient, depending on the patient's age. If not, the number of false alarms can increase dramatically, and the value of monitoring is lost.

Furthermore, some of the solutions for problems of alarm management considered for adult populations are not feasible or safe in neonates, such as lowering or raising SpO2 or heart-rate alarm limits to reduce the number of alarms, or building in delays before the alarm sounds, effectively lengthening the duration that the neonate might spend with a high or low heart rate or blood oxygen level. Although widening the alarm limits or delaying the alarm would certainly reduce the number of alarms,these are dangerous practices in neonatal care. Neonates are still developing and are at risk for retinopathy of prematurity and blindness from high blood oxygen levels, and for necrotizing enterocolitis, brain damage, and death from low blood oxygen levels.

Furthermore, the recommendations to reduce the number of false or nuisance alarms in adults by widening alarms limits or building in delays are based on studies in adults showing that up to 99% of the alarms in adults are false alarms. Such studies have not yet been conducted in children or neonates, so it would be premature to apply similar solutions to the problems of alarm fatigue to the neonatal or pediatric population at this stage. The types of alarms and their causes in neonatal and pediatric settings are likely to differ significantly from those in adult populations. All of these differences underscore the importance of assessing the unique needs of each patient population with respect to alarm management, and not instituting universal policies that cross age boundaries or patient populations.


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