COMMENTARY

Alarm Fatigue? Smarter Monitors Needed

Laura A. Stokowski, RN, MS

Disclosures

November 13, 2014

In This Article

Insights Into the Problem of Alarm Fatigue With Physiologic Monitor Devices: A Comprehensive Observational Study of Consecutive Intensive Care Unit Patients

Drew BJ, Harris P, Zègre-Hemsey JK, et al
PLoS One. 2014;9:e110274

The Scope of Alarm Fatigue

To combat "alarm fatigue," healthcare organizations must develop better programs of alarm management. This is no small task. Monitors alarm for hundreds of reasons, and the nurse is charged with sorting this out and separating the clinically important from the clinically insignificant (sometimes called "non-actionable" or false) alarms. On top of the audible alarms, monitors also display frequent inaudible "text" alarms, notifying users of less critical but still important patient or monitoring conditions. It would take a full-time monitoring technician to respond to and correct every monitor alarm that occurs during patient care. Alarm noise is bothersome to patients as well. Frequent alarms interrupt sleep and provoke fear on the part of patients and families.

Perhaps the most critical issue in alarm management of adult patients is the ability to identify a true and clinically relevant arrhythmia. With so many alarms, however, confidence in the output of monitoring devices is low, and this is the major stumbling block in alarm management. As a first step in finding solutions to this problem, Drew and colleagues have conducted a comprehensive investigation of the frequency, types, and accuracy of physiologic monitor alarms collected in a real-world adult intensive care unit (ICU) setting. In addition to developing this database, they set out to answer several key questions:

Are false arrhythmia alarms a consequence of poor ECG signal quality that might be resolved by a better skin preparation electrode regimen?

How important is it to analyze all available ECG leads for arrhythmia diagnosis?

How often are non-ECG waveforms (eg, pressures, pulse oxygen saturation) needed for arrhythmia diagnosis?

How often are ventricular arrhythmia alarms clinically relevant in terms of meeting published practice guideline criteria for treatment in hospital settings?

Using a state-of-the-art technology acquisition infrastructure, all monitor data including seven ECG leads, all pressure, pulse oxygen saturation, and respiration waveforms, as well as user settings and alarms, were collected from a total of 461 adult patients in five ICUs during a 1-month period. With a well-defined alarm annotation protocol, nurse scientists with 95% interrater reliability annotated 12,671 arrhythmia alarms.

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