Clinical Alarms in Intensive Care Units: Perceived Obstacles of Alarm Management and Alarm Fatigue in Nurses

Abstract

ObjectivesThe purpose of this descriptive study was to investigate the current situation of clinical alarms in intensive care unit (ICU), nurses' recognition of and fatigue in relation to clinical alarms, and obstacles in alarm management.MethodsSubjects were ICU nurses and devices from 48 critically ill patient cases. Data were collected through direct observation of alarm occurrence and questionnaires that were completed by the ICU nurses. The observation time unit was one hour block. One bed out of 56 ICU beds was randomly assigned to each observation time unit.ResultsOverall 2,184 clinical alarms were counted for 48 hours of observation, and 45.5 clinical alarms occurred per hour per subject. Of these, 1,394 alarms (63.8%) were categorized as false alarms. The alarm fatigue score was 24.3 ± 4.0 out of 35. The highest scoring item was "always get bothered due to clinical alarms". The highest scoring item in obstacles was "frequent false alarms, which lead to reduced attention or response to alarms".ConclusionsNurses reported that they felt some fatigue due to clinical alarms, and false alarms were also obstacles to proper management. An appropriate hospital policy should be developed to reduce false alarms and nurses' alarm fatigue.

A multidisciplinary approach to reducing alarm fatigue and cost through appropriate use of cardiac telemetry

“…Many studies have demonstrated that 72%–99% of clinical alarms may be inaccurate 1 3 4 6. Also, overuse of clinical and bedside monitoring devices has led to a tremendous increase in false and unreliable alarms, significantly contributing to AF 7. In 2014, The Joint Commission and the Food and Drug Administration recognised AF as a ‘national healthcare problem’ that is among the top 10 technology hazards in hospitals 3 8 9.…”

Perceptions of Infusion Pump Alarms

“…However, sound levels in hospitals and patient rooms can surpass these recommendations, as levels have been measured between 43 dB (eg, the sound of birdcalls) at night and as high as 85 dB (eg, a food blender) throughout the day 1,3–5. It is important to note that these hospital sound recommendations date from 1999,2 at which time there were approximately 6 types of alarms in a critically ill patient's room 6. By 2011, there could be as many as 40 types of alarms in a patient's room, despite research to suggest that nurses have difficulty differentiating between more than 6 distinct alarm sounds 6…”

Measuring Alarm System Quality in ICUs (WIP)

“…Alarm fatigue, cognitive overload and desensitization, and its consequences, fatal and near-fatal events as well as staff burnout and the "second-victim effect", are almost invariably described qualitatively. The work by Cho et al [13] targeting a scoring system for AF using on a questionnaire based on the HTF survey [14] was a first step to come to a quantification of alarm fatigue. There is, to the best of our knowledge, no published attempt to make the various facets of AF routinely measurable and comparable in a comprehensive manner, i.e.…”