06 Dec Staggering Number of Hospital Monitors Leads to Alarm Fatigue
MedicalResearch.com Interview with:
Barbara J. Drew, RN, PhD, FAAN, FAHA
David Mortara Distinguished Professor in Physiological Nursing Research, Clinical Professor of Medicine, Cardiology
University of California, San Francisco (UCSF)
Department of Physiological Nursing San Francisco
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Drew: Hospital cardiac monitors are plagued with alarms that create a cacophony of sounds and visual alerts causing “alarm fatigue” which creates an unsafe patient environment because a life-threatening arrhythmia may be missed in this milieu of sensory overload. Our study is the largest prospective study to date on the alarm fatigue problem. We found a staggering total number of alarms (>2,500,000 in one month) in 461 consecutive patients treated in our 77 adult intensive care unit beds. Although many of these alarms were configured to be visual text messages, we still found a high audible alarm burden of 187 audible alarms per bed per day. A noisy alarm environment interrupts patients’ sleep and invokes fear in patients and their families. We analyzed nearly 13,000 arrhythmia alarms and found that 88% of them were false alarms.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Drew: The excessive number of ICU monitor alarms is due primarily to 3 factors: inappropriate alarm settings by the clinical staff, certain patient conditions like pacemaker devices or other rhythm abnormalities, and algorithm deficiencies by the monitor manufacturers. What hospitals can do right now is to review their alarm settings, both the hospital default settings and the settings that nurses at the bedside set up for their individual patients. Our article gives practical advice about how to reduce the excessive number of alarms. For example, we discuss what settings are safe to change from an audible alarm to a text message alarm. Our article also provides recommendations for monitor manufacturers. Because computer devices have the potential to be more reliable than humans, an opportunity exists to improve these computer devices to reduce the problem of alarm fatigue.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Drew: We need research on commercially-available electrodes and how often they should be changed to prevent false alarms due to electrode failure. It is also unknown what measurement would indicate electrode failure and how best to measure that continuously. There is also insufficient data on the best skin prep regimens that will decrease electrode impedance without causing skin breakdown. Some investigators report that adding alarm delays for SpO2, heart rate, respiratory rate, and blood pressure are effective in reducing alarms. However, these investigators have not measured the effect of such delays on patient outcomes. Thus, future research is required to determine whether these alarm delays are safe as well as effective in reducing alarm burden. Finally, computer algorithm changes to reduce alarms should be tested to determine any unintended adverse consequences.
Citation:
Last Updated on December 6, 2014 by Marie Benz MD FAAD