Bringing order out of chaos

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Nuisance alarms and alarm fatigue pose severe risks to patients. The problem is complex and calls for multi-faceted solutions.

From 2005 to 2010, some 216 U.S. hospital patients died in incidents related to management of monitor alarms. This was determined from an analysis of the FDA database of adverse events involving medical devices, performed by the Boston Globe newspaper with help from ECRI Institute. The Institute went further, saying the actual number of such cases is “likely to be much higher,” since “most hospitals significantly underreport device-related incidents.”

No one questions the importance of monitoring alarms in delivering quality care and protecting patient safety. But too-frequent alarms that do not actually signal serious conditions can be a nuisance and cause stress for caregivers and patients.

ECRI Institute reports that alarm-related adverse incidents typically involve staff becoming overwhelmed by the volume of alarms, failure to restore alarms to default levels after they are modified to suit temporary conditions, and failure to relay alarms to notification systems like pagers and wireless phones. Alarm fatigue may occur when the sheer number of monitor alarms overwhelms clinicians, possibly leading to alarms being disabled, silenced, or ignored.

A review literature suggests that the problem is complex and the solution multifaceted. Remedies can include a combination of:

• Hospital-wide strategies to identify and address the causes of alarm issues
• Training of staff on how monitors function and how to set and respond to alarms
• Standardization of protocols for setting alarm levels
• Evidence-based adjustment of alarm limits to reduce false alarms
• Proper skin preparation and correct placement of ECG electrodes
• Customization of alarm settings according to patients’ condition
• More integration between monitoring parameters, so that alarms are more likely to signal clinically significant conditions
• Use of sophisticated monitor alarm technologies