The American Association of Critical-Care Nurses (AACN) in Aliso Viejo, CA, recently issued new guidelines for reducing the burden of alarms involving ECG monitoring.

The Practice Alert, “Managing Alarms in Acute Care Across the Life Span: Electrocardiography and Pulse Oximetry,” addresses an area in which repeat alarms are particularly common and may be reduced with specific strategies, says Nancy Blake, PhD, RN, NEA-BC, CCRN, FAAN, former nursing director at Children’s Hospital Los Angeles, former board member with AACN, and a member of the Association for the Advancement of Medical Instrumentation Alarm Coalition.

The AACN Practice Alert gives guidance to the team on what the leaders and the bedside care providers should do. It provides the most recent information to guide evidence-based practice, which is important to safe, quality, patient-centered care, she says.

“Many clinical areas did not know where to begin, and the AACN Practice Alert brings the current evidence and current best practices together in one place. It also encourages nurse leaders to establish an interprofessional team to address alarm issues,” she says. “It is important that the physicians, nurses, leaders, risk managers, and biomedical technicians come together to bring their own expertise and knowledge to the table to address issues as a team and allocate the appropriate resources to address this problem as a systems issue which can improve patient safety if done right.”

The Practice Alert encourages hospitals to assess who should be monitored and to follow the American Heart Association’s Update on Electrocardiographic Monitoring in Hospital Settings, which is a current best practice released in 2017.

The following are some of the recommended interventions:

• Provide proper skin preparation for and placement of ECG electrodes.

• Use proper oxygen saturation probes and placement.

• Check alarm settings at the start of every shift, with any change in patient condition and with any change in caregiver.

• Customize alarm parameter settings for individual patients in accordance with unit or hospital policy.

These strategies are for nursing leaders:

• Establish an interprofessional team to gather data and address alarm-related issues.

• Develop unit-specific default parameters and alarm management policies.

• Provide initial and ongoing education on monitoring systems and alarm management for unit staff.

• Develop policies and procedures for monitoring only those patients with clinical indications for monitoring.

The Practice Alert is available online at: