AACN issues practice alert to manage clinical alarms
Clinical alarms designed to alert nurses to changes in their patients' conditions have become a continual barrage of noise that poses a significant threat to patient safety, according to the American Association of Critical-Care Nurses (AACN). A new AACN Practice Alert outlines evidence-based protocols to reduce false or non-actionable alarms and improve the effective use of these monitoring aids.
Since 1983, the average number of alarms in an ICU has increased from six to 40, despite the fact that humans have difficulty learning more than six different alarm sounds, the group reports. The sensory overload from sounds emitted by monitors, infusion pumps, ventilators, and other devices, known as alarm fatigue, can cause a person to become desensitized to the alarms. This might result in delayed responses or missed alarms, sometimes contributing to patient deaths, explains AACN Senior Director Ramón Lavandero, RN, MA, MSN, FAAN.
"Today's hospital bedsides are filled with devices that support patient care even while sometimes creating unsafe situations," Lavandero says. "Patient care staff are inundated with alarm sounds, many of which are false or don't require action. True alarms can be missed, compromising patient safety."
Based on the latest available evidence, this AACN Practice Alert summarizes expected nursing practice related to alarm management, including the following:
- Provide proper skin preparation for ECG electrodes, which can improve conductivity and decrease the number of false alarms.
- Change ECG electrodes daily.
- Customize alarm parameters and levels on ECG monitors.
- Customize delay settings and threshold settings on oxygen saturation via pulse oximetry (SpO2) monitors. The combination of appropriate alarm delays and threshold settings optimizes the monitor to its highest potential, and it produces an alarm when action is required.
- Provide initial and ongoing education about devices with alarms.
- Establish interprofessional teams to address issues related to alarms, such as the development of policies and procedures.
- Monitor only those patients with clinical indications for monitoring. (For more on the risks of alarm fatigue, see Healthcare Risk Management, June 2013, p. 68. For information on a specific case involving alarm safety, see "Commissioners approve $20 million settlement for boy's brain damage suit against county hospital" in this month's Legal Review & Commentary supplement.)