A descriptive investigation of alarm activation in a critical care setting.

Abstract

Background: Alarm fatigue, a phenomenon referring to clinicians being desensitized to the high volume of monitoring alarms, can impact the working environment, clinical care and patient outcomes. Explorations and understandings of alarm fatigue have yet to be a focus of attention in the Australian context.

Aim: To describe the prevalence and type of alarms activated in intensive care and cardiac units in a major metropolitan hospital in Victoria, Australia.

Study design: This study was a descriptive observation study of patient monitoring data gathered over a 1-month time frame during April 2019. Data from the Philips Healthcare IntelliVue® Patient Monitoring system were extracted. After classifying the alarms into types (clinical or technical) and levels of urgency (lower or higher priority), further descriptive analysis was conducted to quantify the most prevalent alarms.

Results: During the study period, a total of 271 414 activated alarms were identified. The majority were clinical alarms (89.1%) compared with technical alarms (10.9%). Clinical alarms tended to be classified as high priority (55.1%); the most common were heart rate (36.7%) and premature ventricular contraction (18.8%). Technical alarms were predominantly electrocardiogram lead disconnection (89%). The frequency of alarms per patient-bed day was highest in the acute cardiac unit (98 alarms) compared with the intensive care unit (67 alarms).

Conclusion: Staff education and a culture of individual alarm customization might influence the number of alarms activated in the study settings. Further research is also required to examine alarm fatigue in other Australian critical care settings, and responses to alarms by clinicians, and whether these responses are calibrated to detect clinical deterioration and sentinel events.

Relevance to clinical practice: A bundle of interventions should be in place to increase the accuracy of alarm monitoring and to reduce non-actionable alarms in order to reduce the possible impacts on clinicians, patients and their families/visitors.