The Problem with Clinical Alarms

Paying attention to a clinical alarm is crucial. What happens when a ventilator, IV pump, and feeding pump are all alarming – simultaneously?

According to The Joint Commission, 98 alarm-related events were reported to them between January 2009 and June 2012. Eighty of those events lead to death; thirteen led to permanent loss of function and five led to unexpected care or an extended stay.

The FDA received 566 reports of alarm-related patient deaths between January 2005 and June 2010.

Technology relies on humans to hear, interpret, and respond to alarms.

Many times, alarms are false and do not signify anything. Sometimes alarms are annoying, and the nurses turn them off. Sometimes the alarm is turned off because the patient is being taken off the equipment temporarily and the nurse forgets to turn it back on. Sometimes the nurse incorrectly programs a complicated piece of medical equipment. And sometimes the volume is turned down, or the nurse is at a spot on the nursing unit where she cannot hear the alarm.

Listen to what a critical care nurse has to say about clinical alarms: “There are days when every red alarm is ringing on all 16 patients in the unit and probably 80% or more are erroneous or just too sensitive to minute or intermittent changes. Many alarms reset on their own, as long as the event doesn’t continue. Others stay ringing until a human resets them. A cardiac monitor lead comes off; an IV pump detects an air bubble; 3 patients’ call bells are ringing simultaneously; phones are ringing; a patient on a ventilator coughs; people are calling out to each other; the doorbell to the electric doors of the ICU rings and rings; and a tube feeding pump detects a clog. It’s a cacophony of dings and beeps and buzzes. Chronic loud constant noises like that can really begin to fade out of the nurses’ awareness after a while. If alarms ring all day long, no one pays attention to them after 4-5 hours. They begin to tune into only the ‘important’ ones and tune out the minor ones.”

What The Joint Commission Requires

As of January 1, 2016, staff and licensed independent practitioners should receive education about the purpose and proper operation of alarm systems for which they are responsible. A facility should also have policies and procedures in place for managing alarms which at a minimum:

• Identify appropriate settings for alarm signals.
• Define when alarm parameters can be changed.
• State who in the organization has authority to set alarm parameters.
• Identify who in the organization has the authority to set alarm parameters to “off.”
• Specify how to monitor and respond to alarm signals.
• Explain how to check individual alarm signals for accurate settings, proper operation and detectability.

Examples of Safe Practices with Clinical Alarms

The American Association of Critical Care Nurses offers some strategies for helping nurses avoid becoming desensitized to clinical alarms.

• Troubleshoot false alarms at the time they occur.
• Never disable or turn off an alarm – consider silencing it while you trouble shoot the problem.
• Avoid keeping patients on telemetry monitoring longer than needed.
• Tailor the alarm parameters to the individual patient and/or the specific patient population
• Ensure all alarms are audible and visually displayed.
• Be certain critical alarms are distinguishable over unit noises and other alarms.
• Routinely replace ECG electrodes every 24 hours to prevent them from drying out.
• Use disposable adhesive pulse oximeter sensors and replace them when they no longer properly adhere to the patient’s skin.

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