New AACN Practice Alert Aims to Improve Patient Safety, Minimize Alarm Fatigue

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 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 may result in delayed responses or missed alarms, sometimes contributing to patient deaths.

 

“Today’s hospital bedsides are filled with devices that support patient care even while sometimes creating unsafe situations,” says AACN Senior Director Ramon Lavandero, RN, MA, MSN, FAAN. “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:

 

• 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 both appropriate alarm delays and threshold settings optimizes the monitor to its highest potential, producing 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.

 

This alert is the latest in a series of guidelines issued by AACN to standardize practice and update nurses and other healthcare providers on new healthcare advances and trends. All alerts are available on the AACN website, www.aacn.org/practicealerts.

 

Supported by authoritative evidence, each AACN Practice Alert seeks to ensure excellence in practice along with promotion of a safe and humane work environment. Topics address both nursing and interprofessional activities of importance to patients in acute and critical care environments. Some alerts include additional resources for staff education and performance-improvement activities.

 

Additional alerts address ventilator associated pneumonia, pulmonary artery pressure monitoring, dysrhythmia monitoring, ST segment monitoring, family presence during resuscitation and invasive procedures, and verification of feeding-tube placement.

 

AACN Practice Alerts can be downloaded free at www.aacn.org/practicealerts.