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American Journal of Critical Care. 2010;19: 28-34 doi:10.4037/ajcc2010651
Copyright © 2010 by the American Association of Critical-Care Nurses.
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CE Article

Monitor Alarm Fatigue: Standardizing Use of Physiological Monitors and Decreasing Nuisance Alarms

By Kelly Creighton Graham, RN, BS and Maria Cvach, RN, MSN, CCRN. Kelly Creighton Graham is a nurse clinician III, quality improvement and safety representative in the medical progressive care unit and Maria Cvach is assistant director of nursing, clinical standards, at The Johns Hopkins Hospital, Baltimore, Maryland.

Corresponding author: Maria Cvach, MSN, RN, CCRN, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287 (e-mail: mcvach1{at}jhmi.edu).

Background Reliance on physiological monitors to continuously "watch" patients and to alert the nurse when a serious rhythm problem occurs is standard practice on monitored units. Alarms are intended to alert clinicians to deviations from a predetermined "normal" status. However, alarm fatigue may occur when the sheer number of monitor alarms overwhelms clinicians, possibly leading to alarms being disabled, silenced, or ignored.

Purpose Excessive numbers of monitor alarms and fear that nurses have become desensitized to these alarms was the impetus for a unit-based quality improvement project.

Methods Small tests of change to improve alarm management were conducted on a medical progressive care unit. The types and frequency of monitor alarms in the unit were assessed. Nurses were trained to individualize patients’ alarm parameter limits and levels. Monitor software was modified to promote audibility of critical alarms.

Results Critical monitor alarms were reduced 43% from baseline data. The reduction of alarms could be attributed to adjustment of monitor alarm defaults, careful assessment and customization of monitor alarm parameter limits and levels, and implementation of an interdisciplinary monitor policy.

Discussion Although alarms are important and sometimes life-saving, they can compromise patients’ safety if ignored. This unit-based quality improvement initiative was beneficial as a starting point for revamping alarm management throughout the institution.

Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your understanding of the following objectives:
  1. Describe causes of increased nuisance and false-positive alarms, and appropriate nursing interventions to decrease their occurrence.
  2. Identify the effects of frequent false-positive physiological monitor alarms and their relationship to the potential for compromised patient safety.
  3. Discuss ways nurses can appropriately tailor parameters for monitoring system alarms to meet the specific needs of each patient.
To read this article and take the CE test online, visit www.ajcconline.org and click "CE Articles in This Issue." No CE test fee for AACN members.


Related articles in AJCC:

Monitor Alarm Fatigue
Linda Bell
AJCC 2010 19: 38. [Full Text]  



This article has been cited by other articles:


Home page
 Am J Crit CareHome page
L. Bell
Monitor Alarm Fatigue
Am. J. Crit. Care., January 1, 2010; 19(1): 38 - 38.
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Copyright © 2010 by the American Association of Critical-Care Nurses.