A framework for reducing alarm fatigue on pediatric inpatient units.

Abstract

On my (AK) first day on the patient floors as a medical student, I couldn’t help but notice the buzzing, beeping, cacophony of alarms that ostensibly indicated impending danger for just about every patient on the unit. I looked around, waiting for someone (a nurse, a doctor, anyone) to react. Yet thus far in my brief career, I’ve come to learn that most of the alarms I hear do not indicate emergencies, and in fact most do not warrant any clinical intervention at all. As a result, the buzzing and beeping fades into the background now. Physiologic monitor alarms are intentionally designed to alert clinicians immediately to any deviation from the norm, regardless of the quality of the signal or cause of the deviation.1 In theory, this design ensures that doctors and nurses will always be informed of physiologic changes to respond to important deterioration events quickly. However, we know that monitors generate frequent alarms (39–352 alarms per patient, per day)2–9 and that a high proportion are false, defined as not being actionable (>90% of pediatric ICU2,3 and >70% of adult intensive care alarms).6,7 The task of separating the true, actionable alarms from the false or nonactionable alarms falls to the clinicians responsible for responding to alarms, who in most settings are nurses. However, we rely on nurses for myriad other important responsibilities that we really care about, from administering antibiotics to a septic child, to discharging a kid with asthma so the mother can pick up the child’s inhaler before the pharmacy closes. Thus, nurses are forced to make difficult decisions on a nearly continuous basis about whether to respond to alarms from different patients or to continue with the tasks at hand, assuming that the alarms do not …